Introduction: Endoscopic Sleeve Gastroplasty (ESG) is an organ sparing bariatric procedure aimed to reduce gastric volume and modify gastric motility with full thickness endoscopic suture. Pregnancy is a condition in which physiologically the pregnant woman potentially undergoes weight gain. Methods: A retrospective analysis of a prospective database was conducted to evaluate weight trajectories and lifestyle modification in women that got pregnant after ESG. Weight loss outcomes, evolution of comorbidities and Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire were analyzed at the beginning and at the end of the pregnancy and at the first follow-up visit after delivery. Results: From May 2017 to October 2021, out of 115 fertile women 10 became pregnant after ESG [nine Rome (Fondazione Policlinico Universitario Agostino Gemelli) and one in Israel [Hadassah Medical Center]) with a mean interval of 5,8±4,0 months. Baseline BMI was 38,4±3,5 kg/m2. Two patients reported H-INS and another one had both H-INS and HBP. Two women affected by Poly-Cystic Ovary Syndrome (PCOS) reported difficulty getting pregnant before ESG. At the beginning of pregnancy and at the delivery mean TBWL was 18,1±8,1% and 10,4±12,2 %, whereas mean EWL was 55,7±24,6 % and 30,4,2±37,2%. Six out of 10 patients had weight gain in the ranges recommended by the Centers for Disease Control and Prevention. At the first follow-up visit after the delivery (mean interval, 3,7±2,5 months) the TBWL was 9,9±9,9 %, the EWL was 30,5±30,7 %, whereas the BAROS score was 3,5±2,2. The patient affect by H-INS and HBP resolved both before and during the pregnancy, whereas one patient with H-INS had an improvement during the gestation. Conclusion: Lifestyle changes after ESG do not disappear after pregnancy and allow for a gradual loss of weight gained during gestation. Weight loss following ESG could help those women who have difficult-to-get-pregnancy, such as PCOS. Table 1. - Weight loss outcomes of the ten patients who got pregnant after Endoscopic Sleeve Gastroplasty. All data are reported as mean value ± Standard. Deviation Population (N=10) Weight loss (kg) EWL (%) TBWL (%) BMI (kg/m2) ΔBMI (kg/m2) EBMIL (%) BAROS (pt) QoL Beginning of Pregnancy 18.3±8.9 55.7±24.6 18.1±8.1 30.9±4.0 6.8±3.2 55.7±24.6 4.8±1.9 2.3±0.7 Delivery 11.4±14.1 30.4±37.2 10.4±12.2 33.7±4.5 4.0±4.6 30.4±37.2 3.4±1.7 2.1±0.7 First follow-up after the delivery 10.3±11.2 30.5±30.7 9.9±9.9 34.0±5.0 3.7±3.7 30.5±30.7 3.5±2.2 2.1±0.9 Abbreviations: EWL= Excess Weight Loss; TBWL= Total Body Weight Loss; BMI= Body Mass Index; ΔBMI= Variation of BMI; EBMI= Excess BMI Loss; BAROS= Bariatric Analysis and Reporting Outcome System questionnaire; QL= Quality of Life subcategory of the BAROS.