Pregnancy and weight loss surgery

I hadn't intended to get pregnant. I already had two children at the time—my oldest was almost 5, and my youngest was almost 3—and I was on the mini pill.

2. You should wait 18 months before getting pregnant

It's true that the mini pill, statistically speaking, is only so effective , but most other contraceptives weren't an option. I also get weird migraines, so I can't take regular birth control pills. The mini pill had worked for me the past, so I thought it would again. Obviously, it didn't. While many women have successful pregnancies after bariatric surgery, doctors usually advise waiting at least 18 months after surgery before you conceive.

In the beginning, your body is in rapid weight-loss mode, and that was certainly the case for me. By the time I took a positive pregnancy test, I'd lost pounds. Check out 12 habits of women who have lost pounds and kept it off. Here I grow again After the initial shock wore off, I started to get pretty scared. Would I lose the baby due to malnutrition or issues with caloric intake?

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After bariatric surgery, your daily calorie intake is highly restricted: I was only eating calories a day. While some people imagine that it's hard to eat so little, after weight loss surgery it's actually difficult to eat that much. My appetite had plummeted, plus it's hard from a mental standpoint since you know that you're supposed to be losing weight.

After I got pregnant, eating was even more challenging. During the first trimester everything made me want to throw up, plus I was also dealing with something gastric bypass patients call the "foamies. My OB had me immediately start seeing a nutritionist once a month who was familiar with bariatric surgery and pregnancy, just to make sure that I was getting enough to sustain a healthy pregnancy.

Who is eligible for bariatric surgery?

Since I could only eat a very small quantity of food at a time, she had me add some foods to my diet that were very dense in calories, like heavy cream, coconut oil, and butter. By the time I was 18 weeks I had lost about another 12 pounds, but once I got the hang of eating what I needed for the baby, my weight stabilized.

While most women are advised to gain about 25 pounds during pregnancy, my doctor said I should try to avoid gaining or losing at this time. I managed to do that—toward the end of my pregnancy I regained the 12 pounds that I lost early on, but nothing more. But my body did change shape, which was emotionally challenging: As I watched it happen, I remember thinking, "Well, this isn't the direction I wanted my stomach to go.

But there were also positives. Talk with your doctor about medications and lifestyle changes that can help you to deal with nausea in an effective way. Be prepared for changes in your body. You are going to see yourself become larger during pregnancy and that is completely normal. After all of your hard work to lose weight, you may begin to panic. Remember that there is a baby growing inside of you and that you will return to a healthy weight after your delivery.

Because bariatric surgery involves removing and rearranging portions of the stomach you will experience significant changes in the way you consume food. Take the biliopancreatic diversion BPD procedure for example, a malabsorptive procedure that restricts both the amount of nutrients and calories you can absorb into your body. Patients of other types of bariatric surgeries, such as gastric banding or Roux en-Y gastric bypass surgery also eat less, but rarely have nutritional complications depending on whether or not they listen to the advice of their doctor.

To ensure your baby is getting the nutrition it needs to develop properly speak with your doctor. During the first trimester, you only need extra calories a day and an additional daily extra calories for the next two trimesters. Remember to eat healthy to improve sufficient fetal growth. After bariatric surgery, you will need specific vitamins and minerals to counteract nutritional deficiencies to ensure your baby develops properly.

More often than each type of bariatric surgery has unique supplemental needs. Patients who undergo gastric sleeve surgery require prenatal vitamins and minerals. Every trimester it may be necessary to undergo blood tests to check nutrition levels. When you first become pregnant have your calcium, vitamin B12, and iron ferritin levels checked.

BPD may also cause your vitamin A levels to change. Find a proper balance of vitamin A intake, as too much can harm your baby. You may also need calcium, iron supplements and vitamin D on top of prenatal vitamins and minerals. Before pregnancy, have your calcium, iron ferritin , and Vitamin B12 levels checked.

Take prenatal vitamins along with calcium, vitamin D, and iron supplements. Pregnancy after bariatric surgery could lead to complications.

Your risk may be higher than it would be for other pregnant women when it comes to developing gestational diabetes mellitus or high blood pressure that is induced by pregnancy. There is also a good possibility that you will be a candidate for a cesarean. While having a C-section is not a must after bariatric surgery, many doctors will lean in this direction. Other factors such as inflammatory-induced sequestration of iron to the reticuloendothelial system and higher iron requirements due to larger blood volume add to the association between obesity and hypoferremia [ 49 ].

Weight loss after BS results in falling serum hepcidin levels and potentially improved iron status [ 50 ]. Patients who underwent malabsorptive surgery, however, showed an increase in anemia rates anemia prevalence from A history of BS before pregnancy seems to increase the risk for the development of IDA during pregnancy [ 51 , 52 ]. However, all studies on the topic have limitations and further research is required to reinforce the currently available supplementation recommendations for the prevention of IDA in pregnant women after BS [ 22 , 52 , 54 ].

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As IDA during pregnancy has adverse effects on pregnancy outcome e. Also, maternal iron deficiency seems to have long term health effects on the offspring, mainly neurobehavioral abnormalities and an elevated cardiovascular disease risk [ 46 , 57 ]. Any dose within this range should therefore be applicable; however, frequent laboratory tests should be performed and the dose adapted according to the results [ 61 , 62 ].

The ACOG recommends a complete blood count and measurement of iron and ferritin every trimester [ 23 ]. Folic acid and Vitamin B12 deficiency can also lead to maternal anemia. Folic acid deficiency seems to be rare after all BS procedures [ 26 , 63 , 64 ]. Gascoin et al. Weng et al. They suggest that folate absorption occurs throughout the entire small intestine and any deficiency caused by inadequate dietary intake can therefore easily be corrected by supplementation [ 26 ].

Jans et al. As there is still controversy regarding the benefit of folic acid supplementation on pregnancy outcomes [ 65 ], it seems prudent to follow the general folic supplementation recommendations for pregnant women and screen for folate deficiency every trimester [ 60 ]; which is also supported by the ACOG [ 23 ].

The additional requirement of vitamin B12 during pregnancy is estimated to be 0. Vitamin B12 deficiency seems to occur especially after malabsorptive or combined BS as the secretion of intrinsic factor and gastric acid is decreased and the duodenum, being the main absorption site, is bypassed.

For pregnant women after BS Kaska et al. Although the available data is still conflicting, vitamin B12 deficiency seems to be associated with a higher risk of preterm birth [ 68 ], recurrent abortion, low birth weight LBW , intrauterine growth retardation IUGR , neural tube defects and impaired cognitive development [ 69 ].

Therefore, obstetricians should assess the Vitamin B12 status of pregnant women after BS every trimester and treat deficiencies accordingly [ 24 , 60 ].

There is a physiological increase in the need of vitamin D and calcitriol during pregnancy seemingly related to the calcium transfer to the fetus, particularly in the last trimester [ 70 ].