Pregnancy after Bariatric Surgery

It’s estimated that over two thirds of Americans are overweight or obese, and these numbers do not appear to be abating. According to the Center for Disease Control and Prevention, childhood obesity has more than doubled in children and quadrupled in adolescents over the past 30 years. 

Women of childbearing age are also experiencing higher rates of obesity, and these rates are affecting not only pregnancy but birth outcomes. Obese mothers are more likely to experience higher rates of complications like gestational diabetes, hypertension, preeclampsia, and cesarean delivery rates. Fetal risks like prematurity, stillbirth, birth defects, as well as increased rates of childhood and adolescent obesity are more common with obese women. Additionally, many obese women will find that conceiving can be especially difficult. 

With these statistics in mind, some women will consider bariatric surgery as an option to improve not only their chances of becoming pregnant but to help minimize complications during their pregnancy. Typically, individuals with a Body Mass Index or BMI of 35 or higher and another serious weight-related health problem are candidates for bariatric surgery. A safe pregnancy is possible after gastric bypass surgery, but women should consider a few things before embarking on pregnancy after surgery. Pre-conceptional counseling is always a good idea but especially if you are considering gastric bypass surgery or have already had surgery. The dietary and nutritional changes that your body will experience after surgery can have an important effect on a growing fetus. 

Generally speaking, it is advised to wait at least 18 months after gastric bypass to start trying to conceive. This is usually a long enough period for your weight loss to occur and stabilize. Pregnancy should be avoiding during the immediate period of rapid weight loss following surgery since it may cause problems for a growing fetus. Reliable birth control is recommended immediately following gastric bypass because many women may experience a surge in fertility following surgery. Often times, conditions like polycystic ovarian syndrome or PCOS or other ovulating conditions will resolve quickly after weight loss begins.

Once pregnant, women who have undergone bariatric surgery will need to work closely with their health care provider to monitor their nutritional needs. Special attention will be paid to the absorption of certain vitamins and minerals, such as folic acid, calcium, and vitamin B12, which are important for the health of the growing fetus. Bariatric surgery can sometimes alter the body’s ability to properly absorb these essential nutrients. Your healthcare provider may prescribe more of these supplements in additional to standard prenatal vitamins. 

Depending on the type of bariatric surgery performed, you may need to consult with your bariatric surgeon about whether modifications may need to be made. For instance, LAP-BAND is a typical bariatric procedure performed where the upper part of the stomach is cinched with a silicone band, essentially creating a small gastric pouch. This silicone band can be adjusted or even removed. While not typically necessary, adjustment in pregnancy is an option. Also if you have experienced any post-surgery complications such as wound infections, digestive problems, ulcers, and anemia, you should make your healthcare provider aware of any of these uncommon complications so they may address them.

All pregnant women are counseled by their healthcare providers about what is a healthy weight gain during pregnancy and generally follow a scheme based on BMI and the number of fetuses being carried. Women carrying multiples will usually be expected to gain some additional weight. Women carrying one child with a normal weight and BMI falling between 18.5 and 24.9 should gain between 25-35 pounds during pregnancy. Overweight women (BMI between 25-29.9) should only gain between 15-25 pounds. Women with a BMI of 30 or more, which is considered obese, should try to limit weight gain to between 11- 20 pounds.

Women who have had bariatric surgery will follow the same guidelines and will be advised about weight gain based on their current BMI. One caveat, however, is that women who have experienced considerable recent weight loss may experience extra apprehension about gaining weight during pregnancy. Speaking with a nutritional expert or psychiatric specialist can help women resolve any concerns they may have. 

Pregnancy after bariatric surgery is becoming more common, and consulting with your healthcare provider about your questions and concerns is always a great idea. With appropriate planning, a healthy pregnancy is possible following bariatric surgery. 

 

Timothy J. Hardy, M.D.

Dr. Timothy Hardy, M.D. has been practicing medicine in the community for many years. He received his medical degree from Eastern Virginia Medical School and founded his own practice, Atlantic OB-GYN, in 1990, where he has been providing women with exceptional care ever since. Website: www.atlanticobgyn.com
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