Is Pregnancy Safe After Bariatric Surgery?

Medically Reviewed by Katelyn J. Mock, US-Registered Dietician (R.D.)

Thinking of having a baby after your bariatric surgery? Are you in the process already? Then this article is for you!

Weight loss is known to enhance fertility and resolve hormonal imbalances, as well.^[1]Karin Schindler, Felix Langer et al. “Management of Pregnant Women after Bariatric Surgery” Journal of Obesity 2018 (3
View in ArticleBariatric surgery helps eliminate co-morbidities that can help you conceive if obesity is preventing you from getting pregnant.

It can also reduce the risk of certain problems related to pregnancy, such as:

• Gestational diabetes
• Hypertension
• Preeclampsia (high blood pressure, organ damage exclusively during pregnancy)

Getting Pregnant After Bariatric Surgery

• It is not recommended to get pregnant soon after the surgery.
• According to The American Academy of Family Physicians (AAFP), one should wait for 1 to 2 years after bariatric surgery before conceiving.
• A pregnancy occurring during a period of malnutrition (such as the period after bariatric surgery) could lead to adverse outcomes such as low weight at childbirth or malformations.^[2]Michelle A. Kominiareak “Preparing for and Managing a Pregnancy After Bariatric Surgery” Semin Perinatol (2011); 35(6): 356-361
  View in Article

Why Wait to Get Pregnant After Weight Loss Surgery

• There is drastic weight loss because of restrictive meal plans and drastic lifestyle changes after the surgery. This time frame is not favorable to provide adequate nutrition for the baby. 
• Waiting for 12 to 24 months is a good idea as it will help one achieve their weight loss goals as well.
• Conceiving after this time frame will ensure that the fetus is not adversely impacted by the rapid weight loss and is not deprived of nutrients.
• Conceiving before this time frame would warrant closely monitoring your weight as well as your state of nutrition.
• The Mayo Clinic states that continuous weight loss might contribute to a low birth weight on account of deprived nutrient supply to the fetus.^[3]Tobah, Yvonne Butler. Getting pregnant – What do I need to know about pregnancy after gastric bypass surgery? Will my baby be able to get enough nutrients?
  View in Article
• For this purpose, according to AAFP, close surveillance will have to be placed on the baby’s growth with a series of ultrasounds.

• A 2013 study showed that babies born following a maternal bariatric surgery can be lower birth weight if they do not get the proper nutrition during the gestation period. This could give rise to complications.^[4]Mette Mandrup Kjae, Jeannet Lauenborg et al. “The risk of adverse pregnancy outcome after bariatric surgery: A nationwide register-based matched cohort study,” American Journal of Obstetrics and Gynecology 2013(6) 464.e1-464.e5
  View in Article

Pregnancy After Bariatric Surgery and Weight Gain

Pregnancy can result in some weight gain which can be frustrating after having undergone bariatric surgery. But, with healthy practices, one can always get back in shape within 6 months after delivery. The amount of weight gained will be based on:

• Weight at the time of pregnancy
• BMI at the time of pregnancy
• How far you are out from surgery

Weight Goals and BMI

Using current BMI (post-op):

Expected weight gain during pregnancy

Remember that after a baby is born, breastfeeding is the best nutrition for your little one; it is also a great way to help moms lose the extra pounds.

These days gynecologists have become more aware of the anatomical requirements of bariatric surgery patients.

Women who have undergone bariatric surgery are more likely to have a C-section delivery. The gynecologist will work in collaboration with the bariatric surgeon to avoid unforeseen circumstances.

Nutrition for Pregnant Women Post Bariatric Surgery

In your prenatal stage:

• You may have to consult a dietitian to ensure all your nutritional needs are met.
• You may be required to take extra vitamin and mineral supplements after bariatric surgery and mineral supplementation after bariatric surgery as it may make it difficult for your body to absorb certain nutrients, such as calcium, iron, and vitamin B12.^[5]Christopher Slater, Lauren Morris et al. “Nutrition in Pregnancy Following Bariatric Surgery” Nutrition 2017 Dec; 9(12): 1338
  View in Article

Gastric surgeries can cause nutritional deficiencies, especially because there are a lot of food items that are prohibited, and calorie intake is relatively reduced. Keep note of signs and symptoms of malnutrition after bariatric surgery.

It is essential to monitor the health status of the woman every trimester to keep track of the level of nutrients. At times, supplements may have to be provided intravenously (through a drip).

Tips on Pregnancy After Weight Loss Surgery

• Eat small, frequent meals and snacks (at least 5-6 per day) in order to reach calorie and protein goals.
• Weight gain during pregnancy is completely normal. Do not starve yourself if the scale starts going up.
• Do not skip meals or planned snacks.
• Eat a variety of foods from all the food groups.
• Do not eliminate or severely restrict carbohydrates. Carbohydrate goal is 175 gm. Look below for examples of carbohydrates and gram amounts.
• Separate consumption of solids and liquids by at least 30 minutes after a meal.
• Report any persistent vomiting after meals or other significant barriers to meeting the meal plan goals.
• Keep your doctors informed. Your gynecologist needs to know you have undergone a bariatric procedure.

Examples of 15 Grams of Carbohydrate or 1 Serving

• Baseball-sized piece of fruit (apple, orange, peach, etc.)
• 8 oz milk or 6 oz of sugar-free yogurt
• 1 slice of whole wheat bread
• 3/4 cup of cheerios
• 1/2 cup of unsweetened oatmeal
• 1/4 cup of unsweetened dried fruit

Weight Loss Surgery and Pregnancy Tests

1. Blood test– Women with a history of weight loss surgery will have to undergo blood tests more frequently for a regular checkup of nutrients such as protein, calcium, iron, ferritin, etc.
2. Glucose test– The liquid administered to examine glucose levels cannot be tolerated by women with altered stomachs. Therefore, such tests might not be performed on them. As mentioned by the American Academy of Family Physicians (AAFP)^[6]Carrie Armstrong. “ACOG Guidelines on Pregnancy After Bariatric Surgery.” AAFP – American Family Physician, 2010.
   View in Article, an alternative to this is home glucose monitoring.

Our Clients’ Experience with Pregnancy Post Gastric Sleeve and Bypass

• Many of our clients have been successful in getting pregnant post-surgery.
• On average, they waited for approximately one and a half years to get pregnant. Some of them have also delivered healthy babies after getting pregnant 12 weeks post-op.
• Most of them were able to maintain their weight through a healthy lifestyle.

References

1. Karin Schindler, Felix Langer et al. “Management of Pregnant Women after Bariatric Surgery” Journal of Obesity 2018 (3)
2. Michelle A. Kominiareak “Preparing for and Managing a Pregnancy After Bariatric Surgery” Semin Perinatol (2011); 35(6): 356-361
3. Tobah, Yvonne Butler. Getting pregnant – What do I need to know about pregnancy after gastric bypass surgery? Will my baby be able to get enough nutrients?
4. Mette Mandrup Kjae, Jeannet Lauenborg et al. “The risk of adverse pregnancy outcome after bariatric surgery: A nationwide register-based matched cohort study” American Journal of Obstetrics and Gynecology 2013(6) 464.e1-464.e5
5. Christopher Slater, Lauren Morris et al. “Nutrition in Pregnancy Following Bariatric Surgery” Nutrition 2017 Dec; 9(12): 1338
6. Carrie Armstrong. “ACOG Guidelines on Pregnancy After Bariatric Surgery.” AAFP – American Family Physician, 2010.

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