Top 10 Questions about Pregnancy after Bariatric Surgery

1. Should I Get Bariatric Surgery Before or After Pregnancy?

The answer to this question will vary by the patient because it depends upon their BMI and overall health. Pregnancy in severely obese women is considered high risk and complications such as hypertension, the development of preeclampsia, gestational diabetes, complications during labor and delivery, etc. may be experienced.

Also the risk for major birth defects, abnormally large newborns, early delivery, or loss of the pregnancy increase as well. The Journal of the American Medical Association published a study showing that losing weight before pregnancy decreases the risks of major birth defects by at least 30%.

2. What Are the Benefits of Having Bariatric Surgery before Pregnancy?

• Decreases risks that you will experience obesity-related complications such as high blood pressure, preeclampsia, gestational diabetes, labor and delivery complications, abnormal gestational infant size, stillbirth, etc.;
• Losing excess weight increases your ability to conceive;
• Reduction of pre-existing obesity-related health issues will prevent additional problems during pregnancy.

3. What Are the Drawbacks of Pregnancy after Bariatric Surgery?

4. How Does Weight Loss Surgery Affect Fertility?

It may seem like a strange concept to think about having surgery to lose weight before getting pregnant where you are going to gain weight. It does make sense when you understand some of the ways obesity messes up the natural order of our bodies.

Did you know that obesity triples the risk of infertility? As women, our bodies require a fine-tuned hormonal balance to keep things running smoothly such as our menstrual cycles. Obesity creates abnormal hormone levels and can lead to polycystic ovarian disease (PCOS), irregular ovulation cycles, and fertility issues. Losing weight can even out these hormone imbalances and surprisingly losing even 5% of your excess weight can help boost your fertility.

Another interesting fact that is noteworthy – obesity can affect fertility in men too. Obesity can cause testosterone levels to drop and create fertility problems in men. Studies show that among couples who are experiencing fertility issues, 30% are obesity-related. It makes sense, that your chances of having a healthy pregnancy and a healthy baby begin with healthy parents.

5. How Long Should I Wait after Weight Loss Surgery to Get Pregnant?

When planning a pregnancy after bariatric surgery, timing is very important. Based on statistical data, waiting somewhere between 12 and 18 months after bariatric surgery before getting pregnant would be recommended. The optimum BMI for experiencing a healthy pregnancy is somewhere in the 18.5 to 24.9 range. If your BMI is much higher than this range, then getting it as close to this range as you can before pregnancy will help lessen risks and increase the potential of healthy full-term delivery.

6. What Happens if You Get Pregnant Too Soon after Bariatric Surgery?

The first 12 months, post-surgery is the time of most active weight loss and would not be optimal conditions for the development of the fetus. This may expose both mother and baby to risks associated with obesity, nutritional deficiencies, or both, depending on where the patient is on their weight loss journey. Working closely with your team of specialists, i.e. OB-GYN, bariatric surgeon, and nutritionist, would be necessary to closely monitor your progress during pregnancy, especially your nutritional intake levels. Adjustments in nutritional supplements can be made as necessary to ensure both you and the baby are getting what you need.

7. Is Pregnancy High-Risk after Bariatric Surgery Or Can You Have a Healthy Pregnancy after Weight Loss Surgery?

If you become pregnant after bariatric surgery you are at a higher risk than a woman of healthy weight that has not had bariatric surgery. That being said, the degree of higher risk would be dependent on the mother’s BMI and overall health.

Many women experience uneventful, full-term pregnancies and deliver healthy babies after undergoing bariatric surgery. Not every OB/GYN will fully understand how bariatric surgery will affect pregnancy, so if at all possible, choose an OB/GYN that has worked with bariatric surgery patients before.

Also, keep in close communication with your bariatric weight loss team during the entire pregnancy so they can monitor your health as your pregnancy progresses. Most risks that are related to bariatric surgery and pregnancy are associated with deficiencies, so working closely with your team of experts will help keep you on track. If your team of doctors feels that you are at a higher risk for developing complications, they will monitor you continuously throughout the pregnancy and make corrections as needed.

8. Can You Have Weight Loss Surgery While You Are Breastfeeding?

Some doctors may be hesitant to perform surgery on a breastfeeding mother. Typically, weight loss surgery will not affect the composition of your breast milk. However, anything like pain medication or anesthesia introduced to you during your surgery and recovery will pass through to your breast milk. You may be able to freeze enough breast milk in advance to ensure all of the medication has gotten out of your system before you resume breastfeeding.

You will also have to be mindful to take all of your recommended supplements as you and the baby both will need these vitamins and nutrients. It would be advisable to wait until you are finished breastfeeding before having bariatric surgery but is not an unattainable goal.

9. Is the Post-Bariatric Surgery Diet Going to Be Safe For Me When I am Pregnant?

After weight loss surgery, your diet will be quite different than it was prior. You will even have to drastically adjust the way you eat and even the timing of drinking liquids between meals. If you become pregnant after bariatric surgery, you will need to be even more diligent to ensure you are eating healthy foods and taking your vitamins and mineral supplements. Your growing baby will take what it needs from you and your body so it will be important that you are eating a healthy balanced diet.

Normally pregnant women do not need to eat any extra food in the first few trimesters of their pregnancies, it is the third trimester that you may need to increase your calorie intake. To avoid nutritional deficiencies you should work closely with your team of doctors who can assist you with a dietary plan, physical exercise recommendations, and monitoring your progress. They will routinely do blood tests to check your vitamin and mineral levels, monitor the baby’s growth through ultrasounds, and keep an eye on your amniotic fluid level to ensure all is as it should be. Following your medical team’s recommendations, dietary plan, and taking your supplement, should provide you and your baby with a healthy and safe pregnancy.

10. What Kind of Supplements Are Needed When Pregnant after Bariatric Surgery?

There are specific vitamins and minerals that your body needs to function properly. Bariatric surgery patients are required to take supplements after surgery for life to obtain all they need since they will not be able to get them all from their diet.

During pregnancy, women normally need to take extra vitamins to ensure both mother and baby are getting what they need. If you are pregnant after weight loss surgery, it is even more important that you take vitamins and minerals that are specially formulated for pregnant women.

Your bariatric weight loss team of doctors will help determine which supplements are best for you and how much you will need daily. If you become pregnant after a gastric bypass, gastric sleeve, duodenal switch, etc, you may need regular blood tests each trimester, to check your nutrient levels.

The supplements you will need may include:

• Iron
• Vitamin B12
• Calcium
• Folate
• Vitamins A, D, E, and K
• Folic acid