Post Bariatric Surgery Concerns in Pregnancy
Whether you are thinking about bariatric surgery or have had it in the past, it is important to be aware of and discuss with your doctor how this will affect your future; most specifically your reproductive future. A multidisciplinary team approach is recommended preconception and throughout the pregnancy including your Ob/Gyn, Bariatric Surgeon, and Nutritionist.
The rate of bariatric surgery being performed in the United States has drastically increased in the last decade, with the majority of patients being female and of reproductive age. Most pregnancies after bariatric surgery result in favorable outcomes with decreased occurrences of gestational diabetes, hypertension, and large for gestational-age babies. Although the study numbers are limited, most suggest no change in perinatal mortality or congenital malformations.
Because the greatest weight loss occurs in the first 12-18 months post-surgery, many societies have recommended waiting at least 12 months prior to conception. This allows you to accommodate to new dietary regimens, nutritional fluctuations, and optimize weight loss. Limited studies, however, note no change in overall outcome with pregnancies conceived within the first year. It is important to note that the rapid weight loss post bariatric surgery may improve fertility as it can restart ovulation. For this reason, you should discuss family planning goals and contraception with your team before you are ready to try to conceive.
The greatest concern for a pregnancy post-bariatric surgery is maternal nutrition. After any bariatric surgery, your body doesn't digest food and absorb nutrients the same way it used to. Anemia due to iron or B12 deficiency and vitamin deficiencies including calcium, vitamin D, protein and folate are big concerns. Most doctors advise that patients take supplemental vitamins and minerals in order to avoid severe medical problems in the mom and inadequate fetal growth of the baby. Guidelines recommend monitoring lab values of these levels at least once a trimester if normal, more frequently when low.
Other important issues include a higher risk for gestational diabetes, careful evaluation of any gastrointestinal complaints, and appropriate counseling for people who still remain obese during pregnancy. Some bariatric patients may not be able to tolerate the Glucola test used to diagnose gestational diabetes and will need to monitor their finger sticks instead. There are case reports of surgical complications during pregnancy, such as adhesions, hernias, intestinal ischemia and band slippage, although the numbers are small. Early recognition of these complications is key. All complaints of nausea, vomiting and abdominal pain should be investigated and not just attributed to pregnancy.
The overall trend suggests that most women who give birth after having bariatric surgery do so via cesarean section. While having a cesarean is not a physiologic must, many doctors will lean in this direction. You should discuss possible problems you may experience due to your unique situation with your doctor and form your own delivery plan.
If you’ve had successful weight loss following bariatric surgery, it is also important to be prepared for changes in your body. You are going to see your weight increase again. Discuss realistic weight gain with your Obstetrician, nutritionist and mental health professional if needed to allow you to embrace the changes and prepare for a healthy delivery.