Pregnancy Before and After WLS

  

How long should you wait after bariatric surgery before getting pregnant?

What can you do to have a healthy pregnancy? Can I still breastfeed? ……

 

With the prevalence of obesity among women of reproductive age expected to rise from 24.2% in 2005 to 28.3% in 2015, the number of women undergoing bariatric surgery is increasing¹.

I. Pregnancy after weight loss surgery

Pregnancy outcomes

Obesity increases the risk of obstetric complications. Pregnancy outcomes after all types of weight-loss surgery are universally safer and better than outcomes of obese pregnancies. Even if mothers are still obese after their surgery, the outcomes are better than if they haven’t had surgery.

These improvements include a reduced rate of pre-eclampsia (an increase in blood pressure leading to chronic high blood pressure) and gestational diabetes, a lower incidence of stillbirths and fewer miscarriages. The offspring of bariatric surgery patients are also less likely to be underweight or overweight at the time of birth.

How long should you wait after bariatric surgery before getting pregnant?

Women are advised not to become pregnant within 12 months of having had weight-loss surgery². This is due to the possibility of nutritional deficiencies during the weight loss period. At 12 months post bariatric surgery you should have reached a stable weight and be able to provide your baby with enough nutrition for a healthy pregnancy.

If you do become pregnant within 12 months of bariatric surgery the following complications may occur:

• Excessive vomiting: regurgitation can be common following weight-loss surgery but recurrent vomiting needs assessment as it could mean that your band has moved, slipped or is leaking.
• Pain: any severe pain in your abdomen requires further assessment as it could mean that there is internal damage.
• Rapid weight loss: your weight loss surgeon would need to be involved in the management of your pregnancy and you may need nutritional supplements.

Weight loss offers a fertility boost

Obesity is a major cause of infertility. Weight loss, by surgery or other means, often helps you get pregnant if obesity was the reason you had trouble getting pregnant.

Women with fertility problems linked to obesity who have bariatric surgery can start ovulating regularly for the first time in years. If you have polycystic ovarian syndrome (PCOS) your metabolic and reproductive abnormalities may also be resolved after surgery and your fertility improved.

Let your ante-natal team know you’ve had weight loss surgery

Ideally you should let your antenatal care team know that you’ve had weight loss surgery. The key to a healthy pregnancy for women who have undergone bariatric surgery is a multidisciplinary team including obstetricians, surgeons, primary care clinicians, anaesthetists, fertility specialists, nutritionists, psychologists and plastic surgeons working with you before, during and after your pregnancy.

What can you do to have a healthy pregnancy?

Making healthy choices can support a healthy pregnancy. Eating well and being active are two of the most important things you can do.

a) Eat well

Some women who have had weight loss surgery may worry that their diet isn’t nutritionally adequate for pregnancy. As there are no extra requirements during pregnancy, generally a well- balanced and nutritional diet is fine.

However, some women have nutritional deficiencies that can be problematic during pregnancy. Weight loss surgery can make it hard for your body to absorb some nutrients, such as folic acid, calcium, vitamin B12, and iron. In some cases, post-surgery patients can experience protein calorie malnutrition and fat malabsorption.

To ensure you and your baby are getting enough nutrients you should see a nutritionist who is knowledgeable about weight loss surgery. Discuss the type of weight loss surgery you’ve had, how much weight you’ve gained during pregnancy so far and your dietary likes and dislikes. Your nutritionist will work with you to make sure you’re getting the nutrition you need and to help you plan meals. They may recommend that you eat several small meals throughout the day, which improves nutrient absorption. You may need to take extra vitamins and minerals. You should have your vitamin levels checked regularly to determine this.

b) Nausea in pregnancy

It may be extra difficult to get the nutrients you need during pregnancy because of nausea, a common post-surgery complication that morning sickness can exacerbate. If nausea has squashed your appetite or you can’t keep food down, talk to your doctor about anti-nausea drugs that you can safely take during pregnancy.

c) Be active

Swimming and walking are good choices. If you weren’t very active before you were pregnant, talk to your doctor about how you can slowly get more active.

Putting on weight

Women who’ve had bariatric surgery may be anxious about gaining weight during pregnancy as they’ve worked hard to achieve their desired weight loss. Talk to your doctor if this bothers you.

Caesarean section

Weight loss surgery may increase your risk of having a caesarean section. There is some debate about why. Talk with your doctor if you have concerns about your delivery options.

You may be able reduce your chances of having a caesarean section by following your doctor’s dietary advice, exercising during pregnancy and taking childbirth preparation classes.

Can I still breastfeed after having bariatric surgery?

Yes, breastfeeding is recommended. Your nutrition whilst breastfeeding is especially important. If you have low levels of nutrients or vitamins in your body, they can also be low in your breast milk. While breastfeeding, ask your doctor to check your blood to see that you are absorbing enough vitamins (especially vitamin B12) and protein³.

Many women who have had bariatric surgery are still overweight or obese and this can delay lactogenesis (milk coming in). You may want to talk to a breastfeeding midwife who can support you through breastfeeding and help you to be successful with it.

Will my baby have any side effects because I’ve had bariatric surgery?

If you keep to a diet that offers appropriate nutrition and vitamin/mineral supplementation as directed by your doctor then bariatric surgery does not cause growth or development problems for offspring.

It is important to provide your baby with a healthy and balanced diet to negate any problems and to ensure they do not suffer from childhood obesity.

II. Pregnancy BEFORE weight loss surgery

Weight gain during pregnancy is normal and healthy. Unfortunately, many women find it difficult to lose this weight after their baby is born. For women who were considerably overweight before pregnancy, post-partum weight loss can be even more difficult to achieve. The reasons for this are both biological and environmental. For women with a BMI of more than 40, keeping up with a new baby can be exhausting and frustrating.

The benefits of weight loss surgery post-partum

For obese women with a BMI of 35 and greater, bariatric surgery can help them achieve a healthy weight and improve health problems related to excessive weight, including type 2 diabetes, high cholesterol, sleep apnoea, high blood pressure and asthma.

As a mother if you maintain a healthy weight then your family will benefit. A study has shown that a family member who undergoes weight loss surgery may have a healthy effect on the whole family and help offset childhood obesity.

Feature courtesy of Ramsay Health Care UK

References:
¹ https://www.rcog.org.uk/en/news/tog-release-women-should-wait-at-least-12-months-before-trying-for-a-baby-following-weight-loss-surgery-experts-advise/
² http://www.tommys.org/pregnancy-after-weight-loss-surgery-advice-for-professionals
³ http://www.bestforbabes.org/science-you-can-use-what-should-moms-know-about-weight-loss-surgery-and-breastfeeding/#sthash.veonw8q6.d