Obesity, Bariatric Surgery, and Pregnancy

Morbidly obese women are often infertile, according to The Consumer Guide to Bariatric Surgery, but if they are able to become pregnant, they are considered high risk.  These women are more likely to experience pregnancy-related complications, including gestational diabetes, hypertension, preeclampsia (high blood pressure, fluid buildup in the body and protein in the urine during pregnancy) and fetal distress. And they are more likely to require a cesarean or C-section delivery.

So is it safe to become pregnant after weight loss surgery? If so, how long should you wait? What can you do to ensure a healthy pregnancy and delivery after gastric bypass, gastric banding or other bariatric surgery? While many questions remain, the latest reports suggest that pregnancy after bariatric surgery is actually safer than becoming pregnant while still obese!

According to Science Daily, a recent study published in International Journal of Gynecology and Obstetrics finds that women who undergo bariatric surgery will reduce the risk of medical and obstetric complications when they become pregnant. The study was conducted by researchers from Ben-Gurion University of the Negev’s (BGU) Faculty of Health Sciences.

The study indicated that the risk of gestational diabetes alone drops by 60 percent when an obese woman has bariatric surgery before getting pregnant. There were significantly lower rates of hypertensive disorders in general and severe pre-eclampsia in particular, as well as lower rates of diabetes mellitus and anemia following bariatric surgery.

Science Daily reports that the prevalence of people who are overweight or obese has increased dramatically in high-income countries over the past 20 years. In the United States, for example, some two-thirds (65.1%) of Americans aged 20 years or older are considered overweight; one-third (30.4%) are considered obese, and 4.9% are morbidly obese. Between 1999 and 2002, close to one-third of women of childbearing age in the United States were classified as obese.

In response, the incidence of bariatric surgery in the United States increased by 800 percent between 1998 and 2005. The Consumer Guide to Bariatric Surgery asserts that women of reproductive age (18 to 45) accounted for 83 percent of these weight loss surgeries (more than 50,000 women each year).

Wait Before Attempting Pregnancy After Bariatric Surgery

Women of childbearing age who wish to become pregnant after gastric bypass surgery or other malabsorptiove surgeries such as the duodenal switch procedure should wait 18 months, because this is when the rapid weight loss occurs. It can be challenging to meet nutritional needs during this time without the added concerns of pregnancy. Such rapid weight loss may deprive a developing fetus of the nutrients it needs to grow and thrive.

Gastric banding induces more gradual weight loss and does not cause any nutritional issues. Women who get banded should wait about six months before becoming pregnant so they will be at a healthy weight during pregnancy.

Women who are overweight or obese may have difficulty getting pregnant, but weight loss increases fertility. In fact, infertility issues linked to obesity are often resolved as hormones return to more natural levels.  Most surgeons advise women of childbearing age to use reliable contraception during the waiting period.

Will You Need a C-Section?

There is no medical reason that women who have become pregnant after bariatric surgery should require a C-section delivery, but they do seem to be more likely to deliver via C-section. Talk to your obstetrician about your chances of needing a C-section delivery as well as your preferences for delivering your baby. While a C-section is a relatively safe way to deliver a baby, it does carry more risks than vaginal delivery.

Make sure your Nutritional Needs are Met

The Consumer Guide to Bariatric Surgery advises you to make your obstetrician aware of the type of bariatric surgery that you had, and be in contact with your bariatric surgeon during your pregnancy to make sure you and your baby are getting proper nutrition. You may be referred to a registered dietitian to help make sure you are getting proper nutrition during pregnancy. Women who have had gastric banding have the same nutritional requirements as women who have not had gastric banding. Women who have had malabsorptive weight loss surgery such as gastric bypass or biliopancreatic diversion may need regular blood tests to check for nutrient deficiencies during pregnancy.

Prenatal vitamins are an important part of a healthy pregnancy and contain many essential nutrients. Women should start taking prenatal vitamins before they even become pregnant.

Gastric Banding: Special Pregnancy Issues

Gastric banding surgery is adjustable. Some women who are pregnant require deflation of the band due to severe nausea and vomiting, which can occur during pregnancy and as a result of gastric banding. This is typically an individual decision. If you are having severe morning sickness, your bariatric surgeon may deflate the band to help you feel better. Your surgeon can also loosen your band so you can eat more. However, many women don’t have to touch their band at all during pregnancy.

Women who have undergone gastric banding before pregnancy may have trouble tolerating over-sized prenatal vitamins. They may develop heartburn, or the prenatal vitamin may remain in their esophagus, causing ulcers. Talk to your obstetrician about chewable or liquid prenatal vitamins to avoid these complications.

Breastfeeding After Bariatric Surgery

Women who become pregnant after bariatric surgery can still breastfeed, provided there are continued nutritional monitoring and supplementation. Talk to your surgeon, obstetrician, a lactation consultant and/or a registered dietician to make sure you and your baby are getting all the nutrition you need.It’s also important to make sure you are drinking enough water so your milk does not dry up.

Please visit The Consumer Guide to Bariatric Surgery to find out more about weight-loss surgery and pregnancy-related issues.

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