Sharon McLemore RN MSN NP-C
I’m often asked if one can safely get pregnant after bariatric surgery. The short answer is, yes. It’s not unusual for women with obesity-related infertility problems, like polycystic ovarian syndrome (PCOS) to start ovulating regularly after bariatric surgery. For this reason, we recommend women of child bearing age who don’t want to get pregnant use some type of contraception after bariatric surgery. Post-bariatric patients that want to get pregnant should wait until their weight has stabilized before getting pregnant. This varies dependent on the surgeon preference and type of bariatric surgery, but generally weight stabilizes between 12-24 months post-surgery. Most bariatric surgeons prefer you be at least 18 months post- surgery before getting pregnant. Women have and do get pregnant before the 12 months and deliver perfectly normal babies, but they are considered at higher risk for complication.
- Women may become more fertile post bariatric surgery
- Wait until weight has stabilized before getting pregnant. Usually 12- 24 month post-bariatric surgery
The body goes though stressful changes and nutritional upheaval after bariatric surgery. These changes can pose problems for the growing fetus. Women with lap bands may need the band totally de-filled during pregnancy. Some women may have nutritional deficiencies that can be problematic during pregnancy. Extra vitamin supplementation may become necessary. The most common nutritional deficiencies are protein, iron, folate, b12, calcium, and vitamin d. Morning sickness may prove to be particularly challenging to get in adequate nutrients. Post bariatric surgery women are often concerned their baby won’t get adequate nutrition during pregnancy. The good and bad news is that the baby takes the nutrients they need from the mother during pregnancy. In general, while additional vitamins may be necessary, additional calories aren’t needed until the third trimester when the baby goes through a period of growth and weight gain. Your doctor may want to check labs each trimester to check your nutritional status.
- You will need to monitor your nutrition intake closely
- You may need additional vitamin and/or protein supplementation
- Risks are rare. Could include abdominal hernias, gallstones, gastrointestinal hemorrhage, internal herniation of bowel, and bowel obstruction
- Malnutrition (mother and consequently baby) could result in an increased risk of low weight baby, restricted growth of the fetus, or pre term birth
- More likely to have cesarean delivery
Although weight loss surgery has been around for years, your obstetrician may not be familiar with how to treat the pregnant post bariatric patient. You may have to educate your obstetrician regarding the type of bariatric surgery you had, your bariatric diet, and current vitamin/supplement intake. It is important you keep follow up appointments with both your obstetrician AND bariatric team.
- You may need to educate your obstetrician about bariatric surgery
- Keep follow up appointments with both obstetrician and Bariatrics
Finally, there may be some psychological aspects to deal with during pregnancy. Some women are concerned with regaining the weight they have lost. It is healthy and expected that you will gain weight during pregnancy; however, you shouldn’t expect to gain any more than a normal healthy pregnancy. Generally weight gain for a single fetus pregnancy (if at your ideal weight before pregnancy) is between 25-35.lbs. If your pre pregnancy weight falls in the overweight category weight gain should be between 15-25lbs. Multiple fetus weight gain would obviously be more. If you are planning on breast feeding, you may need to continue additional vitamins/supplements throughout the breast feeding period. Pregnancy weight usually is lost within the first 6 weeks after delivery.
- You may face body-image challenges
- You will gain weight during pregnancy
- Breastfeeding – may need to continue additional vitamins/supplements
It conclusion, it is perfectly safe for the post bariatric surgery woman to conceive and have a normal healthy pregnancy provided she watches her nutritional intake and keeps regular follow ups.