Prior to getting pregnant, you and your partner are encouraged to have an appropriate weight or body mass index (BMI). Because people who have a high BMI are at risk of many pregnancy complications, starting pregnancy at a healthy weight or at least reducing your BMI is one of the best ways to ensure you and your baby have the healthiest start possible.
However, losing weight is not simple, and many people find conventional dieting does not work for them. These issues have given rise to the weight loss surgery techniques of today, also known as bariatric surgeries. Weight loss surgery and subsequent weight loss can increase fertility rates.
While bariatric surgery is a way to lose weight, it does pose risks to the health of the individual, if not carefully managed. If you have had bariatric surgery and now want to get pregnant, you may wonder whether there are any precautions you need to take. The general recommendation is to avoid pregnancy for at least two years after weight loss surgery, though this belief is not shared by all practitioners and researchers. Here are other things to keep in mind.
Benefits of weight loss surgery prior to pregnancy
There are a number of studies that show benefits of having weight loss surgery prior to pregnancy. Remember, the goal of the surgery is to reduce the risk of complications both to the mother and to the baby. One major study found that there was a reduction in the number of cases of gestational diabetes and excessive fetal growth.
Potential risks of pregnancy after weight loss surgery
There are risks associated with pregnancy after weight loss surgery. This can include a shorter gestational age and a small-for-gestational-age baby, meaning your baby weighs a lot less than their peers. However, this risk can be reduced by waiting at least two years post-surgery to get pregnant. One study showed that the risks of having a stillbirth or neonatal death were very slightly increased, but this finding was considered to be on the borderline for significance.
Some studies show that there are mothers who have had weight loss surgery whose babies were born with problems like neural tube defects (NTD). It’s important to keep in mind that because obese women may already be at a higher risk of having a baby with an NTD, it’s not possible to say if an NTD is the result of the previous issue or the result of a new issue post-surgery. This is one reason why some doctors are quick to say that we simply need more data before we can state that there are benefits across the board for weight loss surgery prior to pregnancy. However, there is a recommendation that women who get pregnant after bariatric surgery be considered high risk. This means you may need to see a high-risk obstetrician, or at least a practitioner who works with a team of nutrition experts.
There may also be a higher risk of surgical complications in pregnancy, meaning that you have complications related to the weight loss surgery while you are pregnant. These can include abdominal adhesions, an obstruction in your bowel, or even a hernia. These are normal complications of surgeries, but they may be exacerbated by the expanding abdomen during pregnancy.
After bariatric surgery, you may be at a greater risk of having a cesarean birth. This is true for women who have a higher BMI in general. There is not a physiologic reason for this phenomenon, which leads some researchers to believe it has to do with health care provider bias.
Special testing in pregnancy
Because it is more common for people to experience micronutrient deficiencies after weight loss surgery, this needs to be carefully watched in pregnancy. It is recommended that you get laboratory testing both before and during pregnancy. While specific testing usually isn’t done until there is a diagnosis of anemia, all women who have had weight loss surgery should be tested. You should at least be tested for iron, folate, vitamin B12, vitamin D, and thiamine, though other studies point to the potential for deficiencies involving other micronutrients.
Supplements in pregnancy
Supplementation is one way to begin to address any micronutrient deficiencies found during pregnancy, but it’s only partially effective. The real key is to find someone who has experience working with your nutritional needs after bariatric surgery, who can help your doctor or midwife order appropriate tests and guide you in getting enough protein and micronutrients to help you and your baby stay healthy.
Women in their reproductive years make up over 80 percent of the cases of bariatric surgery, and 30 percent of women who are obese state that pregnancy is their ultimate plan. This means that pregnancy after weight loss surgery will be an emerging area of research for years to come as more and more women go through this experience.
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Robin Elise Weiss, Ph.D., LCCE, CLC, AdvCD(DONA) is a childbirth educator, doula, founder of Childbirth.org, and the award-winning pregnancy and parenting author of “The Complete Illustrated Guide to Pregnancy” and more than 10 other books. Between her nine children, teaching childbirth classes, and attending births for more than two decades, she has built up an impressive and practical knowledge base. You can follow Robin on Twitter @RobinPregnancy, Instagram, and Facebook.