Pregnant after weight-loss surgery

Most women who get pregnant after weight-loss surgery have an uncomplicated pregnancy and birth.

If you become pregnant after weight-loss surgery, your pregnancy will depend on how long it has been since the operation and what type of surgery you had. It’s best to wait to get pregnant for at least 12 to 18 months after surgery and once your weight has stabilised . However many women have babies safely before 12 months.

Is pregnancy safe after weight-loss surgery?

Yes. For most women pregnancy following weight-loss surgery can be safer than before due to the weight loss. Complications such as gestational diabeteshigh blood pressure and larger birth weights that are linked to being overweight can be reduced. It is essential that you get the right advice however. Talking to your team is important as soon as you know you’re pregnant.

Talk to your care team

The key things are to:

  • make sure that your midwife knows that you had weight-loss surgery
  • tell your weight loss surgery team that you’re pregnant.

Your care should then be based on the type of surgery you had and how long it has been since your operation. If your operation was more than 18 months ago, your centre may advise you to follow the usual pregnancy advice on healthy eating and exercise. If your surgery was less than 12 months ago, you will need more specific advice.

Early Contact

Make early contact with your surgery centre to let them know you’re pregnant, however soon it is after your operation. If you had your operation abroad, contact your GP to discuss whether you need to be referred to a UK Specialist Weight Loss Surgery Centre.

Will my post-surgery diet be enough for my baby and I?

Eating well during pregnancy is very important for you and your baby. The way you eat is probably quite different from before you had surgery. You may be quite used to taking vitamin and mineral supplements every day now. If you’re planning to get pregnant or have just found out you’re pregnant, talking to your weight loss surgery centre about your diet and supplement use is a good idea. This way you can be sure they are suitable for your pregnancy needs. Your weight loss surgery team is there to help you with this. Your midwifery team may also need to know what they’ve advised you to do, so don’t forget to tell them. You may also need some regular blood tests to keep an eye on the levels of nutrients in your body.

You may worry that if you eat less as a result of surgery, you won’t be getting enough food to support your baby’s development. This is unlikely, because your baby takes what they need for growth from you. You don’t need any extra calories until the third trimester.

Talk to your surgery centre about anything that worries you and make sure you follow the advice they give you on healthy eating. They will be able to explain what amounts and types of foods are suitable at this time to give you enough nutrients for you and your baby.

Supplements needed for different types of surgery

Gastric bypass

  • Pregnancy-specific vitamin and mineral supplements. In addition you may need vitamin D, calcium and possibly iron supplements
  • Your levels of Vitamin B12, iron (ferritin), calcium, folate and fat-soluble vitamins should be checked at the start of pregnancy.
  • You may need regular blood tests to check nutrient levels in each trimester. 

Gastric sleeve

  • You will need pregnancy-specific vitamin and mineral supplements.
  • Your levels of Vitamin B12, iron, calcium and folate and fat-soluble vitamins should be checked at the start of pregnancy.
  • You may need regular blood tests to check nutrient levels each trimester. 

Duodenal switch

  • You will need pregnancy-specific vitamin and mineral supplements. You may also need vitamin D, calcium and possibly iron supplements.
  • Your levels of Vitamin B12, iron, calcium, folate and fat-soluble vitamins should be checked at the start of pregnancy.
  • You may need regular blood tests to check nutrient levels each trimester. 
  • Your levels of vitamin A may need to be adjusted and monitored. Your levels of vitamin E and K may also need to be assessed.

Bilopancreatic Diversion (BPD)

  • You will need pregnancy-specific vitamin and mineral supplements. You may also need vitamin D, calcium and possibly iron supplements.
  • Your levels of Vitamin B12, iron, calcium, folate and fat-soluble vitamins should be checked at the start of pregnancy.
  • You may need regular blood tests to check nutrient levels each trimester. 
  • Your levels of vitamin A may need to be adjusted and monitored. Your levels of vitamin E and K may also need to be assessed.

Gastric band

  • You will need pregnancy-specific vitamin and mineral supplements.
  • Your levels of Vitamin B12, iron, calcium, folate and fat-soluble vitamins should be checked at the start of pregnancy.
  • Some centres may suggest fluid is removed from your band while you’re pregnant.   

NOTE: Following surgery you might need to have up to 5mg of folic acid until the 12thweek of pregnancy, please speak with your weight-loss surgery and midwifery team to see if this is necessary.

Am I going to put all the weight back on?

This is unlikely, although during pregnancy it is likely that you may gain some weight. Your size and shape will have changed a lot after your surgery, and you’ll be adjusting to the new you. Weight gain is different for everyone during pregnancy, and it is something many women worry about, whether they had weight-loss surgery or not.

It is perfectly normal to be worried about your weight at this time. Chat with your midwife and weight-loss surgery team about how you feel so they can support and advise you. Remember they are there to help.

Pregnancy itself will make you gain weight. Your baby is growing and surrounded by amniotic fluid and placenta. Your body is producing more blood, your breasts are getting bigger, and so are your muscles and bone mass.

However, if you are still losing weight after your surgery, you may not notice these changes on the scales.

Changes to your weight will depend on a number of factors, including:

  • How long it has been since your surgery. You may continue to lose weight if it hasn’t been long since your operation. If this is the case, ask your surgery or midwifery team for advice. If it has been 18 months or more since your surgery and your weight is now stable, you may need to look after your weight as you normally would during pregnancy.
  • The type of surgery you had. Some weight loss surgery centres may remove fluid from a gastric band if you’re pregnant, and you may experience some weight gain as a result. This can be managed as normal through healthy eating and exercise.

'I worked so hard to lose weight that, although I was thrilled to be pregnant, I was also scared that my body would be out of control again. But I talked to the bariatric nurse and my GP and it’s been fine.' Tara, mum of one, 4 months post-birth

Pregnancy can cause weird and wonderful changes to your body. Many are perfectly normal but, following surgery, some symptoms should be checked out quickly with your surgery centre to make sure all is well.

  • I feel sick. Although nausea and/or sickness in early pregnancy are common, vomiting in pregnancy following weight loss surgery should be checked out. If you are having regurgitation and vomiting due to food intolerance but you should discuss this with your weight loss surgery centre.
  • I’m in pain. Any severe pain in the stomach area needs to be looked at.
  • I am losing weight very quickly. If you had your operation in the 12 to 18 months, you may still be losing weight because of it. However, if the weight loss is faster than expected, go back to your weight loss centre and midwifery team for support, as you should not be actively losing weight during pregnancy.

If you have a BMI over 30, it is normal practice for you to be monitored more carefully by your midwifery team as you are at higher risk of pregnancy related complications, such as blood pressure, gestational diabetes and blood clots. You should get extra care and support to ensure that you have the healthiest pregnancy possible.

Glucose tolerance test (OGTT) after weight-loss surgery

Women with a BMI of over 30 are usually given a glucose tolerance test (OGTT or mini-GTT) to check for pregnancy diabetes. This involves having a sugary drink followed by blood tests to see how your body copes with the sugar.

If you had bypass surgery, you are not advised to have an OGTT as there is a risk of having a reaction called ‘dumping syndrome’. You must let your midwife and consultant know about your weight loss surgery and contact your surgery centre for guidance on your situation and to arrange another type of test.

 

Read more

Sources

  1.  American College of Obstetricians and Gyncologists, ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol, 2009. 113(6)
  2.  Mechanick, J.I., et al., Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring), 2013. 21 Suppl 1
  3.  Maggard, M.A., et al., Pregnancy and fertility following bariatric surgery: a systematic review. Jama, 2008. 300(19)
  4. Kjaer, M.M., et al., The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study. Am J Obstet Gynecol, 2013. 208(6)
  5. Khan R , Dawlatly B, Chappatte O Pregnancy outcome following bariatric surgery. The Obstetrician & Gynaecologist 2013;15:37–43.
  6. BOMSS (2014) Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery.British Obesity and Metabolic Surgery Society 2014.
  7. American College of Obstetricians and Gyncologists, ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol, 2009. 113(6): p. 1405-13
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Last reviewed on February 1st, 2015. Next review date February 1st, 2018.

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