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Pregnancy After Bariatric Surgery: 7 Things to Know

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Posted by Charis Ripley-Hager, MD

One of the many benefits of weight-loss surgery is that it can boost fertility rates for people who are otherwise struggling to conceive a child because of weight-related health problems. The surgery can also help reduce the risk for certain pregnancy complications that are sometimes caused by an unhealthy weight.

Many of the bariatric surgery patients that I work with are people of reproductive age. Some seek weight-loss surgery with the goal of improving their chances of getting pregnant, while others try for a baby after their surgery.

In either instance, it's important to know that some of the side effects of bariatric surgery can pose challenges during pregnancy — but these challenges can be managed. Pregnancy after weight-loss surgery is safe. Patients just need to take certain precautions to keep themselves and their baby healthy, and they should work with a team of dedicated experts during their pregnancy.

All of my patients are different and each of them requires their own unique care. But when one of them comes to me with questions about getting pregnant, I always start by laying out the same key points. Here's what we talk about.

1. Losing weight can support your efforts to conceive and have a healthy pregnancy.

There's an intricate relationship between excess weight and fertility. A higher-than-healthy weight may trigger hormonal imbalances that affect ovulation cycles and increase the risk of developing conditions like polycystic ovary syndrome. It may also increase the risk for other health problems, like diabetes or metabolic syndrome. These weight-related conditions can make it harder to get pregnant. Oftentimes, losing weight can make ovulation cycles more predictable and also decrease the risk of other health problems, which can help improve someone’s chances of getting pregnant.

Once a person becomes pregnant, maintaining a healthier weight also greatly reduces the odds for obesity-related complications during pregnancy, such as miscarriage, preeclampsia (dangerously high blood pressure during pregnancy), gestational diabetes, macrosomia (a too-large baby), congenital birth defects, and others. A healthier weight may also make it easier to perform prenatal ultrasounds, and it can lower the risk for postpartum complications like bleeding or infection.

2. A multidisciplinary team will offer the best pregnancy care.

It’s important to work with experts who understand the effect of bariatric surgery on pregnancy. I continue to oversee the care of my patients post-surgery, including when they become pregnant. I also typically recommend seeing an obstetrician who has experience caring for patients who have had weight-loss surgery. In some cases, a maternal-fetal medicine specialist may be preferred. These experts closely monitor a patient's nutritional status, ensuring the baby’s growth is normal.

Many patients also benefit from working with a registered dietitian who specializes in weight-loss surgery. They will help patients get a handle on their supplement needs during pregnancy and to identify the foods they should prioritize eating.

3. It's best to wait to conceive.

Patients who have had bariatric surgery should consult with members of their care team before trying to get pregnant to ensure that their bodies are ready for pregnancy. I typically recommend waiting 18 to 24 months after weight-loss surgery before trying to conceive.

This wait period can be challenging – especially for patients who sought out bariatric surgery to improve their chances of getting pregnant – but it's worth it: Delaying pregnancy is necessary to help maximize someone’s weight loss after surgery, and to reduce the risk of potential complications. The wait allows their body's vitamin levels and weight to stabilize. It can also help encourage healthy weight gain during pregnancy, which is important for the health of the baby. And all of these things support good pregnancy health and a healthy baby.

4. You shouldn't try to continue losing weight while pregnant.

Weight gain is crucial for a healthy pregnancy, so patients shouldn't try to restrict calories once they've conceived. This can obviously be a big shift for patients who recently had surgery to lose weight, but it's important to not restrict yourself, as eating enough food is crucial for a baby’s growth. It is important to continue working with your bariatric dietician to help optimize food choices so that you gain necessary weight during pregnancy.

The amount of weight a post-bariatric surgery patient should aim to gain during pregnancy depends on their pre-pregnancy weight, so you’ll need to discuss this with your bariatric surgeon and obstetrician to determine a healthy target for you.

5. Pregnancy after bariatric surgery increases the risk for nutrient deficiencies.

Not getting enough vital nutrients typically poses the biggest challenge for bariatric patients who have become pregnant. Because of their surgery, they're taking in fewer calories overall, and it may also be harder for their bodies to absorb nutrients from foods. Morning sickness can then increase that problem.

These factors can affect a person's ability to take in the calories needed to gain weight during pregnancy. They also increase the risk for falling short on nutrients needed for a healthy pregnancy, including protein, folate, iron, vitamin B12, calcium, and vitamin D.

For these reasons, I closely monitor my patients' nutrition status with regular screenings — ideally before they become pregnant – but if not, starting at their first prenatal visit. We'll use the results of these screenings, along with the patient's individual needs and bariatric surgery history, to determine what supplements they should be taking.

Often that means taking prenatal vitamins along with additional supplements for protein, calcium, iron, folate, and vitamin B12. These supplements can typically be taken orally, but some patients may require intravenous iron. A dietitian can help advise patients on supplements and dietary strategies as well.

6. Most patients have healthy pregnancies and uncomplicated deliveries.

Being proactive about nutritional deficiencies ensures that the majority of my patients who’ve had bariatric surgery go on to have healthy pregnancies and babies. Many also have uncomplicated vaginal deliveries, though the data on whether weight-loss surgery increases a person's chance for needing a C-section is conflicting. It may depend, in part, on factors like a patient's age and their current weight.

I encourage patients to talk with their obstetrician ahead of time about the possibility of a C-section. Together, you can discuss your risk factors and get a sense of what the likelihood of your needing a C-section may be.

7. You can breastfeed your baby if you want.

Many of my pregnant patients ask whether it's OK to breastfeed their baby. I tell them that breastfeeding is encouraged and that their ability to do so isn't usually affected by their surgery. However, they'll need to continue taking supplements to support their increased nutritional needs while nursing.

Learn more and find support

Pregnancy after bariatric surgery poses special considerations, but the risks are manageable with the right care. For help and support before, during, and beyond your pregnancy, schedule an appointment with a dietitian from Temple's bariatric team.

If you’re considering bariatric surgery to increase your chances of becoming pregnant, sign up for our free seminar about weight-loss surgery. Led by an experienced bariatric surgeon, the seminar is an overview of the surgery and answers many common questions people have about bariatric surgery.

Helpful Resources

Looking for more information?

Charis Ripley-Hager, MD

Dr. Ripley-Hager is a board-certified surgeon at Temple's Bariatric Program and Assistant Professor of Surgery at the Lewis Katz School of Medicine at Temple University.

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