Pregnancy After Weight Loss Surgery
This topic really caught my attention since Labor and Delivery, Postpartum and Newborn Care were my areas of expertise for 18 years. Now having joined the Bariatric field of nursing, the dynamics related to weight loss surgery and pregnancies are even more apparent to me.
Weight loss surgery is growing in popularity as a choice for people who have struggled with obesity for years. Some age appropriate women are especially interested in the benefits it may offer in relation to fertility. A study in the Journal of Obstetric, Gynecologic and Neonatal Nursing found that women with fertility problems linked to obesity who have weight loss surgery can start ovulating regularly for the first time in years. And if you have polycystic ovarian syndrome (PCOS), your fertility could also get a boost after surgery. A study in the Journal of Clinical Endocrinology and Metabolism reported post-surgery weight loss for women with PCOS resolved their metabolic and reproductive abnormalities.
So it is important to note that accidental pregnancies can occur if not using adequate birth control, preferably dual forms, after weight loss surgery. Physicians strongly recommend practicing safe birth control for 12-18 months after weight loss surgery because this period of time allows your weight loss to stabilize, your nutritional state to become more balanced and the stressful changes post weight loss surgery to resolve. After this time frame, the potential for maternal and fetal malnutrition and small gestational age infants is greatly reduced and a woman should be able to provide herself and her baby with adequate nutrition.
It is important to closely monitor your nutrient intake. Many women have nutritional deficiencies that can be problematic during pregnancy. The most common nutritional complications associated with bariatric surgery are vitamin B12, iron, calcium and vitamin D. In some cases, post operative patients can experience protein-calorie malnutrition and fat malabsorption. Therefore, after certain types of weight loss surgery, it becomes increasingly important to take additional vitamins to compensate for the way your body no longer metabolizes nutrients.
Should pregnancy happen in your future, it will be important to inform your OB at your initial prenatal visit that you have had weight loss surgery and be specific as to which procedure type. This will allow your OB an opportunity to do some research and have the most up-to-date facts for your upcoming care. Be proactive during your prenatal period to keep an open line of communication with your OB to ensure you’re monitored closely for ways to consume the proper amount of calories and to have your vitamin levels checked regularly.
With weight loss, your complication rate during pregnancy drops, but it isn’t completely diminished. A study in Obstetrics and Gynecology found that women who had weight loss surgery developed pregnancy induced hypertension and gestational diabetes at rates similar to those of healthy weight women. Therefore, although you are still at risk for complications, the overall risks to you are less at a healthy weight than becoming pregnant at an obese weight.
Psychologically, pregnancy can play a tug-of-war with your emotions. After weight loss surgery, you’ve worked very hard to lose excess weight and once becoming pregnant, you’re told to gain weight. It will be important for you to accept your new body image all over again and to realize that ‘now is the time to gain weight for the health of my baby.’ Some women run the risks of extremes-either dieting while pregnant, which leads to serious consequences for the baby or gaining back some of their lost weight because they are eating more food than they need after delivery. It may be helpful to think about the baby before you eat so that you’re thinking about what is best for him/her. Putting the baby’s needs before your own may help to improve your mood, help you to accept you are protecting your baby’s outcome and to move your anxieties away from yourself and your weight.
According to an article in the American Journal of Obstetrics and Gynecology, it’s not exactly clear why women who have had weight loss surgery are more likely to end up with a C-section delivery, but ask your OB if he/she sees any risk factors developing which may indicate your need to take action to either prevent or emotionally prepare yourself for this type of delivery. Be sure to follow your OB’s weight management recommendations, exercise throughout your pregnancy (unless contraindicated) and attend childbirth preparation classes. I believe the better informed one is about the prenatal and delivery experience, and the possible complications, the less anxiety is experienced which improves the overall outcome.
So for women with child-bearing potential considering weight loss surgery or may have already had surgery, take note of the information in this blog which may offer you encouragement or may have given you insight into ways you can prepare for or prevent against future pregnancies. As always, I wish for you a happy and glorious life!
By: Robin H. Saunders, BSN, RN, CBN