Pregnancy After Bariatric Surgery
Maternal obesity is associated increased risk for many complications including miscarriage, cesarean delivery, preeclampsia, pregnancy induced hypertension, thromboembolic events, gestational diabetes, large for gestational age infants, preterm birth, congenital malformations, and stillbirth. The risk for these complications increases in parallel with BMI. Obesity as a risk factor for poor pregnancy outcome is a major public health issue at this time. In many countries, maternal overweight and obesity have surpassed smoking as the most preventable risk factor for adverse pregnancy outcome. Pregnancies after bariatric surgery were associated with lower risks for gestational diabetes and excessive fetal growth.
Expert opinion has been to delay pregnancy for 18 months after bariatric surgery in order to maximize weight loss prior to pregnancy. This minimizes obesity related complications. Bariatric surgery may lead to a significant increase in fertility due to improvement in menstrual dysfunction. Return to fertility may be rapid. Women undergoing bariatric surgery should receive contraceptive and preconception counseling. To ensure the mother and baby are getting enough nutrients, bariatric surgery patients should continue to work with the dietician and bariatric surgery provider, and a high risk OB-GYN who is knowledgeable about bariatric surgery. It is necessary to monitor vitamin levels regularly in order to identify and correct deficiencies. Studies have proven the importance of monitoring vitamin levels as deficiencies may occur in spite of supplementation.
Malabsorptive procedures place women at risk for nutritional deficiencies. All women should comply with vitamin and mineral supplementation recommendations before and during pregnancy. The most common nutritional deficiencies after bariatric surgery are protein, iron, calcium, vitamin B12 and vitamin D. Reduced oral intake and alterations in digestive anatomy result in malabsorption of micronutrients and minerals. Absorption of iron and folate are reduced due to lower acid content in the gastric pouch and bypass of the duodenum, the main site of absorption. Calcium deficiency can also result from bypass of the duodenum as well as reduced intake of calcium and vitamin D rich foods. Oral absorption of vitamin B12 depends on the presence of intrinsic factor. Sometinmes use of non-oral supplements is sometimes necessary due to low intrinsic factor due to partial gastrectomy, as intrinsic factor is found in the stomach.
It is recommended that all bariatric surgery patients take daily supplements such as:
- Prenatal multivitamins containing folic acid
- Calcium citrate with vitamin D
- Vitamin B12
In conclusion, overall pregnancy after bariatric surgery appears to lead to safer outcomes than pregnancy in obese women. Research suggests that bariatric surgery causes minimal risk for nutritional and congenital complications as long as adequate nutrition is maintained and vitamin and mineral supplementation guidelines are followed. Studies have shown women who have undergone bariatric surgery developed pregnancy induced hypertension and gestational diabetes at rates similar to those of those of healthy-weight women who had never been obese.