Is Pregnancy After Bariatric Surgery Safe
Bariatric surgery, also known as weight-loss surgery, has become the ultimate solution and most effective treatment for obesity when exercise and diet won’t work anymore. According to the U.S. Centers for Disease Control and Prevention, its popularity is increasing every day, among women in particular.There are three main problems obese women face more than others during pregnancy: babies with larger birth weights, gestational diabetes, and high blood pressure. Therefore, the majority of bariatric surgery cases are now performed on reproductive-aged women who want to eliminate these problems and become pregnant. However, one question still exists: is pregnancy after bariatric surgery safe?After reading this article, you’ll have a thorough insight into a comparison between pregnancy before and after this operation, the pros and cons of pregnancy after weight-loss surgeries, the best time to get pregnant, practical suggestions regarding detailed guidelines of nutrition and exercise before and after pregnancy, in addition to the answers of some of your most common questions. 
Pregnancy Before and After Bariatric Surgery
Obesity creates a lot of physical problems for women including the ones that affect their reproductive system, most of which can be solved after bariatric surgery and reaching a healthy weight, hence the better overall physical condition. Findings of a reported issue of the Journal of Obstetric, Gynecologic, and Neonatal Nursing in November 2004 showed that for the first time, women who were dealing with infertility due to obesity and had to have gastric bypass surgery or any other types of weight-loss surgery faced notable growth in their regular ovulation.Even though women with a higher BMI are at more risk of infertility or miscarriage, bariatric surgery can also create some worries for women, for instance, what if my baby is smaller than normal because I eat less than before and they might not get as much nutrition as needed?The good news is that just like obesity that has a final treatment, which is bariatric surgery, all the troubles women might face during pregnancy after these surgeries are solvable! However, still, you need to have clear-cut information on these problems and the solutions.The table below indicates a comprehensive comparison of pregnancy before and after bariatric surgery.
| Obesity-Related Risks During Pregnancy | Post-Bariatric Surgery Risks During Pregnancy |
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Now that you have a clear image of the disadvantages of pregnancy while obese and after bariatric surgery, let’s delve into some medical solutions you’ll find super practical in order to have a happy, healthy pregnancy.
The Best Time to Get Pregnant After Bariatric Surgery
Most doctors recommend postponing pregnancy until at least 12 months after the surgery. The main reason for this recommendation is that obesity is associated with increased pregnancy complications, like gestational diabetes and preeclampsia (pregnancy-related high blood pressure). These problems do not vanish as soon as the surgery is done and are most likely to be treated at some point between 12 and 18 months after bariatric surgery.The other logic behind this idea is that after bariatric surgery you’ll start to lose weight. So, it is better to wait till your BMI stabilizes, and then you can get ready for pregnancy with ease of mind.However, as there are still some successful pregnancies right after the surgery, some experts believe there is no specific time, just do it whenever you feel ready!Regardless of the time of your pregnancy, it is wise to take everything into consideration. After all, pregnancy by itself brings about some abnormalities in your physical situation. You do not want to make it worse by not paying enough attention to your health and that of your baby.
Recommended Birth Control for Pregnant Women After Bariatric Surgery
If you’ve decided to listen to the first group of doctors, you need to prevent pregnancy as much as possible till at least 12 months after your operation.For sufficient contraception, your body needs a certain amount of hormones. Taking pills is a popular method among women, however, they cannot give you the necessary hormone and that is not something you can gamble on.Therefore, it is suggested that you take barrier methods. If you yourself are willing to make changes to your body in order to prevent pregnancy before your scheduled time, you can try female-controlled methods. If not, simply just ask your partner to use male condoms. This can all be arranged in an agreement between the two of you. But remember, it’d be much better if you do not jeopardize your condition by taking oral medication and depending solely on them.
Nutritional Guidelines for Pregnancy After Bariatric Surgery
The amount of nutrition your body delivers is for sure different before and after weight-loss surgery. By now you might be used to taking vitamins and mineral supplements every day in order not to lose your strength due to eating less than before the weight-loss surgery.You might be under the wrong impression that now that you are eating less, the fetus will not grow as much as it is supposed to. No worries because your baby takes what they need for growth from you. So, as long as you are healthy, they’re healthy.Even women who did not undergo a bariatric procedure could face problematic nutritional deficiencies during pregnancy. What you need to know is accurate information about the exact nutrition your body needs during this time, and of course, the necessary amount your body should be given on a daily basis.
| Supplement | Daily Necessary Amount |
| Iron | 45 – 600 mg |
| B12 | 350 – 500 mcg (Orally taken) 1000mcg (Injections) |
| Folic Acid | 400 – 800 mcg |
| Vitamin D | 3,000 – 8000 mg(Pay more attention to Vitamin D absorption in the last trimester) |
| Calcium | 1,500 – 2,400 mg |
| Protein | Minimum level ==> 60 grams per day |
Monthly Necessary Check-ups During Pregnancy After Bariatric Surgery
In addition to getting the vital nutrition for the health of yourself and your baby, don’t forget to have your provider check your vitamin levels regularly. These check-ups differentiate a bit based on the type of surgery you had. Here’s a detailed presentation of what you need to know. Just find the ones related to your surgery and keep up with the suggested plan.
| Main Supplements Specific to Pregnancy | Monitoring B12, iron, calcium, folate, and fat-soluble vitamins (At the beginning of pregnancy) | Blood Tests on a Regular Basis | Monitoring Vitamin A, E, and K | |
| Gastric Bypass |  | | | |
| Gastric Sleeve | | | | |
| Duodenal Switch | | | | |
| Biliopancreatic Diversion (BPD) | | | | |
| Gastric Band | | |
Glucose Tolerance Test (OGTT) After Weight-Loss Surgery
Do not forget continuous glucose monitoring during this time as well. If your BMI is over 30 it is likely that your doctor will regular glucose tolerance tests (OGTT or mini-GTT) to check whether you have gestational diabetes or not.A Glucose Tolerance Test is not advised just in case of bypass surgery because you might face what is called ‘dumping syndrome’. So, to make sure there is no gestational diabetes, consult with your surgery team and doctor to give you a replacement.
Food to Avoid While Pregnancy after Bariatric Surgery
– Fish and Shellfish
- Raw shellfish contains harmful bacteria, viruses, and toxins that might give you food poisoning. So, try to avoid them as much as possible.
- Too many pollutants like dioxins in oily fish make it a dangerous food for your baby’s health. Do not eat this type of fish more than twice a week.
- Tuna is a rich resource of Omega 3 and protein for pregnant women. However, the permitted amount is 2 steaks of tuna steaks. at most
Other foods and Drinks to Avoid during Pregnancy after Bariatric Surgery
– Caffeine
The maximum amount of caffeine you can take is 200mg per day. Here’s a list of some of the most popular drinks and food with their specific caffeine level:
- Instant coffee (one mug) ==> 100mg
- Filter coffee (one mug) ==> 140mg
- Cola (one can) ==> 40mg
- Milk chocolate (one 50-gram bar) ==> 10mg (or less)
- Green and regular tea (one mug) ==> 75mg
- Dark chocolate (one 50-gram bar) ==> 25 mg (or less)
– Alcohol
This one is not specific to pregnant women that had weight-loss surgery. No woman should drink alcohol during pregnancy because it will result in serious harm to the baby.
Will my baby have any side effects because I’ve had bariatric surgery?
If you still have this question, do not worry. All you need to do is to make sure you have appropriate eating habits and your body is delivered all the necessary nutrition, including vitamins and mineral supplementation.Also, to prevent any childhood obesity problems for your baby, have a balanced diet while pregnant and after that during the breastfeeding period.
Focus on Healthy Weight Gain
If you’re not mentally ready for any kind of weight gain, then you’re still not ready for a pregnancy. But if an unexpected one occurred, try to forget weight loss. However, it is important to control your weight in order not to gain excessive weight as it will affect both your mental and physical situation. So, try to focus on healthy weight gain instead.The American College of Obstetricians and Gynecologists (ACOG) published some numbers that indicate the ideal weight gain for women according to their BMI before pregnancy:
| BMI | Ideal Weight Gain During Pregnancy |
| 18.5–24.9 | 25–35 lbs |
| 25–29.9 | 15–25 lbs |
| 30 < | 11–20 lbs |
If your body image irritates you as it might remind you of how you used to look, take it as a serious matter and visit a psychiatrist immediately.
Exercise During and After Pregnancy
Exercise will become an inseparable part of bariatric surgery patients. On the other hand, pregnant women are strongly advised to do some regular exercise in order to have healthier babies and easier delivery. Therefore, as a pregnant woman, you should consider routine physical activities that fit your physical circumstances.If you’ve just become pregnant, it is not a good time to begin a new exercise routine. Keep up your previous one, and if you were not used to exercising at all, just try to add some effective, yet not so intense activities to your lifestyle, for instance, walking.Before PregnancyIf you’re not used to exercising, just consult with your doctor to see how you can slowly add it to your life. Here are a few points to consider:- Swimming and walking are good for you and your baby.- An activity/exercise regime of a minimum of 30 minutes per day and five times a weekAfter Pregnancy- Don’t start with heavy activities. Just give it a shot slowly, stick to the plan, and improve it gradually.- The best time for exercising is after nursing as your breasts are not that full and movement is much easier.- Wearing a sports bra adds up to the comfortability of your workout to a high extent. Wear one, especially in case you’ve got large breasts.- It’d be better if you do not drink water during exercise. However, a glass of water before and after the workout is strongly recommended.- Walking is a great way of exercise both during and after pregnancy. You can take short walks outside with your baby as well.- If the weather is not good for a pleasant, short walk outside the house, try having some fun activities in the house with your little one, maybe dancing?- Make sure to take a shower or at least wash your breasts after exercise as some babies prefer their food not to be salty.
Can I Get Pregnant with an Intragastric Balloon in My Stomach?
In comparison with other types of bariatric surgery, the gastric balloon is much simpler and reversible. However, if you’re planning to lose weight using a gastric balloon to increase fertility, it is better that you reach your ideal weight and then go for pregnancy.But sometimes, women get pregnant while having the balloon in their stomachs. This is not so problematic, but the removal of the balloon depends on its type. The 12-months balloons will be dissolved at the end of the year and there is no need for your doctor to remove them, but, the 6-month ones should be removed mostly by anesthesia, which is not suitable for pregnant women, thus not suggested.
Breastfeeding After Having Bariatric Surgery
Most women are concerned about whether they still can breastfeed after bariatric surgery or not. The answer is yes. Breastfeeding is recommended, however, specific attention to nutrition is still very important in this period.If you have any type of nutrition deficiencies, this will affect your milk since it will lack the necessary supplements for your baby’s growth.You can simply consult with your baby’s pediatrician, let them know about your bariatric surgery and your previous and current circumstances, and ask them to monitor your baby’s growth even more closely.If you have not reached your ideal weight before pregnancy and you’re still a bit overweight, there is a probability of after giving birth your milk comes later than usual. In this case, just talk to your doctor and ask for some advice that’ll streamline the breastfeeding process.
Nausea During Pregnancy after Bariatric Surgery
Nausea and vomiting are common in pregnancy. But you can manage it with dietary advice that’ll help you avoid or treat complications:
- Avoid food with strong odors.
- Eat small but frequent meals.
- Take a short walk before meals.
- Make a list of all the food that cause you nausea and try to avoid them.
Bottom LineEven if you’re not thinking about having a child, you might change your mind at some point in the future. However, obesity is a barrier that not only makes pregnancy so risky but in some cases makes it almost impossible.You might have tried everything but still, you’re dealing with excessive weight. In case you’ve done your research and found weight-loss surgeries practical, do not worry about pregnancy after the operation.The problems your mind is concerned about now, including any potential nutritional deficiencies, can all be controlled to a high level after bariatric surgery. But obesity creates barriers on your way to motherhood that cannot be overcome under any circumstances.Just wait for some months after surgery, prepare your mind and body, and you’re good to go: welcome to motherhood!
Is it best natural birth or shall we option for c section after gastric sleeve ?
Dear Veronika,
there is not one better option for everyone. You can do both with no problems according to what the Doctor taking care of you during the pregnancy feels like it’s best for you.
Have a good day,
Ceyhun Aydoğan team