Having excess fat changes the hormonal balance. That’s the reason obesity may affect your ability to get pregnant. You may consider gastric sleeve surgery not only to lose excess weight but also to increase your chances of a healthy pregnancy. If you worry about the potential risks of pregnancy after gastric sleeve, in the article you will find an answer to the question: is getting pregnant after gastric sleeve safe? You’ll also have a thorough insight into some practical recommendations regarding guidelines for birth, nutrition, and breastfeeding. So, if you’re thinking about improving your chances of getting pregnant after your gastric sleeve surgery, here are some important things you should know.
Can you get pregnant after a gastric sleeve?
Can you have a baby after gastric sleeve? Yes, having a child after a sleeve gastrectomy is possible. You may think that undergoing this kind of weight loss surgery can be an obstacle when you want to get pregnant, but you don’t need to worry. Contrary to some misconceptions, pregnancy after a weight loss surgery is very safe, as long as you are planning it at the right time.
When it’s the right time after your surgery, you will start preparing yourself by following all the necessary advice and instructions given to you by your surgeon, an OBGYN, and a dietitian. Remember that your weight loss surgery and pregnancy at the same time will put a strain on your body. You need to prioritize your recovery first and then plan your pregnancy.
Is it safe to get pregnant after gastric sleeve?
Yes, it’s safe for you to become pregnant after your sleeve gastrectomy. Gastric sleeve surgery is one of the restrictive procedures, which means your stomach gets much smaller. For some time, it won’t be possible to get enough nutrition in your body for you and your baby. So it is important to wait until you get the necessary nutrition for two.
What’s important, a pregnancy after gastric sleeve surgery is, in many cases, even safer than having a baby when you are overweight or obese. (1) You need to be aware though that timing plays a huge factor. It’s not recommended to get pregnant too early after your sleeve gastrectomy and we’ll now explain to you why.
How soon can you get pregnant after gastric sleeve surgery?
Can you get pregnant a month after gastric sleeve? Most of the specialists suggest waiting from 12 to 18 months, due to the significant weight loss that happens after your sleeve gastrectomy. You’ll experience rapid weight loss, so it’s crucial that you wait long enough for your body to adapt to the surgery’s outcomes. Keep in mind that they include all the metabolic and hormonal changes you go through on your weight loss journey.
What happens if you get pregnant after gastric sleeve too soon?
When you get pregnant after your gastric sleeve surgery too soon, there might be some potential risks related to your pregnancy’s development. The reason we suggest waiting for at least one year is to prevent your baby’s insufficient growth. It may happen due to not having enough amount of nutrients in your diet. To avoid that, be patient during the first year, because your body needs time to recover after the surgery before you may become pregnant. We cannot emphasize strongly enough the importance of this factor.
Does having a gastric sleeve affect pregnancy?
Yes, it does. Weight loss after the surgery affects hormonal balances in a positive way, which helps in increasing your fertility. On the other hand, there may be some complications during the pregnancy, especially related to nutrient deficiencies, if you get pregnant too early after your sleeve gastrectomy procedure or don’t follow the dietary suggestions of your doctor. It will all affect your pregnancy, so it’s crucial to take these factors into consideration when you decide to have a baby.
Increase in fertility
After a weight loss procedure like sleeve gastrectomy, your fertility is rising. Women who suffered from fertility problems before their gastric sleeve surgery often report regular ovulation after the procedure.
During the first 12-18 months after the procedure, contraception is therefore necessary. You should discuss birth control methods with your doctor. Contraceptives such as patches or shots can be an option. According to many reviews oral contraception is not sufficient. (2) Remember that changes in your digestive tract after the surgery affect your nutrition, which also includes the way you absorb oral medications, including contraceptive pills.
What’s interesting, some of the studies involving twin pregnancies in women show that chances of having twins after gastric sleeve are higher among women who had a weight loss surgery. (3)
What’s more, polycystic ovary syndrome (PCOS) is very common among obese women. Weight loss is good for PCOS and that’s one of the reasons why fertility also increases. (4)
Fewer complication risks
Gastric sleeve surgery may have a positive impact on your pregnancy by helping to control or reduce the risks of illnesses and other problems related to obesity. The proportion of gestational diabetes patients after weight loss surgery significantly decreases.
Gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth. Also, women who had problems with hypertension resolved them after their post-op weight loss and report normal blood pressure. As a result of your new weight, you have more strength and energy now, which is also going to affect your pregnancy in a positive way as you will carry your baby.
How to prepare to get pregnant
First of all, the food that you consume after your surgery must be rich in nutrients and healthy, so that both your health and the development of your child will be fine.
You may also wonder if your entire pre-op weight is going to come back during your pregnancy. No need to worry – it’s not going to happen if you properly prepare yourself before you decide to become pregnant.
Consult your OBGYN
You will be already consulting your obstetrician-gynecologist during the pregnancy. Make sure you inform your doctor about your surgical history. They will prescribe a variety of standard prenatal vitamins and supplements. They will be also monitoring all your medications, lifestyle changes, and your diet. We recommend that you choose a specialist who has experience working with women who underwent gastric sleeve surgery. This way you may feel safer and more certain that you will get the best possible care while you are pregnant.
Nutrition Intake
When you think about your pregnancy after gastric sleeve one thing is extremely important – it’s your nutrition plan post-op. It should include both vitamins and mineral supplements. Prenatal supplements, like healthy fat, folic acid, protein, calcium, vitamin B12, and vitamin D, as well as iron are highly recommended. It’s best that you undergo some check-ups to optimize your vitamin and mineral levels before conception. This way you’ll make sure that your baby will get all the nutrition it needs to develop properly.
Also, don’t worry too much about eating less after the surgery. Within the first three months of your pregnancy, you need 100 additional calories per day, and 300 additional calories daily for the rest of your pregnancy. Remember about healthy eating is to improve the sufficient growth of your baby.
Possible risks in pregnancy after gastric sleeve
In most cases, there is little to no risk associated with weight loss surgery for pregnancies that are not in the early stages. If any risks are present, they are unlikely to be caused by the surgery itself.
When you are pregnant after gastric sleeve, you need to make adjustments to make sure that both you and your baby get adequate nutrition. Otherwise, there is an increased risk of complications that may affect your child and you. Even the risk of preterm birth and miscarriage after gastric sleeve should be taken into consideration, although it’s rare if you follow your doctor’s suggestions. (5)
How to minimize these risks
Your balanced diet and regular exercise should continue after your gastric sleeve surgery. When you have a healthy lifestyle during your pregnancy, you minimize most of the risk factors. Here are some dietary supplements recommendations for pregnant women following their weight loss surgery:
- 1000–2000 mg of calcium citrate with vitamin D addition (50–150 mcg) daily
- 40–65 mg of ferrous iron daily
- 350 mcg of cobalamin sublingual daily
- 4 mg of folic acid daily
- 15 mg of zinc daily
You’ll also most probably get your monthly ultrasound scans and regular blood tests controlling your nutrient levels of iron, hemoglobin, ferritin, transferrin, calcium, homocysteine, cobalamin, and retinol. Your check-ups should include the follow-up of your weight changes during the pregnancy, as well as glucose monitoring for gestational diabetes. (3)
Which one is better a better option: normal delivery or C-section?
The best delivery option is always the one that is the safest for both the mother and the child. In fact, it’s slightly more common for a pregnant woman after gastric sleeve to have a cesarean section, but that’s not because it’s recommended. You need to know that normal delivery after sleeve gastrectomy is entirely possible. There are no medical reasons that women after bariatric surgery should require a C-section. Some doctors may choose a cesarean delivery as a better solution, or you might feel more comfortable with this delivery option, but keep in mind that normal delivery is equally safe in most cases. You should always discuss these possibilities and potential risks with your doctor.
Would normal delivery hurt my gastric stitches?
No, it wouldn’t. Recovery after gastric sleeve takes about 2-3 weeks for the incisions in your stomach and 6-8 weeks for your staple line to heal. You will not be giving birth during these weeks after your sleeve gastrectomy, so there is no risk your gastric stitches can be affected in any way.
Can you breastfeed after gastric sleeve?
Yes, you can. Breastfeeding after gastric sleeve has several benefits both for the baby and the mother. However, you will need to be very careful to make sure that you are following a healthy and varied diet so that your baby gets all the required nutrients. You will also need to drink approximately 3 liters of water daily, to compensate for the extra water that is used to produce your milk. Remember that it’s crucial for optimal growth and preventing any nutritional deficiencies, for both you and your child.
Pediatricians recommend exclusive breastfeeding following pregnancy after gastric sleeve for at least six months. It’s best that you tell your baby’s doctor about your gastric sleeve surgery. They may provide more frequent check-ups and regular blood tests to control your child’s growth and development and to identify any possible nutritional deficiencies as early as possible. (6)
What should I include and exclude from my diet during breastfeeding?
While you are breastfeeding after gastric sleeve, your diet should include fresh fruit and vegetables, nuts, dairy products, some fish (pollock, cod, whiting), meat, dark chocolate (over 70% cocoa), whole grain products and low-processed foods with nutrient-dense ingredients.
Remember to take all the necessary vitamins and mineral supplements. We recommend you ask your doctor to check your blood every three months to see that you are absorbing enough vitamins, minerals, and protein. Be careful with limiting calories too much, because it may decrease your milk’s level. (7)
Here are some recommendations after the surgery that may help in nutritional management:
| Multivitamin and mineral supplement | 1–2 daily | Avoid retinol-based vitamin A intake in pregnancy and during lactation; safe to continue beta-carotene |
| Calcium | 800–1500 mg daily | |
| Vitamin D | 800 units daily | Higher doses may be necessary in case of a deficiency |
| Iron supplements | 45–60 mg daily | |
| Vitamin B12 | 1000 micrograms daily | |
| Thiamine (B1) | In Multivitamin or 12–50 mg daily | |
| Folic Acid | In Multivitamin or 400–800 microgram daily | 5 mg before pregnancy to 12 weeks of pregnancy |
| Vitamin A | In Multivitamin or 5000–1000 IU daily | |
| Vitamin E | In Multivitamin or 15 mg daily | |
| Vitamin K | In Multivitamin or 90–300 micrograms daily | |
| Zinc | In Multivitamin to meet 100–200% RDA † | |
| Copper | In Multivitamin to meet 100–200% RDA † | |
| Selenium | As contained in Multivitamin |
What are the foods that are better to avoid? First of all, you shouldn’t be drinking alcohol while breastfeeding. It can reduce your milk production and have negative effects on your child. When it comes to caffeine, limit it to a maximum of 300 mg per day, or it may disturb your baby’s sleep.
Try avoiding junk food. Highly processed foods are generally low in nutrients, and high in added sugars and processed fats.
While fish is a great source of omega-3, remember that some fish, like tuna, mackerel, or raw fish, may also contain high levels of mercury. It’s a metal that can be toxic, which is especially dangerous for children because it can affect your baby’s central nervous system.
Keep in mind that your OBGYN, a bariatric surgeon, a dietitian nutritionist, and a psychologist need to take care of you during your pregnancy after gastric sleeve and the time that you are breastfeeding.
References:
(1) Różańska-Walędziak A, Bartnik P, Kacperczyk-Bartnik J, Czajkowski K, Walędziak M, Kwiatkowski A. Pregnancy after bariatric surgery – a narrative literature review. Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):30-37. doi: 10.5114/wiitm.2020.99281. Epub 2020 Sep 24. PMID: 33786114; PMCID: PMC7991924. Link
(2) Kaska L, Kobiela J, Abacjew-Chmylko A, Chmylko L, Wojanowska-Pindel M, Kobiela P, Walerzak A, Makarewicz W, Proczko-Markuszewska M, Stefaniak T. Nutrition and pregnancy after bariatric surgery. ISRN Obes. 2013 Jan 30;2013:492060. doi: 10.1155/2013/492060. PMID: 24555146; PMCID: PMC3901983. Link
(3) Rottenstreich A, Levin G, Rottenstreich M, Ezra Y, Elazary R, Elchalal U. Twin pregnancy outcomes after metabolic and bariatric surgery. Surg Obes Relat Dis. 2019 May;15(5):759-765. doi: 10.1016/j.soard.2019.01.014. Epub 2019 Jan 25. PMID: 30745150. Link
(4) Malik SM, Traub ML. Defining the role of bariatric surgery in polycystic ovarian syndrome patients. World J Diabetes. 2012 Apr 15;3(4):71-9. doi: 10.4239/wjd.v3.i4.71. PMID: 22532886; PMCID: PMC3334389. Link
(5) Stephansson O, Johansson K, Söderling J, Näslund I, Neovius M. Delivery outcomes in term births after bariatric surgery: Population-based matched cohort study. PLoS Med. 2018 Sep 26;15(9):e1002656. doi: 10.1371/journal.pmed.1002656. PMID: 30256796; PMCID: PMC6157842. Link
(6) Stopp T, Falcone V, Feichtinger M, Göbl C. Fertility, Pregnancy and Lactation After Bariatric Surgery – a Consensus Statement from the OEGGG. Geburtshilfe Frauenheilkd. 2018 Dec;78(12):1207-1211. doi: 10.1055/a-0706-7578. Epub 2018 Dec 14. PMID: 30655646; PMCID: PMC6294640. Link
(7) Slater C, Morris L, Ellison J, Syed AA. Nutrition in Pregnancy Following Bariatric Surgery. Nutrients. 2017 Dec 8;9(12):1338. doi: 10.3390/nu9121338. PMID: 29292743; PMCID: PMC5748788. Link
