Nutrition
December 15th, 2020
While obesity is a well-known contributor to female infertility, studies have also shown that weight loss "can restore ovulatory cycles, allowing for spontaneous pregnancy" in obese patients with PCOS.1 Bariatric surgery has been proven to improve menstrual regulation and fertility2, but there are nutritional complications one should consider before becoming pregnant after bariatric surgery. We will dive into the different potential complications and how you can navigate through pregnancy safely after bariatric surgery.
Malnutrition and vitamin/mineral deficiencies are high-risk nutritional complications that can impact fetal growth. These complications are due to rapid weight loss and inability to eat large portions of food (adequate nutrients) in the first year after bariatric surgery. It's generally recommended to avoid pregnancy for at least 12-24 months after bariatric surgery to avoid these risks.3 Optimal care for women undergoing bariatric surgery planning on becoming pregnant include “pre-conception counselling, optimization of nutrition before, during and after pregnancy, and monitoring for complications.”4
In addition to following the ASMBS guidelines for nutrition supplementation post-bariatric surgery, there are a few modifications that are needed with pregnancy. It’s recommended that pregnant women have nutritional labs done every trimester to screen for deficiencies. As always, please be sure to consult with your bariatric team to ensure modifications and recommendations are appropriate for you and your body. The following are general guidelines:3,4
While weight gain can seem daunting after bariatric surgery, it’s expected and encouraged when pregnant. For women with a pre-pregnancy BMI of 25-29, recommended total pregnancy weight gain is about 15-25 lbs. For women with a pre-pregnancy BMI of 30 or higher, recommended total pregnancy weight gain is about 11-18 lbs.3 While pregnant, your nutritional goals should promote healthy fetal growth, not weight loss.
Dumping syndrome may be triggered by the oral glucose tolerance test used to test for gestational diabetes. While screening for gestational diabetes is recommended, “capillary blood glucose monitoring daily before and after meals for a week at 24 to 28 weeks’ gestation [is] a safer alternative to the oral glucose tolerance test.”6
While there are potential complications and risks of becoming pregnant after bariatric surgery, it can absolutely be done in a safe and healthy way. It is of utmost importance to be open and honest with your bariatric and health care team before, during, and after pregnancy, so they can guide you through a healthy pregnancy.
References:
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