Pregnancy after Bariatric Surgery

Many women of childbearing age want to proceed with bariatric surgery but have questions about infertility, birth control, and pregnancy. Because pregnancy places added demands on the body, it is important to discuss these issues with your bariatric surgeon beforehand. Taking the proper precautions will help to maximize weight loss following surgery and to prepare for a safe and healthy pregnancy at the desired time.

Why Wait to Get Pregnant?

Bariatric surgeons recommend waiting at least 18 months following weight loss surgery before getting pregnant. This is the period when most weight loss occurs and the time when consuming adequate nutrition is challenging even without the added concern of pregnancy. Becoming pregnant during this time would not only reduce the weight loss benefits of bariatric surgery but it could potentially jeopardize the health of the mother and developing child.

  • The rapid weight loss that occurs in the first 18 months following bariatric surgery increases the risk of nutritional deficiencies.

Without the proper nutrients, the growing child may not develop normally and may suffer from many serious health complications. Once weight loss has stabilized and the pregnant woman is able to eat a more regular diet, a healthy pregnancy is possible for both mother and child.

Expect a Boost in Fertility

Following bariatric surgery, many women experience a boost in their fertility and a return of ovulatory function. Reproductive and infertility issues linked to obesity are often resolved quite quickly as hormones reach more natural levels due to the rapid weight loss. This renewed fertility increases the chance of getting pregnant.

In order to prevent an unplanned pregnancy during the 18 month weight loss period, women who are preparing for bariatric surgery, should also plan for effective reliable contraception. Prior to having bariatric surgery, women of childbearing age who are sexually active should visit their obstetrician/gynecologist and find out about their birth control options.

Pregnancy after Lap Band Surgery

One of the benefits of lap band surgery is that the procedure can be adjusted if necessary. In the event of pregnancy, the band can be emptied to allow the mother to eat a more regular diet for proper nourishment. Since lap band surgery does not involve altering the stomach or intestines, malnourishment is not an issue as it is with the malabsorptive types of bariatric surgery.

Even though the lap band can be adjusted for pregnancy, women are strongly advised to wait 18 to 24 months before getting pregnant. This is the time when most weight loss occurs and getting pregnant during this time would significantly reduce the amount of excess weight loss.

Pregnancy after Gastric Bypass Surgery

The potential for nutritional deficiencies can complicate a pregnancy following gastric bypass surgery or other malabsorptive bariatric procedures. The intestinal rerouting involved with gastric bypass surgery and duodenal switch surgery causes malabsorption and deficiencies of many vital nutrients, especially folic acid, B12 and iron. Oral supplementation will be necessary to help ensure adequate amounts of nutrients for both mother and child.

Women who are planning a pregnancy or become pregnant following gastric bypass surgery, must work closely with their bariatric surgeon and obstetrician to monitor nutrient levels in the body and determine the appropriate level of vitamin and mineral supplementation through each stage of the pregnancy. With proper nutrition and care during pregnancy, it is possible for a post-bariatric woman to deliver a healthy baby.

Bariatric Surgery Patients by Gender

Bariatric Surgery by Gender Chart
Source: Healthcare Cost and Utilization Project (HCUP)

Obesity and Pregnancy

Although women who become pregnant after bariatric surgery should take special precautions, their potential for a healthy pregnancy is greater than for women who remain morbidly obese. Studies have shown that the risk of gestational diabetes, fetal macrosomia (overly large babies), cesarean section, and other pregnancy-related complications are less in post-bariatric women than in morbidly obese women.

Morbidly obese women are often infertile, but if they are able to pregnant they are considered high risk and are more likely to experience pregnancy-related complications, including diabetes, hypertension, preeclampsia, fetal distress, and cesarean section. If a woman would like to have children but is morbidly obese, bariatric surgery can help her lose the excess weight and provide many health benefits that will extend to the pregnancy and the developing child.

Nutritional Guidelines

Pregnancy places additional nutritional demands on the body for all women, but it is especially a concern for women who have had bariatric surgery. Pregnant women and their doctors will need to monitor nutrient intake closely. Whether it was lap band surgery or gastric bypass surgery, changes have been made which affects food and nutrient intake. Special steps must be taken to ensure that the nutritional needs of the pregnant woman and developing child are met.

The most common nutritional deficiencies are low levels of these nutrients:

  • folate
  • vitamin B12
  • iron
  • calcium
  • vitamin D

All of these nutrients are needed for a healthy pregnancy. Protein-calorie malnutrition and fat malabsorption may occur as well due to low-calorie diets and changes to the digestive system in the malabsorptive procedures. Additional supplementation is usually necessary to provide the body with sufficient amounts of vitamins and minerals during pregnancy.

Bariatric Surgery and Lactation

Lactation is usually not adversely affected by bariatric surgery and a woman should be able to breastfeed her child after delivery without undue complications. In most cases, breastfeeding is not only healthy for the baby but helps the mother's body recover from pregnancy as well. It will be necessary for the lactating mother to continue with nutritional monitoring and nutrient supplementation as recommended by the doctor to ensure adequate nourishment.

Ready to Get Pregnant

A healthy pregnancy is possible for both mother and child following bariatric surgery, provided steps are taken to ensure adequate nutritional intake. When you are ready to get pregnant, talk to your bariatric surgeon and obstetrician about the special concerns and necessary nutritional guidelines involved with post-bariatric pregnancy. With the proper care and planning, a woman can enjoy a healthy pregnancy and deliver a healthy baby after having bariatric surgery.

Bariatric Surgeons
The number of patients undergoing bariatric surgery in the United States has increased sharply from 16,200 in 1992 to 220,000 in 2008.