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Five important things to consider when becoming pregnant after weight loss surgery.

What is bariatric surgery?

Bariatric surgery, also known as weight-loss surgery, is a type of surgery that involves making changes to your digestive system to help you lose weight. It is designed to make the stomach much smaller, which causes you to feel full after eating only a small amount of food.

The most common types in Australia are gastric bypass (called Roux-en-Y gastric bypass) and gastric sleeve surgery (called sleeve gastrectomy). Lap band surgery (called gastric banding) is also a type of bariatric surgery.

 

How does bariatric surgery help fertility problems?

Bariatric surgery can help you lose significant amounts of weight and improve your overall health. Being above your most comfortable or healthy weight may trigger hormone imbalances that can affect your ovulation cycles and make it harder to get pregnant. Moving towards a healthier weight can help address these issues. Improved fertility results from promoting more predictable ovulation cycles and reducing insulin resistance.

Significant weight loss can lead to dramatic fertility improvements. As such, it is important to consider contraception following this type of surgery and not to try to become pregnant straight away. This is for a number of reasons. The first is that it  gives your body time to lose weight (and importantly, stabilise) before conceiving. Secondly, delaying conception also allows your body’s vitamin levels to stabilize, which reduces the risk for fetal malnutrition as well as complications like premature birth and low birth weight.

Here are five important tips for women who want to fall pregnant after bariatric surgery:

  1. Wait at least 12 to 18 months after surgery before trying to conceive. This will give your body time to heal and adjust to the changes caused by surgery.
  2. Reach and maintain your most comfortable or healthy weight before getting pregnant. This will help to reduce the risks of complications during pregnancy. You should not be actively trying to lose weight.
  3. Eat a nourishing diet and take an appropriate multivitamin. This will help to ensure that you are getting all the nutrients that you and your baby need. Bariatric surgery causes malabsorption, a significant reduction in nutritional intake, or both. Following this type of surgery you need lifelong multivitamin supplementation. A “pregnancy multivitamin” will not be enough.
  4. Be as physically active as possible. Prioritising movement, reducing sitting time and finding activities that you enjoy all support your health and wellbeing. Think bone, heart, and mental health as well as helping to manage your weight and metabolic and reproductive health.
  5. See your health care professional team regularly for antenatal care. This will help to ensure that your pregnancy is progressing normally.

How can a dietitian help?

At a minimum, a pregnant person who has had bariatric surgery should see a dietitian in early pregnancy and then approximately every trimester. Bariatric surgery can change the way your body absorbs nutrients, so you can be at increased risk of developing nutrient deficiencies.

Once you become pregnant you have the additional issues of juggling:

  • increased requirements for protein and most micronutrients,
  • the pregnancy symptoms that can further affect your intake (nausea, vomiting, reflux, constipation, food aversions), and
  • the need to monitor your weight gain closely, especially in the second and third trimesters.

It is important to talk to your bariatric surgery team and a maternal health accredited practising dietitian about your specific needs and to develop a plan to make sure that you are getting all the nutrients that you and your baby need and that this is monitored through blood tests.

The dietitians at Lifestyle Maternity are expert maternity dietitian who have also worked with bariatric surgeons, providing care to their patients. For further information book an appointment with a Lifestyle Maternity Dietitian.

References:

Queensland Clinical Guidelines. Obesity and pregnancy (including post bariatric surgery). Guideline No. MN21.14-V6-R26. Queensland Health. 2021.

 

IMAGE CREDIT: Photo by 青 晨 on Unsplash

IMAGE DESCRIPTION: 5 eggs in a column from light to dark brown

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Can what I eat and how I move help my Polycystic Ovary Syndrome?

What is PCOS?

Polycystic Ovary Syndrome (PCOS) affects around 10% of Australian women in their reproductive years. This is due to hormonal changes.

This ‘syndrome’ is linked to a range of health issues for affected women, trans or non-binary people. In the short term, those with PCOS may have reduced fertility and difficulty conceiving. In the longer-term obesity, diabetes and cardiovascular disease are more likely for people with PCOS.

Normally the ovaries produce large amounts of the female hormone oestrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels are often mildly increased.

The causes of PCOS are unknown. In some cases, it seems to run in the family whereas for other women the condition only occurs when they are above their most healthy weight.

Women who have PCOS may experience:

  • Irregular menstrual cycles – menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
  • Amenorrhoea – some women with PCOS do not menstruate, in some cases for many years.
  • Infertility – related to less frequent, incomplete or absent ovulation.
  • Increased body hair (hirsuitism)
  • Obesity
  • Acne

There may also be long-term health risks. Recent research suggests that PCOS is related to insulin resistance and the development of type 2 diabetes. Some women with PCOS develop type 2 diabetes, especially if they are overweight.

What is the latest research on PCOS and lifestyle changes?

Recently, new international evidence-based guidelines for the assessment and management of PCOS were released. This large body of work documented results from studies around the world and gives direction for the best treatment steps to take.

A take home message from these guidelines is the important role of ‘lifestyle management’ as the first line of therapy for PCOS and outline the clear benefits that result from a very achievable weight loss and increase in physical activity.

Do I have to get back to my ‘healthy’ BMI range for me to see improvements in my health?

No, the good news is that research shows that achieving a loss of just five to ten percent of your body weight, whatever weight you are at now, has significant effects for fertility and symptom management in women with PCOS. What might this look like? For most women, it is a loss of only 4 to 5 kg. Further health benefits come from greater losses, and are enhanced by increasing physical activity.

How active do I have to be to get health benefits?

A good goal is at least half an hour of moderate-intensity physical activity on most, preferably, all days. You do not have to do it all at once. Your exercise can be spread over the day, in ten minute blocks. Try three ten minute walks, or two fifteen-minute periods of activity.

What does moderate-intensity activity mean? Moderate-intensity means you are exercising at a comfortable pace. A good guideline is the “talk test” – you should be able to maintain a conversation easily without being short of breath.

What happens if I am already in my healthy BMI range?

Maintaining your weight in the healthy range can help prevent symptoms and longer term health risks for women with PCOS. Being a healthy weight is a balancing act: having a good knowledge of nutrition is important, but we also need to understand the reasons for why we eat, how we eat, what we eat, who we eat with and where we choose to eat. Believe it or not, there is a lot more to reaching and maintaining a comfortable weight than counting up kilojoules!

Dietitians are trained to take a key role in assisting women with PCOS to manage their symptoms. Here at Lifestyle Maternity, specialist women’s health dietitians are able to tailor a program to support you to adapt guideline recommendations to your lifestyle and preferences. We look forward to supporting you on your journey to better health and quality of life. For further information book an appointment with a Lifestyle Maternity Dietitian or enrol in an online, self-paced course.

 

Interested in the new PCOS app that was produced to accompany these guidelines? Check it out here

 

 Figure 1. The Lifestyle and PCOS infographic produced to accompany the new PCOS guidelines.

 

 

Image credit: Unsplash/Jessica Ruscello

Image description: Sugar snap peas with one pod open, showing three peas.

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