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.

 

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