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Having a Healthy Pregnancy, Delivery and Postpartum Recovery After Bariatric Surgery

Most pregnancies after bariatric surgery have successful outcomes. However, it’s very important to take the surgery into consideration if a woman plans to get pregnant. Here, Cynthia DeTata - obstetrician at Stanford Health Care - answers the most important questions related to pregnancy after bariatric surgery.

A woman pregnant after bariatric surgery

Which is safer: pregnancy after weight loss surgery or pregnancy complicated by obesity?   

The answer to the question depends on the degree of obesity, and the type of weight loss or bariatric surgery.  

Obesity can lead to many problems with pregnancy, and the risk increases with the level of obesity, or BMI.

BMI, or body mass index, is a measure of your weight in comparison to your height. A BMI between 18-24 is normal. A BMI between 25-30 is overweight, and a BMI over 30 is considered obese. Pregnancies become more dangerous as the BMI of the mother increases.

BMI, or body mass index, is a measure of your weight in comparison to your height. A BMI between 18-24 is normal. A BMI between 25-30 is overweight, and a BMI over 30 is considered obese. Pregnancies become more dangerous as the BMI of the mother increases.

There are several different types of surgery for obesity.  Some surgeries can be related to more nutritional deficiencies which can complicate pregnancy.  When talking to your doctor before surgery, please discuss your plans to have a baby so that you can learn about the pros and cons of each type of surgery.

There is no increased risk of congenital anomalies, or other poor outcomes in comparison to a group of obese women, and outcomes might be better than if the patient did not have bariatric surgery.

What are the risks of obesity in pregnancy?

Risks for the mom

  • Increased risk of sleep apnea
  • Gestational diabetes
  • Hypertension
  • Preeclampsia
  • Stroke
  • Pulmonary embolism.  

Obese mothers have longer labors, and it is more difficult to monitor the baby during labor. There is also a higher chance of having a cesarean delivery.

What is more, obese mothers have an increased risk of complications after cesarean such as wound infections or clots in the legs compared to normal weight mothers. Obese mothers require early testing for gestational diabetes, careful monitoring of their blood pressure and assessment for other medical problems related to obesity at the start of their pregnancy.

Risks for the baby

  • Increased risk of miscarriage
  • Neural tube defects
  • Undiagnosed fetal anomalies due to impact on diagnostic testing
  • Difficult delivery
  • Growth problems
  • Preterm birth
  • Stillbirth.

Losing weight before you conceive is the best way to prevent these problems.

What problems might occur during a pregnancy after bariatric surgery, and what can be done to avoid these problems?

Mothers may have vitamin deficiencies, most commonly of iron, vitamin B12, calcium, and folic acid. If you are pregnant, see your doctor right away for prenatal care and testing for any nutritional deficiencies.

You can have a pregnancy safely after bariatric surgery if you plan ahead and take steps to maximize your health before trying to get pregnant.

Overall the risks of pregnancy after bariatric surgery are low if nutritional deficiencies are corrected. 

There is no increased risk of congenital anomalies, or other poor outcomes after bariatric surgery in comparison to a group of obese women who did not have surgery, and outcomes might even be better than if the patient did not have bariatric surgery.

There are several different types of surgery for obesity, and these surgeries might impact your pregnancy differently.  Please share the records of your surgery with the doctor who is caring for you during pregnancy.

Obese mothers, and mothers who have had bariatric surgery require early testing for gestational diabetes, careful monitoring of their blood pressure and assessment for other medical problems related to obesity at the start of their pregnancy.

Some patients who have had bariatric surgery are at risk for “dumping syndrome”— a complication of food going through the stomach into the intestines too rapidly. This leads to abnormal insulin production from the mother’s pancreas and can cause symptoms such as dizziness, nausea and flushing, palpitations and possibly fainting after meals. This can be more pronounced in pregnancy. Your doctor might send you to consult with a dietician to find ways to eat that reduce the risk of dumping syndrome. 

Mothers might be at a small increased risk of abdominal wall hernias, and intestinal obstruction due to internal scarring from surgery.

Nausea, vomiting and gastric reflux are very common during pregnancy.  These symptoms might be worse for women who have had bariatric surgery, and will further increase the risk of nutritional problems.

Continued monitoring of the pregnant mom to be sure that she is able to absorb enough nutrients to keep up her health and the health of her baby is important. Pregnant women need extra iron to help their babies make their little red blood cells and muscle cells.  Even women who have not had bariatric surgery cannot always absorb enough iron through the food that they eat and may need extra iron, but women who have had bariatric surgery have a more difficult time absorbing iron and other nutrients. She may need additional folic acid, Calcium, Vitamin D, Vitamin B12 and thiamine as well.  

A mother may need IV iron or injections of Vitamin B12 if she cannot absorb enough of these nutrients through her stomach.

Does having bariatric surgery affect the management of labor and delivery? Do I need a cesarean delivery?  

Labor and delivery are unchanged after having bariatric surgery, and the reasons for cesarean delivery are unchanged. Many women have excess skin from losing weight so rapidly after their surgery, and often choose to have “tummy tucks”. The scarring from cosmetic surgeries can make a pregnancy more uncomfortable but will not affect delivery. Losing weight before pregnancy reduces the risk of complications that might lead to a cesarean.

Labor and delivery are unchanged after having bariatric surgery, and the reasons for cesarean delivery are unchanged.

What about after delivery?

Weight loss after delivery seems to occur at the same rate as in women who have not had bariatric surgery.  It is important for future health that all mothers try to get back to their pre-pregnancy weight.  Eating a healthy diet and getting some exercise after delivery is very important but can be difficult with the demands of taking care of a baby.  Please see our other articles on how to manage getting back into shape after having your baby. 

Does bariatric surgery cause problems with breastfeeding?

First of all, breastfeeding is the healthiest way to feed your baby, and has many health benefits for mom as well.   Breastfeeding can help the mother lose weight faster, and reduce her future risk of diabetes, and reduce her risk of some cancers. Did you know that breastfeeding mother uses up to 500 extra calories per day? That’s as much as running 5 miles!

Breastfed babies have a reduced risk of future obesity as well.   

Please see our articles on breastfeeding to learn more about these health benefits!

If a breastfeeding mother is deficient in B12 or iron, she may not have enough B12 in her milk and the baby may also become deficient. Breastfeeding mothers should continue their prenatal vitamins and iron supplements, and both mom and baby should be monitored to see any other supplements are needed.  

Overall the risks of pregnancy after bariatric surgery are low if nutritional deficiencies are corrected.

Rapid weight loss can cause changes in the shape of your breasts and your nipples, and these changes can sometimes make it difficult for babies to latch on to breastfeed well. Some women have cosmetic breast surgery after their weight loss that might have caused damage to nerves or milk ducts. The changes from breast surgery might cause problems with not enough milk, or blocked milk ducts and infection.

A lactation consultant or knowledgeable health care worker should observe and offer helpful advice to be sure breastfeeding gets off to a good start.  

Birth control after delivery

It is best to wait at least 18 months from delivery of one baby to the delivery of the next to get back into shape, heal adequately from delivery and to reduce the chance of nutritional deficiencies. 

You might not be thinking about sex immediately after delivery when your doctor asks you about contraception, but it is important to think about. Surprise pregnancies in the year after having a baby are common. 

Women who have had bariatric surgery may not completely absorb oral contraceptives, so non-oral forms of contraception such as an IUD, injection, ring, pill, patch or implant might be better. 

Estrogen in contraceptives will not harm a breastfeeding baby but might cause decreased production of milk. Non estrogen containing contraceptives are a better choice while breastfeeding.

Some contraceptives are less effective in women who weigh over 70kg. Talk to your doctor to find out which form of contraception is the best for you.   

The best form of contraception is the one that you will use!

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