1. Getting pregnant
  2. Planning for pregnancy
  3. Preconception planning

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Thinking of Pregnancy After Bariatric Surgery? Here Is What You Should Take Into Account

You can have a safe and successful pregnancy after bariatric surgery. It is important to plan ahead and take steps to maximize your health.

Here, Cynthia DeTata — obstetrician at Stanford Health care — answers the most important questions about preparing for a pregnancy after bariatric surgery.

How does obesity impact your cycle and your hormones?

The relationship between fat cells “adipocytes”, the ovaries, reproductive hormones and the menstrual cycle is very complex

Fat cells are more than just storage places for extra energy. They can make substances that affect ovarian production of hormones, and they can change the hormones made by the ovaries so that they act differently in the body. Estrogens and progesterone, hormones made by the ovaries can affect the fat cells themselves, and also act on the brain to change behavior that may lead to changes in activity and eating that can increase and decrease weight. 

To make this even more complicated, there are other influences on hormones, such as genetics, stress, age, sleep, substances in the environment, and probably other factors that we do not understand yet.

What is the connection between obesity and Polycystic Ovarian Syndrome, or PCOS?

Polycystic ovarian syndrome is a common cause of irregular menstrual periods and infertility. It can also be associated with heavy bleeding, acne, male pattern hair growth and central storage of fat. 

Along with the problems that PCOS causes with menstrual cycles and infertility, PCOS can impact health over a woman’s lifetime. Women with PCOS are more likely to have type 2 diabetes, hypertension, cardiovascular disease, and endometrial cancer.

Not every woman with PCOS are obese. In fact, 60% of women with PCOS are obese, but the other 40% are either normal weight or underweight. 

Whether obese or thin, PCOS is associated with insulin resistance, increasing the risk of diabetes for both groups. There are insulin receptors on the ovary, and when obese women become more obese, their PCOS worsens. 

Some diabetes medications can improve fertility and make menstrual cycles more regular in women with PCOS. Losing weight also improves ovulation and the regularity of menstrual cycles and decreases infertility. 

What is more dangerous, obesity in pregnancy or pregnancy after bariatric surgery?

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. Your BMI can fall into different categories. A BMI between 18-24 is normal, between 25-30 -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.  

How soon is it safe to get pregnant after bariatric surgery?

After bariatric surgery, most women lose weight rapidly during the first 12-18 months. It is best to avoid pregnancy until your weight loss reaches a plateau. Many women find that their overall well-being increases with weight loss and exercise. 

Losing weight makes it easier to exercise, and more exercise makes it easier to lose weight. This positive cycle of weight loss, exercise and improvement in body image may carry over to other areas of your life, and you might find a new partner. Surprise pregnancies are not uncommon. 

If you have struggled with infertility, or haven’t worried about birth control previously, please realize that losing weight may increase your fertility.  It is a good idea to use contraception until you are ready to conceive.

What is the best way to prepare for a healthy pregnancy after bariatric surgery?

Mothers may have vitamin deficiencies, most commonly of iron, vitamin B12, calcium, and folic acid. Deficiencies should be identified with blood tests and corrected before trying to conceive.  

It is important to have adequate folic acid before trying to have a baby because deficiency of folic acid is associated with severe birth defects called neural tube defects.These birth defects develop between 2 and 9 weeks after conception, which means that the problem has already occurred by the time the patient shows up for her first prenatal visit.   

Obese women are more likely to have medical problems such as diabetes and hypertension. Mothers considering pregnancy should also be evaluated for medical illness, in order to treat these problems before getting pregnant. The good news is that losing weight can make some of these problems go away.  

Important things to remember

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. It is best to wait at least a year to year and a half after surgery, when weight loss is happening rapidly. 

Please discuss your pregnancy plans with your doctor so that you can work together for the best outcome. 

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