Weight loss surgery and pregnancy, bariatric surgery before and after pregnancy

Added by Klaudia Grabowska on 07.10.2020 | Related treatment: Bariatric Surgery

Weight loss surgery and pregnancy

It is widely claimed that obesity, a civilization disease in the 21st century, has a very negative impact on women’s fertility, pregnancy, and unborn babies. No wonder, the tendency is that the more obese women, the less babies are born. Weight loss surgeries help women overcome obesity, which triggers the wish to have a baby. Bariatric surgery and pregnancy is a frequent concern of all female patients waiting to have or already having a weight loss surgery. Giving birth to a child is one of the most exciting and beautiful experiences, no wonder women would like to know if they can safely get pregnant. In this article, we will explain the most important aspects and relations between pregnancy and weight loss surgery.

Pregnancy before weight loss surgery

Belly

One of the biggest advantages of having bariatric surgery after pregnancy is getting rid of these excessive kilograms which were gained during the pregnancy period

Having a weight loss surgery after pregnancy has one significant advantage – women gain weight during pregnancy, which is totally natural, so bariatric surgery after giving birth to a child helps get rid of these excessive kilograms. The amount of weight women gain during pregnancy differ and depends on a woman’s lifestyle, starting weight, diet, genetics, and sometimes it is just a lottery whether a woman ends up with 5 or 35 excessive kilograms. The tendency that is proved is that women who are overweight or obese before getting pregnant, gain more weight, and find it much harder to lose than women with a normal weight. So, for this reason, it is a good idea to wait with weight loss surgery until a baby is born. 

A bariatric surgery after pregnancy helps women lose weight that they have gained for years as well as kilograms gained during pregnancy. Numerous studies show that mothers after weight loss surgeries offer a better quality of care after their kids, teach them healthy eating habits which prevent child obesity and influence their family life in a positive way.

How long I should wait to get weight loss surgery after being pregnant

Generally, women just after the delivery should focus on motherhood, care after their little babies, and recover from the birth. The postpartum period is the time when no surgeries should be done to women unless they are life-saving ones. So, once a postpartum period is over, it is the time when women may consider weight loss surgery. As for having a child via cesarean section, women should wait about 3 months before having the surgery. However, these 2-3 months of the afterbirth-recovery is the minimum period and the longer women wait, the better for scars healing and success of the surgery.

Finally, the decision about weight loss surgery after pregnancy should be always consulted with a bariatric surgeon and gynecologist. 

Pregnancy of Obese women

Pregnancy for obese women entails many more risks than for healthy women. Having a BMI over 30 indicates an obese pregnancy. Such high BMI may influence women’s fertility by blocking ovulation, making it much more difficult to get pregnant, or even inhibiting in vitro fertilization. 

The complications for pregnant women  that stem from obesity include:

  • gestational disease
  • cardiac dysfunction
  • increased risk of miscarriage, recurrent miscarriage, and stillbirth
  • such pregnancy complications as hypertension or preeclampsia
  • sleep apnea
  • inability to give a natural childbirth
  • increased risk of cesarean section complications.

Obesity among pregnant women may negatively influence not only women but also their children – and it is of uttermost importance that all women realize these risks.

The morbidly obese pregnancy may impact babies in the following ways:

  • congenital disorder
  • fetal macrosomia
  • childhood asthma
  • baby obesity
  • impaired growth.

The healthy weight gain during pregnancy for obese women (with a BMI higher than 30) is 5-9 kilograms with a single pregnancy and 11-19 kilograms with multiple pregnancies. Women with a BMI over 40 should gain even less weight than mentioned. All women, especially those with high BMI, should pay special attention to staying healthy for themselves and their children – following a healthy balanced diet and maintaining a regular physical activity certainly reduces all the complications risk and improves the mother’s and her unborn child’s physical and mental condition.

Risks of being pregnant with obese

It is rather widely known that pregnancy risks for obese women are higher than for women with a healthy weight.

The obese pregnancy risks for women include:

  • gestational diabetes (for women with BMI over 30 the risk of gestational diabetes is 3 times higher than for women with BMI below 25)
  • miscarriage (there is 25% chance for a miscarriage fo women with BMI over 30)
  • preeclampsia and high blood pressure
  • postpartum hemorrhage (exceeding bleeding after the birth)
  • blood clots
  • higher chance for a caesarian section or instrumental delivery.

The risks for a baby include:

  • shoulder dystocia (the child’s shoulder becomes stuck while labouring)
  • baby is likely to weigh over 4kilograms (almost 14% are born with a weight exceeding 4 kg for women with BMI over 30)
  • babies are at risk of stillbirth (1 in 100 babies for women with BMI over 30)
  • there is a risk of earlier birth (before 36 week)
  • the risk of neural tube effect for babies.
Overweight girl reading book

Women should wait around 12-18 months after bariatric surgery to get pregnant and this decision should be discussed with the doctor

Getting pregnant after weight loss surgery

Getting pregnant after weight loss surgery is one of the main determinants for women considering bariatric surgery. Firstly, we need to stress that getting pregnant after bariatric surgery is possible and is safe both for women and babies. A weight loss surgery in fact helps women get pregnant (obesity prevents fertility), lowers chances for problems during and after pregnancy, reduces weight gained during pregnancy, and facilitates weight loss after pregnancy. What may trouble women having surgery for weight loss before pregnancy is the increased chance for C-section.

There are some important aspects that pregnant women after the surgery need to pay attention to:

  • being in contact with the bariatric surgeon who performed the surgery throughout the pregnancy (just to control if there are not any long-term complications after the surgery)
  • using the help of a dietician to make sure mother and baby stay well-nourished
  • taking necessary supplements, especially calcium, folic acids, iron, Vitamin B12.

Last but not least, women should just eat balanced meals and stay active during pregnancy – such a healthy lifestyle combined with a lower BMI after bariatric surgery will influence a mom and baby only in a positive way. 

Is pregnancy safe after weight loss surgery?

Getting pregnant after bariatric surgery is safe both for a woman and her baby. There have been numerous studies analyzing the relation of bariatric surgery and pregnancy, however, there are no restrictions on having a baby after gastric sleeve, bypass, or balloon. The truth is, bariatric surgery makes pregnancy much safer for women who have been obese. Women having a weight loss surgery return to their normal lives afterward where pregnancy post-bariatric surgery is totally normal – the only issue is following the surgeon, gynecologist, and dietician instructions on how to stay healthy during and after pregnancy. 

How soon can I get pregnant after weight loss surgery?

pregnant belly

Getting pregnant after weight loss surgery might be easier due to fertility increased (thanks to the normalized weight and estrogen level) so the patient should be careful during the first 12 months after the surgery

It is proved that women are more likely to get pregnant after weight loss surgery because of their fertility increases (thanks to the normalized weight and estrogen level). Also, the psychological and social attitude of women changes for the better, which influences the family life and relationships. However, women should be aware of the fact that getting pregnant too soon after weight loss surgery may pose some risk and at the same time the birth control pills may not work for some time after the surgery because of the other medications that are taken during or after the surgery. So, we advise women to also follow some other methods preventing pregnancy just after weight loss surgery.

Well, the safe time between bariatric surgery and pregnancy is 12-18 months. Patients experience a rapid weight loss during that time and should be focused on losing excessive weight and restoring their health. The diet during the 1st year after surgery is rather strict and additional supplementation might be necessary, so it would be difficult to nourish the baby. After 1 -1,5 years, when the final results are reached and weight is stabilized, all the risks related to pregnancy get much lower than for obese women and patients may go ahead with trying to get pregnant.

Diet and nutrition after weight loss surgery and pregnancy

A weight loss surgery diet is very strict for the first months, so it requires some additional supplementation. Here, gastric sleeve seems to win over gastric bypass because it does not influence vitamins and minerals absorption (while bypass does). Yet, the nutritional deficiencies may pose a problem during pregnancy, especially at the beginning when women suffer from nausea and morning sickness. The best idea would be asking a dietician to compose both a weight loss surgery post-op diet and pregnancy diet – then, there is the biggest chance for a woman and baby to stay nourished. The important vitamins that might need to be supplied are Folic acid, Iron, Calcium, Vitamin D and Vitamin B12. Also, any prenatal multivitamins should be taken.

The useful guidelines for women include:

  • control any vitamin deficiencies before conception and during pregnancy
  • take prenatal supplements
  • pay special attention to nutrition during the 1st trimester 
  • check the level of homocysteine limit the intake of Vitamin A (maximum 10,000 IU a day)
  • eat 5 balanced meals a day and practise sport.

Weight gain during pregnancy after weight loss surgery

Scale and meter

Huge weight gain during the pregnancy may be avoided but patients should be exceptionally conscientious of calorie intake and quality of food. The best option is to have a diet plan prepared by the dietician that would guarantee enough macro elements, vitamins, and minerals

Weight gain during pregnancy is totally normal regardless of the fact whether a woman had weight loss surgery or not. Women who have had a weight loss surgery who have reached the desired weight should not panic once they get pregnant. Pregnancy does not mean that women become fat again, it is only their body that changes due to a growing baby inside. So, the additional kilograms do not indicate the obesity reversion or yo-yo effect but are an implication of a baby’s growth and natural body reactions. Of course, we assume that pregnant women eat healthy balanced meals that nourish themselves and their babies and stay active. Once women start to treat pregnancy as an excuse for overeating, eating sweets or fatty food, they are very likely to throw all the surgery results away and do harm to a baby also. 

The specialists admit that the main advice of how to avoid weight gain during pregnancy is being exceptionally conscientious of a calorie intake and quality of food. Women are advised to ask a dietician for a diet plan that would guarantee enough macroelements, vitamins, and minerals. Women should be prepared for body changes as it is totally natural that they become bigger, however, it is also natural that women lose this weight after giving birth (assuming they follow a healthy diet all the time). Lastly, if women wonder what is normal weight gain during pregnancy or if it differs when a woman has bariatric surgery, please note that women may gain even 15 kilograms(that is not fat) and it is still normal, so what we suggest is a healthy diet and physical activity, and then any amount of gained weight will get naturally lost.

Glucose tolerance test (OGTT) after weight-loss surgery

Glucose tolerance test (OGTT) determines whether women suffer from gestational diabetes once they are pregnant. Such a test for glucose needs to be done especially by women with BMI 30 or higher. The test involves drinking liquid sugar and having blood tests after that to check how the body deals with the sugar. Patients having gastric bypass should not have such a test because they are at the highest risk of dumping syndrome, so the doctor needs to use other methods of monitoring and testing patients. 

What kind of delivery is the safest after weight loss surgery?

small baby's feet

The way of delivery depends on a woman’s health condition so there is no rule for the safest delivery after weight loss surgery

Women are more likely to have a c-section after weight loss surgery. However, the idea of the safest delivery is so individual that we cannot admit that c section after bariatric surgery is the best way for giving birth. The way of delivery depends on a woman’s health condition, test results, psychological attitude, baby position, and weight, and some women after bariatric surgery are advised to give birth naturally while others are recommended a c-section. There is no rule for this, so we advise that each woman asks her doctor and gynecologist what would be the safest way of delivery for her. 

Benefits of pregnancy after weight loss surgery

Pregnancy after weight loss surgery has a very positive influence on a woman and a baby and getting pregnant after weight loss surgery has more advantages than pregnancy for obese women.

The benefits are:

  • lower risk of high blood pressure
  • lower risk of gestational diabetes
  • weight loss surgery often cures infertility
  • the risk of maternal complications is significantly reduced
  • a risk of baby’s obesity is decreased
  • lower risk of cardiovascular problems for babies
  • better neonatal outcomes, including premature deliveries
  • women do not gain much weight after weight loss surgery.

Possible problems with pregnancy after weight loss surgery

There are a few risks with pregnancy that concern mostly women after weight loss surgery, they include:

  • nutrients deficiency of a mother and baby (women should pay attention to food quality and supplements to stay nourished and prevent any health conditions of their babies or themselves stemming from such a deficiency)
  • higher risk of bowel obstructions and internal hernias (any symptoms like swelling or pain in the abdomen or vomiting should be discussed with the doctor)
  • risk of prematurity, increased NICU (neonatal intensive care unit)  admission and SGA (small gestational age) – it is important to say that the studies prove that these risks are reduced when women get pregnant not earlier than 2 years after weight loss surgery.

Contraception and weight loss surgery

birth control pills on pink background, close up

Birth control pills are generally not recommended after weight loss surgery due to the digestive system change, this matter should be discussed with the doctor individually

Women after weight loss surgery should wait at least 12 months before getting pregnant. The first year after the surgery is the time when the body experiences a rapid and dynamic change, so pregnancy at this time entails some risk both for women and babies. There are a few contraception methods available for women after bariatric surgery. Women should discuss with their doctors all the recommended types of contraception and follow a doctor’s advice about the best type. Generally, birth control pills are not recommended because the digestive system may not absorb them properly. The better methods are non-oral ones, such as an implant, Mirena (intrauterine device with progesterone), vaginal ring, or barrier methods. Every woman will be advised individually about the most effective contraception method, so we strongly advise patients to discuss this issue with the doctor.

Weight loss surgery and pregnancy summary

It is totally understandable that women have concerns about getting pregnant when they are obese when they prepare for weight loss surgery, or after the surgery. However, those who are well-informed realize that pregnancy and weight loss surgery do not exclude each other. On the contrary, pregnancy after bariatric surgery is much safer both for a woman and her baby. It is enough to follow the medical guidelines such as waiting with pregnancy at least 12 months after weight loss surgery, following a healthy diet, supplementation, and exercising as well as using effective contraception methods just after weight loss surgery. And finally, to resolve all the doubts, weight loss surgery does not prevent giving birth, but even encourages women and their partners to have a baby.

Sources:

Graham, Yitka, et al. “Contraceptive Needs of Women Following Bariatric Surgery.” BMJ Sexual & Reproductive Health, British Medical Journal Publishing Group, 1 Oct. 2014, srh.bmj.com/content/40/4/241.

NHS Choices, NHS, www.nhs.uk/conditions/pregnancy-and-baby/overweight-pregnant/.

NHS Choices, NHS, www.nhs.uk/conditions/weight-loss-surgery/afterwards/.

“Pregnancy after Weight Loss Surgery.” BOPDHB, www.bopdhb.govt.nz/health-advice/patient-information-handbooks/laparoscopic-gastric-sleeve-procedure/pregnancy-after-weight-loss-surgery/.

published 2017-03-23T15:30:00Z. “Bariatric Surgery, Birth Control, and Pregnancy.” Bedsider, www.bedsider.org/features/1018-bariatric-surgery-birth-control-and-pregnancy.

Slater, Christopher, et al. “Nutrition in Pregnancy Following Bariatric Surgery.” Nutrients, MDPI, 8 Dec. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5748788/.

Klaudia Grabowska

Klaudia started to work for Clinic Hunter many years ago, just after graduating from the John Paul II Catholic University of Lublin in Poland and since that time, this job has become her biggest passion and inspiration.

She has gained necessary expertise and experience by serving patients from all over the world (mainly the UK, Scandinavian countries, and the USA), taking an active part in numerous live and video trainings with clinics in Poland, Hungary and Turkey, participating in international medical tourism conferences and events, and completing internal Clinic Hunter courses. Now, Klaudia is an accomplished patient advisor specialising in such fields as dentistry, plastic and bariatric surgery and hair loss treatment. Her main idea is helping people nad making their lives better, that is why this job brings her so much satisfaction and joy.

In private, Klaudia is a bike-tour lover. She travelled to over 25 countries and many of them she visited by bike. However, now she spends every spare moment with her little son.

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