Pregnancy after sleeve gastrectomy

A very common question I get asked by those considering weight loss surgery is whether it is dangerous to become pregnant after sleeve gastrectomy. As you’ll discover, generally there is no increased risk of developing problems after a sleeve, and in fact, you may even have better pregnancy outcomes than if you had not had the surgery at all. However, there are some specific things you need to think through, so here goes!

When is it safe to fall pregnant?

Most research and guidelines suggest waiting for 12-18 months after surgery before you fall pregnant. This gives you enough time for maximum weight loss, allows your weight to stabilise, ensures you are used to your new stomach and that you are well nourished before pregnancy. It’s really important to know that fertility rates increase after weight loss surgery and the risk of oral contraceptive failure can increases due to malabsorption of the pill, so it’s important to use non-oral contraception until you are ready for pregnancy.

Will my baby be healthy?

Most pregnancies after bariatric surgery have successful outcomes. Studies suggest some benefits of surgery pre-pregnancy include a reduced risk of gestational diabetes and high blood pressure as well as lower birth weight (which is often high in overweight mothers). But, and this is an important but, you must do your best to stick to the advice of your team, including diet and supplement recommendations and more regular monitoring to check for any issues (see below).

Do I need to take supplements?

Yes, definitely. You should be taking daily supplements after weight loss surgery anyway (see this post if you’re not)

but you should also be especially careful to be getting enough folic acid and iodine. Folic acid helps to prevent neural tube defects and iodine is essential for brain development. Ask your obstetrician and dietitian what you should be taking on a daily basis.

You should also have a blood test done before you start trying for a baby to make sure there are no nutrient deficiencies that need to be corrected (iron or vitamin D for example). A pre-pregnancy blood test also acts as a baseline so your team can compare throughout your pregnancy and correct as you go through.

What else do I need to do during the pregnancy after sleeve gastrectomy?

You should follow all of the regular pregnancy guidelines with regards to dietary restrictions, exercise and check-ups and be guided by your obstetrician, however, also make sure you:

• Have more regular monitoring of both you and your baby throughout the pregnancy (some obstetricians recommend monthly).
• Have more regular blood tests to check for deficiency (and quick supplementation if there are any).
• See your dietitian regularly to check your food intake, especially if you have morning sickness.
• Discuss any vomiting immediately with your team to check the cause and to help prevent vomiting occurring too often. If you’re vomiting often, you’re at great risk of deficiencies. To help with this, make sure you are focusing on your eating habits to minimise vomiting due to overeating or eating too quickly.

What should I eat during the pregnancy?

Whilst supplementation during pregnancy after sleeve gastrectomy is important, it’s also really important to think about what you are eating each day. Ideally during pregnancy you should:

• Focus on protein (making ~75% of your meal protein) and aiming for 65-90g per day.
• Choose low GI carbohydrates for energy (up to 100-150g per day) rather than refined sugars or highly processed foods. Think fruit, vegies and whole grains.
• Add unsaturated fats to your day as these help with development of the baby and are a source of energy for you. Aim for 25-35g of unsaturated fat per day.
• Try to stick with your 1-cup portion sizes rather than overeat as this may make you feel uncomfortable. You may need to have snacks between meals, especially if you have nausea or reflux and are a struggling to get the 1-cup meals in.
• Keep drinking! Ideally aim for the 1.5-2L if you can.

What will happen to my weight during and after pregnancy?

I know this is hard to hear but it is important not to be too concerned about your weight during pregnancy. It’s normal for your weight to increase due to the baby, but depending on your weight when you conceived, you may not gain much at all or may even lose weight during pregnancy after sleeve gastrectomy. The most important thing to focus on is your nutrition, exercise and the health of the baby. The weight bit will sort itself out. Similarly, after your baby is born, give yourself some time to adjust to your new life before worrying too much about your weight. See your dietitian soon after birth, and they’ll be able to help advise you on the best steps to take.

If you’d like more information, check out these references or discuss them with your dietitian and obstetrician:

• Armstrong, C. (2010). ACOG guidelines on pregnancy after bariatric surgery. Am Fam Physician. Apr 1;81(7):905-906.
• Delamont K. (2011). Clinical Considerations and Recommendations for Pregnancy after Bariatric Surgery. Bariatric Times. 2011;8(10):12–14
• Kral, J.G., (n.d.) Pregnancy after Weight-Loss Surgery. Obesity Action Coalition. Retrieved 17^th Nov, 2017 at http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/pregnancy-after-weight-loss-surgery