Pregnancy After Bariatric Surgery: What You Need to Know

You’ve already had bariatric surgery, and now you want to get pregnant. That’s great! Bringing new life into this world is one of the most amazing things you’ll ever do.

But bariatric surgery made substantial changes to your body, and now you’re wondering how your surgery will affect your pregnancy. How will bariatric surgery affect your odds of getting pregnant? Are there any risks or complications to post-bariatric pregnancy? How will you handle the postpartum weight loss?

Let’s walk through these questions together.

How Will Bariatric Surgery Impact Your Odds of Getting Pregnant?

The unfortunate truth is that when you suffer from obesity, it’s a lot harder to get pregnant. Obesity can trigger hormonal imbalances and irregular ovulation cycles, and can even lead to conditions such as polycystic ovary syndrome (PCOS). It also leads to inflammation, rising estrogen levels, and even issues like metabolic syndrome that can make it harder to conceive.

The good news is that losing weight after bariatric surgery alleviates these issues and can make getting pregnant a lot easier. Bariatric surgery can regulate hormonal imbalances and lead to more regular ovulation cycles while resolving PCOS in as little as 1-2 months after surgery. It can also increase levels of sex hormone binding globulin and follicular stimulating hormone. 

However, it is essential that you wait 18-24 months after surgery before becoming pregnant. During the first year and a half after surgery, your body is undergoing tremendous (and positive!) changes, and it is essential that you give those changes time to happen before becoming pregnant. Weight loss after surgery can lead to vitamin deficiencies, and low levels of folic acid can have a negative impact on a developing fetus. Waiting to get pregnant for 18-24 months gives your weight and your vitamin levels time to stabilize. By waiting to become pregnant, you’re dramatically reducing your risk of complications for both yourself and your baby. You’re also setting your baby up for success: the American Society for Metabolic and Bariatric Surgery (ASMBS) notes that when parents wait to get pregnant until the changes from surgery have run their course, their future children are at a lower risk of developing obesity later in life. For this reason, it is very important to have a physician approved contraceptive plan in place before your surgery, even if you weren’t using contraceptives when you suffered from obesity.

What Are the Potential Risks and Complications of Pregnancy After Bariatric Surgery?

A lot of women wonder “Is pregnancy after bariatric surgery high-risk?” The answer is no. In fact, bariatric surgery can also make your pregnancy a lot safer. Maintaining a healthy weight can dramatically reduce your risk of obesity-related complications such as gestational diabetes, preeclampsia (high blood pressure during pregnancy), macrosomia (a too-large baby), congenital birth defects, and miscarriage. Losing weight can also make it easier for your doctor to perform prenatal ultrasounds. Finally, maintaining a healthy weight can lower your risk of postpartum complications such as bleeding or infections. Essentially: bariatric surgery can make getting pregnant substantially easier, and can make your pregnancy a lot safer for both you and your baby as long as the timing is appropriately delayed for at least 18 months after surgery.

There are two potential risks that you should be aware of. First, there’s some evidence that if you had gastric bypass surgery and then breastfeed your infant, then he or she might be at risk of nutritional deficiencies. Second, some women who get pregnant after surgery report small-for-gestational-age babies. This is due to these women’s persistent weight loss. But this problem can be alleviated by making sure to follow your bariatric team’s recommendations: don’t get pregnant until 18-24 months after surgery, and take vitamins and supplements in order to ensure that your body is getting enough nutrients. Ultimately, the risks of post-bariatric pregnancy are small and can be minimized further by following the recommendations of your bariatric team.

How Much Weight Should I Gain During Pregnancy?

During pregnancy, it is crucial that you develop a collaborative plan for your ideal weight progression with your bariatric surgeon and your OBGYN before you get pregnant. When patients are in a normal weight range some weight gain is needed during pregnancy. However, if your starting weight is above a normal weight range less gain or perhaps no gain may be best. It is important to seek multidisciplinary feedback on the ideal amount that you need to plan to gain to support healthy fetal development and your health as well. This represents a radical mindset shift for many women after surgery, who have been working to cut calories and stick to a new dietary regime. However, insufficient weight gain during pregnancy can lead to complications such as small-for-gestational-age babies and preterm birth.

How much weight should you gain? That number depends on factors like your pre-pregnancy weight, and so you’ll need to discuss this question with your bariatric surgeon. However, this chart offers a general starting point:

(source: https://www.brighamandwomens.org/assets/BWH/cwmw/pdfs/pregnancy-after-bypass-sleeve.pdf) 

During your first trimester, you probably won’t need to increase your calorie intake beyond where it was before you got pregnant. In the 2nd and 3rd trimesters, you should add up to 300 calories per day. Again, the goal is to eat a healthy, balanced diet to improve the health of your baby. During pregnancy, that’s more important than maintaining a stable weight. However, as you modify your diet to get more calories you should talk to your bariatric dietitian, who will be able to help you to craft a healthy bariatric pregnancy diet that meets your weight gain goals without encouraging you to fall back into bad habits around food. Additionally, you want to avoid large meals during pregnancy that can stretch your pouch or sleeve and result in permanent weight regain. Instead plan for 5-6 smaller slower meals throughout the day.

Will I Need Additional Supplements During Pregnancy?

It is especially important after surgery to make sure that you get enough vitamins and minerals. Because you’re eating fewer calories than you were before surgery, and because anatomical changes during surgery may make it harder for your body to absorb calories and nutrients, it is very important that you get enough vitamins and nutrients during pregnancy. Morning sickness can also make this more difficult.

During pregnancy, you’ll need to make sure that you get enough protein, folate, iron, vitamin B12, calcium and vitamin D. Some of these will come from supplements, and some will come from food. It is very important that you talk to your dietitian to develop a plan for how you will get enough nutrients during your pregnancy.

Dealing With Postpartum Weight Loss

Losing weight after pregnancy can be hard for a lot of women. Postpartum weight can be very stubborn. It can be even harder to lose weight if you spent most of your life suffering from obesity.

Losing weight after giving birth is a lot like losing weight after bariatric surgery: it’s a marathon, not a sprint. Don’t expect the weight to just melt off in a few days. MedlinePlus says that most women lose about half of their baby weight by 6 weeks after childbirth. The rest comes off more slowly, and you should aim to return to your pre-pregnancy weight within 6 months to a year after giving birth. After 6 weeks, aim to start losing 1-1.5 pounds per week.

If you’re breastfeeding, it’s actually important to not lose weight too quickly. The reason is that rapid weight loss can mean that you produce less milk. In fact, if you are breastfeeding exclusively, then you may need about 500 calories more per day than you did before becoming pregnant. Talk to your bariatric dietitian about how to get these extra calories in a way that still supports your overall health goals.

Importance of Close Medical Monitoring

Before you get pregnant and during your pregnancy, it is very important that you continue to check in with both your bariatric team as well as the specialists who are helping you with your pregnancy. Your bariatric team can continue to monitor your body to make sure that there aren’t any lingering complications from surgery (it’s worth noting that complications are generally very rare) and to handle any that might come up. Your dietitian can work with you to develop a plan for what to eat when you’re pregnant as well as after you give birth, and to make sure that you get all the necessary vitamins and minerals to give birth to a beautiful and healthy baby. 

You’ll also need to get regular ultrasounds. Depending on your medical history, you may also need to be screened for gestational diabetes before the standard timeframe of 24-28 weeks. If you continue to check in with the medical specialists on your team on a regular basis throughout your pregnancy, you have excellent chances of an uncomplicated pregnancy and delivery of a healthy and vibrant baby.

Taking the Next Step

Making the decision to get pregnant is a huge step in your life, and one that many women find to be extremely fulfilling. Pregnancy after weight loss surgery can be very safe and truly wonderful, but it’s important to follow medical guidelines in order to minimize any risk of complications for you and your baby. If you have any other questions or concerns as you contemplate this next step, please don’t hesitate to contact our friendly office staff.