When can I become Pregnant after Having Bariatric Surgery?
Many of our potential weight loss patients express an interest in either starting or expanding their family after surgery. There are various recommendations regarding the timing of planned pregnancy after weight loss surgery which are based on a theoretical understanding of what occurs after the operation.
A truly controlled scientific study evaluating the risk and benefit of pregnancy after surgical weight loss is difficult to design. We employ a common sense approach based on surgical literature as well as an understanding of the changes that occur after surgical operations for weight loss.
Many surgeons suggest that patients wait between one and two years after gastric bypass surgery to become pregnant. Opinions are less clear about the timing of planned pregnancy with regards to both the sleeve as well as the gastric band. In our practice, we prefer that patients wait a full two years before getting pregnant regardless of whether you chose to undergo the laparoscopic gastric bypass, the sleeve or the band. The body undergoes many physiologic changes with regards to hormone levels, sugar levels, and medication requirements. There are also a number of psychological changes that occur with settling in to a new body image as well as other potential problems and sources of stress.
Our team will discuss this concern with each potential patient of child bearing age as you begin the process and get closer to a surgery date. We encourage patients to ask questions about pregnancy so that you can make a well-informed decision very early when thinking about your candidacy for weight loss surgery.
Pregnancy Should be Avoided For Two Years After Bariatric Surgery
Weight loss following bariatric surgery frequently has a positive impact upon female fertility and sexual function in women of reproductive age. However, it is essential to the health of mother and child that women who have undergone bariatric procedures do not become pregnant for at least two years following surgery. Whilst obese women are at increased risk of pregnancy complications including gestational diabetes, preeclampsia, pregnancy-induced hypertension, maternal weight gain and cesarean delivery, pregnancy outcomes following bariatric procedures are generally much improved, but only in those who allow sufficient time for postoperative recovery and adequate weight loss to occur before becoming pregnant.
Although some women have sustained healthy pregnancies during the two year postoperative period, studies indicate that pregnancies occurring within that time are more likely to end in miscarriage and may also be associated with increased risk of a range of problems including pre-term delivery, birth defects and surgical complications.
Why are there increased risks associated with Early Postoperative Pregnancy?
Bariatric procedures facilitate weight loss by restricting food intake and/or decreasing the body’s ability to absorb nutrients and calories. Procedures such as the lap-band and laparoscopic sleeve gastrectomy decrease stomach volume and are therefore classified as restrictive, whilst procedures that result in functional reduction of the small intestine are classified as malabsorbtive. Several procedures, including the Roux-en-Y gastric bypass, include both restrictive and malabsorbtive components. After surgery, significant lifestyle changes are required in order to support surgical recovery, aid weight loss and maintain adequate nutritional status, with ongoing supplementation with multivitamins and iron a necessity.
Nausea and Vomiting are normal during Pregnancy but might suggest a problem after weight loss surgery
Although relatively rare, complications of bariatric surgery are possible, and there is a danger that early symptoms such as nonspecific abdominal pain, nausea and vomiting may go unrecognized if they occur during pregnancy, when those symptoms are relatively common. Surgical complications represent a serious risk to mother and baby in such cases and there have been several reports in the literature of maternal and neonatal deaths occurring as a result of bariatric complications during pregnancy.
CT Scans which may sometimes help determine the source of abdominal discomfort after bariatric surgery should be avoided during pregnancy
Abdominal medical imaging and radiological studies that help with a diagnosis of intestinal obstruction may present an additional risk to the developing fetus. Since the majority of surgical complications occur within two years postoperatively and, without the confounding factor of pregnancy, are almost always treatable, the importance of delaying pregnancy is clear.
Nutritional status is difficult to assess until your weight loss stabilizes
Fetal health is highly dependent upon maternal nutritional status. Whilst most women who have undergone bariatric procedures are able to meet the nutritional needs of their growing baby throughout their pregnancy, the rapid weight loss that follows bariatric surgery, and the potential for nutritional deficits to occur whilst adjusting to new dietary requirements and eating patterns represent a significant source of risk to maternal and fetal wellbeing. An increased incidence of neural tube defects including spina bifida and anencephaly has been observed in infants born to mothers who previously underwent a malabsorbtive bariatric procedure, and who did not adhere to their prescribed nutritional regime.
All women are advised to take prenatal vitamins and to follow the nutritional guidelines of their obstetrician in order to minimize the risk of their baby developing neural tube defects. These defects develop within the early stages of pregnancy and can occur before a woman realizes she is pregnant so supplementation should ideally begin at least three months prior to conception. For women who have undergone malabsorbtive procedures, the dosage may need to be increased in order to counter poor absorbtion.
Bariatric surgery provides a finite window of time to reach your new set-point. You need to be the most important person during this time.
The decision to alter your intestines in a permanent manner in order to achieve lasting weight loss is a very personal decision. Personal in this case implies that it is YOUR decision. This is YOUR time in order to take control of your health, eating habits and positive life style in order to lose weight and in many cases get rid of obesity related comorbidities including hypertension, diabetes, and asthma.
You need to make sure that you have time on your schedule to exercise, to read food labels, to prepare food in a healthy manner and basically to think about yourself. Weight loss occurs very rapidly after bariatric surgery and then slows down. You need to use this period of rapid weight loss as a catalyst, a spring-board, a method of positive reinforcement, so that you can make the other positive changes needed for a successful result.
In short, you need to a window of time in your life where you are the most important person. Worrying about a developing fetus and the future of life of your potential child complicates this period of time considerably. Please discuss all off your concerns with your surgeon and obstetrician.