Pregnancy after weight loss surgery
AS obesity becomes a modern-day health crisis, more and more Jamaicans are going the route of weight loss (bariatric) surgery to aid in permanent weight loss. As a newer weight loss modality, doctors are also getting used to the health and lifestyle changes these surgeries require in their patients. In particular, counselling and treating women who become pregnant after weight loss surgery carries unique challenges that may increase the risk of complications in certain situations. Some common bariatric procedures include gastric banding/balloons, gastric bypass and gastric sleeve surgery.
Obesity is associated with decreased fertility and difficulty getting pregnant, while in those who do become pregnant, there is an increased risk of diabetes, high blood pressure, C-sections, and infection. A common result of bariatric surgery is improved fertility, and so obstetricians will be seeing more pregnant patients after weight loss surgery. In light of this, here are some special concerns for you if you have done or are considering weight loss surgery:
1. Contraceptive/Pre-conception counselling is necessary. The risk of contraceptive failure (especially for hormonal contraceptives) is greater after surgery, so this discussion is important in order to prevent unplanned pregnancies. It is best to switch to a non-hormonal method if possible. After bariatric surgery, a woman should wait 12 to 24 months before conceiving so that the foetus is not affected by rapid maternal weight loss and so that the patient can achieve her weight loss goals.
2. The risk of nutrient deficiencies is high after this surgery, especially protein, iron, folate, calcium, and vitamins B12 and D. It may also be difficult to maintain nutrient levels because of nausea and vomiting, so anti-nausea medication will be very important to prevent this. It is also a good idea to see a nutritionist early in the pregnancy so that an appropriate diet plan can be worked out based on the surgery that was done. Your care provider should also do regular checks of vitamin levels and proteins throughout the pregnancy. Smaller, more frequent meals are a good way to prevent this problem.
3. Drugs taken by mouth should be monitored closely, because of the risk of poor absorption. Extended-release formulations should be avoided where possible. Non-steroidal anti-inflammatory drugs (such as ibuprofen) should also be avoided so as to decrease the risk of gastric ulceration. For medications where the drug level is critical (such as seizure or blood-thinning medications), it is best to test the drug levels to ensure they are accurate.
A great effect of bariatric surgery is decreased risk of pregnancy complications due to the weight loss, such as diabetes and high blood pressure. However, if you are still overweight or obese at the time of pregnancy, then you are still at risk for some of these complications; this is another reason why close monitoring by your doctor is important. Some women cannot tolerate the glucose screening test done at the sixth month, so home glucose monitoring is a good alternative in these patients.
Bariatric surgery should not affect labour and delivery management (although these patients tend to have a higher risk of C-sections), and normal vaginal delivery is still possible. If abdominal surgery was complicated and extensive, then your obstetrician should consult with the bariatric surgeon before a planned C-section.
Finally, some patients may suffer from body image issues as they are forced to gain weight as part of a healthy pregnancy. The changes in their bodies can cause some women to try dieting to prevent weight gain, and this can have serious effects on the growing baby. On the other hand, some women may gain more weight than necessary because of the thought of ‘eating for two’. It is important to accept that weight gain is essential for a healthy baby, while monitoring your diet to keep it balanced and healthy.
It is possible to have a safe and healthy pregnancy after weight loss surgery. Close contact with your obstetrician, bariatric surgeon and nutritionist (and psychologist if necessary) will help you to have the best outcome possible. Of course, a bonus would be the love and support of family members who are on board with the treatment plan.
Dr Anna-Kay Taylor Christmas is a consultant obstetrician and gynaecologist at the Obs and Gynae Centre, Winchester Business Centre. She can be contacted at drtaylorchristmas@ gmail.com or 908-3263, 906-2265, 325-7362.
