Having a Baby after Bariatric Surgery: What You Need to Know
Bariatric surgery has helped millions of Americans improve their health and lifestyle
A benefit that not many people know about is an improvement in fertility. If you’re thinking about having a baby post-surgery, this is wonderful news, but certain precautions need to be addressed. Read on to learn more..
Deciding to try for a baby is a big (and often scary!) decision. There is a lot to think about, even more so if you’re one of the many women who have had bariatric surgery.
Having counseled women through surgery, and also pregnancy, I’ve compiled some of my top tips to support your motherhood journey.
How long should I wait before trying for a baby?
Your body needs time to adjust to a new physiology and heal from the operation.
You will also need time to reach your desired goal weight and get used to a new way of eating. Depending on the procedure, you can be at risk for nutritional deficiency so it is important to be fully replenished before trying for a baby. While maternal age is a consideration, 12 months, and preferably 24 months, is the recommended amount of time to wait before trying to conceive. That said, it’s obviously a very personal decision and you need to do what is right for you and your body.
What should I eat before pregnancy?
Improving your diet and getting to your ideal weight before getting pregnant is a crucial step to lay the foundation for a healthy, trouble free pregnancy. Let your OBGYN know that you are thinking about starting a family. They may want you to get some lab testing done to make sure you are not deficient in any nutrients and your blood sugar control is normal.
One of the most important nutrients before and during pregnancy is folic acid – this vitamin lowers the risk of birth defects, including neural tube defect. Depending on your procedure, surgery can place you at an increased risk of folic acid deficiency. To top up your reserves, it’s a good idea to take a folic acid supplement (400mcg per day) for few months before conception. Choose one that has the activated version of folate (L-methylfolate), such as Pure Encapsulations Folate 400
In addition, I always recommend increasing your intake with rich food sources. Fortified cereals (see below for examples) enriched orange juice, legumes, eggs and leafy green veggies such as spinach and broccoli are all good options.
What should I eat during pregnancy?
Normal nutritional guidelines for pregnancy apply. However, there are a few additional considerations to bear in mind. Common nutrient deficiencies following bariatric surgery can be exacerbated by pregnancy symptoms such as morning sickness or hyperemesis, gastro-esophageal reflux, abdominal bloating and pressure symptoms.
To reduce these symptoms it is important to follow behavioral changes such as:
- Eating small meals often
- Chewing food thoroughly
- Separating liquids and solids
- Stopping eating when full
Other changes that apply to all pregnant women include:
- Avoiding foods that induce nausea such as those with strong smells
- Experimenting with different foods over time as taste preferences can change
- Taking short walks after eating
- Trying ginger to reduce nausea
Ensuring your diet is well-rounded is important to get all the nutrients you need. Important foods include:
Protein: Protein intake is particularly important during pregnancy to support healthy fetal growth. Some signs of protein deficiency such as edema can be misinterpreted as a normal symptom of pregnancy. Aim to consume at least 60g of protein per day through a combination of protein powder and lean, high quality protein sources, such as red meat, poultry, fish, eggs and legumes. Iron from meat-based protein is better absorbed compared to plant-based sources.
Fruits & Vegetables: Eat a variety of colorful vegetables, especially non starchy, green leafy varieties. Aim for 2-3 servings per day of fresh or frozen. Canned is ok too, just make sure there is no added salt or sugar
Dairy: Unsweetened Greek yogurt, milk (try lactose free if dairy is not well tolerated such as Lactaid or unsweetened soy, almond or oat milk) contain protein and calcium. For cheese, choose hard, pasteurized varieties such as cheddar or swiss. Aim for 1-2 servings per day. Avoid unpasteurized cheese and milk
Wholegrains: Brown bread, fortified cereals (oatbran, rolled oats, all-bran wheat flakes), pastas and brown rice. To lower your carb intake, try some alternative, high fiber pastas such as Banza or black bean spaghetti. While these still contain carbs, the added fiber reduces the net carbs
Healthy Fats: Avocados, olive oil, nuts and seeds all contain healthy fats that are beneficial during pregnancy
Fluids: Aim to drink approximately 64 ounces of non-carbonated water per day. Try to limit sugary beverages such as soda and juices as much as possible. Decaffeinated tea and coffee is fine.
What About Prenatals?
The most common nutrient deficiency after surgery are vitamin B12, folate, and iron. The risk of deficiency is higher in malabsorptive procedures such as Roux-en-y gastric bypass and biliopancreatic diversion. As such, closer surveillance by healthcare professionals is required after those procedures during pregnancy.
Even if you follow a healthy, well-rounded diet it is still important to take a prenatal. Chances are you’re already taking a bariatric daily multi vitamin, however, it is important to know that not all multivitamins recommended after surgery are suitable during pregnancy. For instance, the high retinol form of vitamin A in bariatric multivitamins can harm fetal development. Look for a supplement that meets your needs - Procare Vitamins is a multi-vitamin specifically designed for pregnant women after surgery.
Is it OK to gain weight?
Yes, is the simple answer. You may understandably be concerned about weight gain during pregnancy.
Rest assured, weight gain is a natural and important part of pregnancy. You need to feed yourself and your baby during this critical time. That said, it is important to try and be as close to a healthy weight before becoming pregnant as possible. During pregnancy, staying within a recommended weight range can help to keep you and your baby healthy and reduce the risk of gestational diabetes.
Recommendations:
If your pre pregnancy BMI is 25-29, try to keep weight gain below 25 lbs. (50 llbs for multiples).
For a pre-pregnancy BMI greater than 30, the recommendations is a gain of 11- 20 lbs. or 42 lbs. for multiples.
How many extra calories do I need?
There’s no simple answer to this. Calorie requirements vary, however, in general, during the first trimester, no extra calories are required. In the second trimester, add an additional 340 kcals per day and an extra 450 kcals in the third trimester.
Is it safe to do the glucose tolerance test?
This test is usually taken between 24 - 28 weeks gestation to check for gestational diabetes (GDM). The standard test is often poorly tolerated by women that have had gastric bypass, sleeve gastrectomy or biliopancreatic diversion procedures. Consuming a large quantity of sugar too quickly can trigger dumping syndrome with symptoms including nausea, vomiting and abdominal cramping.
Talk to your OBGYN to see if there are any alternatives. One safer option that is better tolerated, is to have continuous glucose monitoring over 1-2 weeks around 24-28 weeks gestation. Adding guar gum or pectin to food can also help to slow down gastric emptying, reducing the risk of symptoms associated with dumping syndrome in the short term.
To Sum Up
Having a baby after bariatric surgery places you at an increased risk for certain complications during pregnancy, however, it is absolutely possible to have a completely normal, healthy pregnancy.
To reduce the risks, talk to your obstetrician before trying to get pregnant. Requesting some nutritional lab testing will ensure that you are not deficient in any key nutrients. Getting to a healthy weight and improving the quality of your diet before and during pregnancy are also vital steps to ensure your baby gets the very best start. Good luck!
Have you had a baby after bariatric surgery? I would love to hear about your experience - please share below!