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Gastric Bypass and Pregnancy

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Published: 21Nov2009
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Obesity in an expectant mother negatively affects her pregnancy, even affecting conception, since infertility is a frequent problem associated with excess weight. In addition, pregnancy in an obese woman tends to increase the risk for problems such as gestational diabetes, high blood pressure and mobility limitations. Gastric bypass surgery before planning a pregnancy is thus a good option for those morbidly obese, resulting in excellent long-term results.

The impact of gastric bypass surgery on pregnancy is an important consideration as women in the reproductive age group (between the ages of 18 and 45 years) accounted for 50,000 bariatric surgery cases annually, or half of the total number of cases, between 2003 and 2005.

The drastic reduction in the size of the stomach and rerouting of food around to the first part of the small intestine reduces the amount of calories and nutrients that the body absorbs. This may lead to a loss of as many as 100 to 150 pounds within a year or two by two mechanisms: decreasing food intake and its absorption.

This is often associated with regularization of menstrual cycles, normalization of hormone levels and resolution of polycystic ovarian syndrome. This may result in an increased or normal fertility, making the use of birth control mandatory.

Since gastric bypass is major surgery, the body needs time to heal before the additional stress of pregnancy. The procedure often results in gastric and/or intestinal alterations and puts the patient into a controlled starvation mode to facilitate rapid weight loss, compromising the nutritional status of the woman. Eighteen months has been determined to be the ideal minimum period of time between weight loss surgery and conception to avoid risks like maternal malnutrition, preterm delivery, and miscarriage. Healthy babies have been born to mothers who became pregnant within the first year following their surgery, but waiting can help to ensure a successful pregnancy.

Because of the altered metabolic and nutritional status, women who decide to get pregnant after gastric bypass surgery are susceptible to deficiencies in B12, iron, folate, calcium, vitamin D and even protein-calorie malnutrition and fat malabsorption.

It may be extra difficult to get the required nutrients because of nausea — a common post-surgery complication that morning sickness can exacerbate. An anti emetic which is safe during pregnancy maybe prescribed to overcome this problem. It is therefore essential that a nutritionist (also called a dietitian) supervise the calorie and nutrition intake of the mother to be.

Dietary modifications may include eating smaller, frequent meals with more protein and adjustments in the routine glucose screening to avoid dumping syndrome, a common long-term effect following gastric bypass surgery. Specialized vitamin supplements specifically designed to suit the needs of pregnancy following gastric bypass maybe required, along with special formulations of iron and other micronutrients.

This problem is often compounded by the problems of poor body image, and the fear of regaining the weight lost after the radical procedure. So expectant mothers are at risk of going to extremes — either dieting while pregnant, which can have serious nutritional consequences for the baby, or gaining too much weight. Additional emotional support and proper nutritional counseling is therefore imperative during this period.

Researchers have noted that there was no significant difference in rates of pregnancy complications between the surgery group and the control group of obese women. Rates of many adverse maternal and neonatal outcomes may in fact be lower in women who become pregnant after having had bariatric surgery compared with rates in pregnant women who are obese. These include a reduction in the rate of macrosomia, preterm delivery and low birth weight. In fact, no cases of gestational diabetes or preeclampsia were reported within the surgery group as against rates of 22.1% and 3.1%, respectively, in the control group of obese women.

A higher incidence of miscarriage, however, has been reported in this subgroup of patients.

The effects of bariatric surgery on the rate of cesarean delivery have been variable. Overall, bariatric surgery does not appear to significantly affect the rate of cesarean delivery. In fact, given that most obstetricians have only a limited exposure to patients who have undergone gastric bypass surgery, a comprehensive discussion of the risk benefit ratio of a cesarean delivery may allay the fears in the mind of the expectant mother. A strict adherence to weight-gain recommendations, exercising during pregnancy and childbirth preparation classes may reduce the risk of a c-section.

Optimizing success for contraception and producing healthy neonates while not compromising on maternal health following surgery requires a multidisciplinary, synergistic effort by surgeons, primary care physicians, reproductive fertility specialists, nutritionists, obstetricians, and patients. Further research is needed to better delineate the impact of gastric bypass surgery on fertility, pregnancy, and neonatal outcomes.

Alma Orozco is a certified patient coordinator of the Ready4Achange team for weight loss surgery in Monterrey, Mexico. Monterrey is rated as the safest city in Latin America and the medical facilities out there are certified by US hospitals. The low cost of living makes surgery very affordable in Mexico. You can check out gastric bypass surgery done by Dr Zapata at CIMA Monterrey by clicking on the link.

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