longing4thin

Pregnancy Nutrition Guidelines from ASMBS 2010

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Hi Ladies,

As some of you know I got pregnant 3 months after surgery, but lost that baby at 14 weeks. Well I am happily pregnant again. My nutritionist went to the ASMBS in June in Las Vegas and specifically attended this seminar with me in mind (she knew I wanted to get PG again as soon as possible. Please no judging on my timing- I know what is best for me and our family. :)

Here are some Cliff Notes of what she learned. I'm only going to include info on RNY & AGB (adjustable gastric band). If you have had a different surgery let me know and I can look in the notes and see if it says anything different. Please know that I am going strictly off the power point presentation. I did not attend in person.

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Prenatal Planning

* general caution against early pregnancy

* If a woman wants a baby, early planning including nutritional screening is ideal- in a perfect world identify and correct nutritional problems before conception

Generally studies show that as compared to the risks of complications of pregnancy in non-operative obesity, the outcomes of pregnancy after surgery are very good.

That said when nutritional complications occur they can be severe and tragic:

* one baby with permanent birth defects

* another baby died:(

Pregnancy- Labs

in addition to the standard prenatal labs, bariatric surgery patients should have addition screenings for:

-B12 and folate

-Thiamine

-Vitamin D

-Pre-Albumin (to determine protein status)

Folate

Deficiency rates in bariatric patients:

RNY= 14-47%

AGB= 10%

How much?

- US guidelines say 600 mcg

- Canadian guidelines for those at high risk (post bariatric surgery included) suggest keeping folate levels above 5 mg/day starting 3 months prior to conception.

B-12

Deficiency rates in bariatric patients:

RNY= 35%

AGB= 17%

Together with Folate, B12 deficiencies enhance risk for nural tube defects and poor placental development

Once baby is born may have failure to thrive, vomiting, megoblastic anemia. In one case when mom was 6 years post-RNY baby has permanent developmental delay.

Iron

Deficiency rates in bariatric patients:

RNY= 38.8% average

Up to 51-52% in menstruating or super obese women

AGB= 14% (similar to pre-op)

Potential Problems:

mom- fatigue, impaired imune function, increased risk of infection, inability to withstand blood loss at birth, overall increased risk of maternal death

baby- low birth weight, preterm delivery, low APGAR scores, growth stunted, generally slower development, possible impaired immunity, overall higher risk of mortailty.

Vitamin D

Deficiency high for both obesity and post-op

fetal/infant risk from matenal Vit D deficiency is a "hot" area of research right now.

Fetal Risks include:

- poor skelatal development (may be corrected with post-partum supplementation)

- low birth weight

- acute hypocalcemia (risk of neurological & cardiac problems)

later in life development of numerous diseases including cancers, autoimmune diseases and disbetes

Maternal Risks include:

- increased risk of pre-eclampsia

- increased risk of gestational diabetes

- increased bone loss (as stores are given preferentially to developing fetus)

There is an anticipation of a revised USRDA

Best to correct deficiency before pregnancy

Calcium

Average woman's intake is only 50% of the US RDA

RNY can cause malabsorbtion of calcium

INtake should be 600 mg 3 times/day

Maternal Risks include:

pre-eclampsia, premature delivery, calcium poor breast milk

Fetal Risks include:

failure of para-thyroid glands to develop, dysfunction of heart rate/rhythm, infantile seizures, small birthweight and low bone density.

Protein

Requirement in pregnancy is 1/g per kg/day

Minimum requirement is 71 g/day with an additional 15-25 g for additional babies

Mom's weight- Protein required/day

100-124 lbs- 60-70 g

125-149 lbs- 71 g

150-199 lbs- 84-94 g

200-249 lbs- 105-115 g

250-299 lbs- 128-138 g

300-349 lbs- 124-134 g

350-399 lbs- 142-152 g

36 months after surgery data shows that RNY patients will be getting around 1400 cal with 18% from protein- 63g

Studies show that protein intake generally decreases over time

37-65% of bariatric patients report food intolerance and meat intolerance is the most common.

Another study showed that meat intolerance was reported in 50% of AGB patients and 17% of RNY patients.

Weight Gain

Normal weight- 25-35 lbs

BMI 25-30- 15-25 lbs

BMI 30-35- 15 lbs

Best not to do Glucose Tolerance Test in RNY patients

Edited by longing4thin
adding info

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Good info, hon.. thanks. I'm going to make this a sticky thread in the pregnancy section.. and also I'll add tags to this so that others can find this info easily in the future!

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So, how much b-12 and folic acid do we take a day?

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Folate/folic acid US RDA is 600 mcg- but most prenatals have at least that much- the presentation doesn't say how much b-12... sorry!

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Hi there. Lots of great info! I'm already 6 months into my pregnancy. Can you expand on why best not to do Glucose testing on RNY patients?

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The glucose challenge test is when they have you drink a bunch of syrup to see how your body processes it. For those of us with RNY it is a gaurantee os dumping! There are other tests they can do instead, I think my doc is just doing multiple A1C tests. (I have no idea what that means, it's just a different blood sugar test.

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The glucose challenge test is when they have you drink a bunch of syrup to see how your body processes it. For those of us with RNY it is a gaurantee of dumping! There are other tests they can do instead, I think my doc is just doing multiple A1C tests. (I have no idea what that means, it's just a different blood sugar test.

And A1c test is a test that will show how your Blood glucose levels have been over the course of the last three months or so... it was explained to me by my doctor that it isn't exactly an average and if your numbers were lower before and higher now, it'll show more of the higher stuff (as the numbers seem to be stronger closer to when you have the test than when you didn't).. (Was easier for her to explain it to me than how I am.. but... that's the jist of things)

The problem is.. it's not really a good way to tell if you're having diabetic episodes, really.. which is why its rarely used by itself as a diagnositic tool.. it's more of a yardstick than anything else. My A1c showed I was perfectly "normal" but after using a blood glucose meter for two weeks (5 times a day for two weeks).... they were able to see I was having high highs and low lows and that sort of averaged out to 'normal'..

Check with Allusien and Sherry7, I think they used some other form of testing when they had theirs done.

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I'll tell you exactly why you shouldn't do the glucose test....My body was going into shock. I was being tested for hypogycemia. 20 minutes into the test, I started feeling faint, so luckily because I was testing at the hospital, they laid me down on a gurny in the ER. I still went on with the test. About 3 hours into the test, my blood sugar dropped to 37, I was laying down on a stretcher in the hallway. My whole body was covered in sweat, and I started going into a complete state of confusion. They immediately stopped the test, shot my arm full of glucose, then fed me a BBQ chicken plate. Scariest thing ever! So DON'T do the test...

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An alternative to the glucose test is a Postperanial test. It is a glucose (food) challenge of an additional 75 g of sugar in your meal with either a finger stick or a standard blood draw 2 hours later.

For example:

Whole grain pancakes with syrup

Eggs

And a large class of OJ

It is better than doing nothing in my OP.

Although it is doubtful that a WLS patient would struggle with gestational diabetes. It is more likely that a WLS patient would struggle with Hypoglycemia! (Low sugar)

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ther eis no way I could do that! I'd be sick as a dog... I know some types of surgery don't have dumping. I do. :)

My surgeon told me I don't need to worry about any gestational diabetes because it would be almost unheard of in someone who has had RNY.

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My surgeon told me I don't need to worry about any gestational diabetes because it would be almost unheard of in someone who has had RNY.

I agree I don't think anyone would have it either. They would really have to be cheating or still haven't recovered from previous diabetes before getting prego.

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An alternative to the glucose test is a Postperanial test. It is a glucose (food) challenge of an additional 75 g of sugar in your meal with either a finger stick or a standard blood draw 2 hours later.

For example:

Whole grain pancakes with syrup

Eggs

And a large class of OJ

It is better than doing nothing in my OP.

Although it is doubtful that a WLS patient would struggle with gestational diabetes. It is more likely that a WLS patient would struggle with Hypoglycemia! (Low sugar)

So what do you recommend for a patient that dumps on sugar. If I ate 15 grams of sugar I would probably dump. No way I could eat 75. I mean, unless I wanted to get really ill.

Kelly

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So what do you recommend for a patient that dumps on sugar. If I ate 15 grams of sugar I would probably dump. No way I could eat 75. I mean, unless I wanted to get really ill.

Kelly

Actually, I wouldn't worry about glucose with them. But we do do a urine dip stick with every appointment. If a client spilled glucose on two consecutive visits or if they where spilling more than +2 then I would do a finger poke.

If they failed the finger poke I would review diet with the client and do another finger poke at the next few visits. But I highly doubt that any WLS patient would fail it unless they are still a diabetic since surgery.

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WOW I agreed to do the t hour food test thing but there is literally no way I could eat 75 g og sugar. I can eat 1/2 a pancake or 1 silver dollar but anything else and sick I get.....

I have heard that some just use a glucose moniter to test but I guess we will just see what happens

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Thank you for sharing all this info ladies!! Very helpful =-D

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my question is why people say not to take flintstone complete? if i take two of them it is the same value as the bariatric advantage vitamins. someone please explain this to me because i am taking flints now and if they are not worth the awful taste and trouble, i will switch. also if i do take something else, am i able to swallow tablets yet? i am only 4 moths out.

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Flinstones complete are fine for some, but don't have enough Folic Acid for women, especially women who may be pregnant. Most women don't learn they are pregnant until 6 week, and by then the damamge to the spinal column has been done.

Otherwise if your Dr says flinstones are fine, then you should be okay.

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Flinstones complete are fine for some, but don't have enough Folic Acid for women, especially women who may be pregnant. Most women don't learn they are pregnant until 6 week, and by then the damamge to the spinal column has been done.

Otherwise if your Dr says flinstones are fine, then you should be okay.

I am sorry, but I totally disagree with this. Flinstones are made for a child not an adult and especially not a pregnancy adult who has had WLS.

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my question is why people say not to take flintstone complete? if i take two of them it is the same value as the bariatric advantage vitamins. someone please explain this to me because i am taking flints now and if they are not worth the awful taste and trouble, i will switch. also if i do take something else, am i able to swallow tablets yet? i am only 4 moths out.

Two Flinstones are NOT the same as two BA. Two BA gives you 200% of the RDA of biotin (which is what the ASBMS says we need). Two Flintstones only gives you 26% of biotin. Two BA gives you 288% of selenium. Flintstones has NO selenium. That is not the same at all.

Kelly

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Flinstones complete are fine for some, but don't have enough Folic Acid for women, especially women who may be pregnant. Most women don't learn they are pregnant until 6 week, and by then the damamge to the spinal column has been done.

Otherwise if your Dr says flinstones are fine, then you should be okay.

No matter what your doctor says, you are not likely to be fine taking a vitamin with no selenium and so little biotin.

Kelly

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Flinstones complete are fine for some, but don't have enough Folic Acid for women, especially women who may be pregnant. Most women don't learn they are pregnant until 6 week, and by then the damamge to the spinal column has been done.

Otherwise if your Dr says flinstones are fine, then you should be okay.

Sorry, I missed your post that you are pregnant- sorry! Flintstones are NOT enywhere near good enough during pregnancy. Are you working with a nutritionist? Getting all your vitamins is so important to the baby's development. Including DHA for brain development. 2 flintstones are okay in the early days if you are not preggo. It is what my doctor reccomends, but there are too mnay holes in them to provide what your baby needs during pregnancy. But you also don't necessarily want to take bariatric advantage because of the high levels of vitamin A, which can cause early miscarriage. Talk to yout OB, nut & surgeon to see if there is a chewable prenatal that you can take. I know that you can get lemon flavored liquid fish oil, that will meet your DHA needs.

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Sorry, I missed your post that you are pregnant- sorry! Flintstones are NOT enywhere near good enough during pregnancy. Are you working with a nutritionist? Getting all your vitamins is so important to the baby's development. Including DHA for brain development. 2 flintstones are okay in the early days if you are not preggo. It is what my doctor reccomends, but there are too mnay holes in them to provide what your baby needs during pregnancy. But you also don't necessarily want to take bariatric advantage because of the high levels of vitamin A, which can cause early miscarriage. Talk to yout OB, nut & surgeon to see if there is a chewable prenatal that you can take. I know that you can get lemon flavored liquid fish oil, that will meet your DHA needs.

I Agree!

But she as long as her doc is OK with it she can take pills if she can handle them. Most fish old comes in a soft gel form and should be easy to swallow.

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Congrats to all of you who have gotten pregnant after obesity related infertility!!!!! It is the #1 reason I am having WLS. I'm 35 and they suggest you wait 18 months after surgery to conceive... it's now or never for me! I lost a baby at 4 1/2 months when I was 31. The father and I are no longer together, but that's just as well. I don't even care about a man anymore, I just want a baby! Anyway, I was so good... took my vitamins, ate well, quit all the bad stuff immediately. They couldn't tell me why my baby died. I know it was my fault though. I weighed over 300lbs. What business did I even have getting pregnant? (It wasn't on purpose). People can tell me it wasn't my fault all they want, but in my heart I know that if I'd been 140lbs. when I got pregnant, I'd have a 3 year old daughter instead of an angelbaby.

I packed on the pounds after my loss. I guess I had to really make sure no one would fall in love with me so I wouldn't get pregnant again. Then after time passed and I wanted to try again, I had no one to try with. So here I am after months of wondering what the point of living was with no one to love and no children to tend to. I'm not a career gal. I'd happily be a stay at home mom if I could. The ability to get pregnant after RNY was one of my main concerns/fears about having the surgery. I couldn't see how you could support a healthy pregnancy on so little food. My surgeon assured me it's better than getting pregnant at my weight!

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Congrats to all of you who have gotten pregnant after obesity related infertility!!!!! It is the #1 reason I am having WLS. I'm 35 and they suggest you wait 18 months after surgery to conceive... it's now or never for me! I lost a baby at 4 1/2 months when I was 31. The father and I are no longer together, but that's just as well. I don't even care about a man anymore, I just want a baby! Anyway, I was so good... took my vitamins, ate well, quit all the bad stuff immediately. They couldn't tell me why my baby died. I know it was my fault though. I weighed over 300lbs. What business did I even have getting pregnant? (It wasn't on purpose). People can tell me it wasn't my fault all they want, but in my heart I know that if I'd been 140lbs. when I got pregnant, I'd have a 3 year old daughter instead of an angelbaby.

I packed on the pounds after my loss. I guess I had to really make sure no one would fall in love with me so I wouldn't get pregnant again. Then after time passed and I wanted to try again, I had no one to try with. So here I am after months of wondering what the point of living was with no one to love and no children to tend to. I'm not a career gal. I'd happily be a stay at home mom if I could. The ability to get pregnant after RNY was one of my main concerns/fears about having the surgery. I couldn't see how you could support a healthy pregnancy on so little food. My surgeon assured me it's better than getting pregnant at my weight!

Oh Sweetie- I am So sorry for you loss. My angel baby is still in my heart as well. I have done extensive research tho and you should know that your weight did NOT cause your miscarriage! Miscarriage is almost always caused by a genetic problem ( my angel baby had Turner's) Did they study the tissue for genetics?

Obesity is much more likely to cause infertility/ inability to get pregnant due to the higher levels of estrogen that our fat holds onto. Hence, it's so much easier to get preggo after WLS. I am 39 and rocking an 11 week old. I am already thinking about another! Good luck on your journey! You are worth loving and you will be a mother!

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Oh Sweetie- I am So sorry for you loss. My angel baby is still in my heart as well. I have done extensive research tho and you should know that your weight did NOT cause your miscarriage! Miscarriage is almost always caused by a genetic problem ( my angel baby had Turner's) Did they study the tissue for genetics?

Obesity is much more likely to cause infertility/ inability to get pregnant due to the higher levels of estrogen that our fat holds onto. Hence, it's so much easier to get preggo after WLS. I am 39 and rocking an 11 week old. I am already thinking about another! Good luck on your journey! You are worth loving and you will be a mother!

Just reading this 4 months later! They did an autopsy and nothing was found. There was no *reason*. That's awesome that you have a healthy baby :) Gives me some hope. My mother went through menopause in her very early 40's so I worry I'll miss my chance.

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