Pregnancy After Gastric Bypass ...

mindy_nicole, on 23 August 2011 - 11:28 AM, said:

I am 6 months post op and have lost 101 lbs. I am at 191 and feel great. I would like to try to get pregnant. If I am watched by an OB and get the adequate protein and supplements why would there be any harm? All my levels are great now so I don't understand why it is important to wait 12-24 months before conceiving. Thank You in advance for your response

Dear Mindy_Nicole,

You should wait until your OB and surgeon agree that is safe for you to be pregnant. It is very hard to balance the nutrition of both mother and baby while the mother is losing weight after obesity surgery. Early on after surgery it is hard to eat enough healthy food, and vitamin and mineral absorption may be erratic and unpredictable. Neurological defects have been reported in babies born to women after gastric bypass who have not had adequate vitamin and mineral supplementation. Second, mothers who are at a more normal weight have fewer pregnancy complications such as diabetes and hypertension. Babies of leaner women have a more normal birth weight and may be less prone to obesity later in life themselves. So you owe it to your baby and to yourself to wait until your weight has plateaued at the lowest possible level for several months before becoming pregnant.

Dr. Callery

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J Neurosurg Pediatr. 2008 May;1(5):406-9.
Gastric bypass: a risk factor for neural tube defects? Case report.
Moliterno JA, DiLuna ML, Sood S, Roberts KE, Duncan CC.
Source

Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Abstract

Gastric bypass surgery has become a safe and acceptable surgical weight loss treatment for individuals who suffer from morbid obesity. Patients who undergo this procedure are subject to vitamin deficiencies due to an iatrogenic malabsorptive state. Folate, a vitamin known for its role in the prevention of neural tube defects (NTDs), can be part of the deficiency spectrum resulting from this procedure. The authors describe the case of a woman who was nonadherent to multivitamin treatment after undergoing gastric bypass surgery. Her lack of understanding and appreciation of the relationship between gastric bypass surgery, folate deficiency, and NTDs may have contributed to her noncompliance with daily multivitamin consumption. As a result, her potential problems with folate absorption could have contributed to her subsequently giving birth to a child with a myelomeningocele. Thus, patient awareness and counseling along with aggressive vitamin supplementation among this particular population may help prevent the occurrence of NTDs after gastric bypass surgery.

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N Z Med J. 2009 Nov 20;122(1306):33-42.
Pregnancy following gastric bypass surgery: what is the expected course and outcome?
Sapre N, Munting K, Pandita A, Stubbs R.
Source

Wakefield Gastroenterology Centre, Private Bag 7909, Wellington, New Zealand.
Abstract
AIM:

To examine the course of pregnancy, labour, and the neonatal period in a group of women who have become pregnant following gastric bypass surgery for severe obesity.
METHODS:

Women who had experienced pregnancy following gastric bypass surgery were identified by an initial questionnaire. A second questionnaire was sent to those identified by the first questionnaire, who were willing to provide details concerning such pregnancies.
RESULTS:

Seventeen women experienced a total of 24 pregnancies and 25 live births. Five had experienced difficulties with conception or pregnancy prior to surgery. The average maternal weight gain was 6.13 kg. No major problems with fetal growth were observed. Babies were delivered at a mean gestational age of 37.5 weeks and with a mean birth weight of 3038 g. Six women reported a complication during pregnancy (25%) and five a complication in labour (20%). Two babies born to the same mother had congenital abnormalities attributable to a rare genetic disorder.
CONCLUSION:

The course of pregnancy and labour appears normalised for severely obese women following gastric bypass surgery. The weight loss and marked reduction in food intake following gastric bypass surgery does not lead to growth or development problems for offspring. Careful monitoring of expectant mothers who have undergone gastric bypass surgery is nevertheless to be recommended.

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Obes Surg. 2009 Sep;19(9):1286-92. Epub 2009 Jul 18.
Pregnancy outcome in patients following different types of bariatric surgeries.
Sheiner E, Balaban E, Dreiher J, Levi I, Levy A.

Departments of Obstetrics and Gynecology, Soroka University Medical Center, Faculty Ben-Gurion University of the Negev, P.O. Box 151, Beer-Sheva, Israel. sheiner@bgu.ac.il
Abstract
BACKGROUND:

The objective of this study was to investigate pregnancy outcome of patients following different types of bariatric surgery.
METHODS:

A population-based study includes all pregnancies of patients with bariatric surgeries delivered during 1988-2008. Pregnancy outcome was compared between the different types of surgeries.
RESULTS:

This retrospective study included 449 deliveries: 394 deliveries following pure restrictive operations-laparoscopic gastric banding (LAGB; n = 202), silastic ring vertical gastroplasty (SRVG; n = 136), and vertical-banded gastroplasty (VBG; n = 56)-and 55 deliveries following restrictive and malabsorptive Roux-en-Y gastric bypass (RGB). While no significant differences were noted between the groups regarding body mass index (BMI) before the bariatric operations or prepregnancy BMI, patients following LAGB had significantly higher BMI before delivery (36.8 +/- 5.9 kg compared to the SRVG 33.4 +/- 6.0, VBG 34.2 +/- 5.4, and RGB 34.9 +/- 6.8 groups; p < 0.001). Following LAGB, patients had higher weight gain during pregnancy (13.1 +/- 9.6 kg) compared to the SRVG (8.8 +/- 7.4), VBG (8.5 +/- 8.0), and RGB (11.6 +/- 9.6; p < 0.001) groups. The interval between operation and pregnancy was shorter in the LAGB group (22.8 months) compared to the SRVG (41.0) and the VBG (42.1) groups and was significantly higher in the RGB group (57.4; p < 0.001). Birth weight was significantly higher among newborns of patients following RBG (3,332.8 +/- 475.5 g) compared to the restrictive procedures (3,104.3 +/- 578.7 in the LAGB, 3,086.7 +/- 533.1 in the SRVG, and 3,199.2 +/- 427.2 in the VBG groups). No significant differences in low birth weight (<2,500 g) or macrosomia (>4,000 g), or low Apgar scores or perinatal mortality were noted between the groups.
CONCLUSION:

There is no difference in the affect on pregnancy outcome among the different forms of bariatric surgeries; all procedures have basically comparable perinatal outcome.

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JAMA. 2008 Nov 19;300(19):2286-96.
Pregnancy and fertility following bariatric surgery: a systematic review.
Maggard MA, Yermilov I, Li Z, Maglione M, Newberry S, Suttorp M, Hilton L, Santry HP, Morton JM, Livingston EH, Shekelle PG.

Rand Corporation, Santa Monica, California, USA. mmaggard@mednet.ucla.edu
Abstract
CONTEXT:

Use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age.
OBJECTIVES:

To estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on pregnancy outcomes and fertility after surgery.
EVIDENCE ACQUISITION:

Search of the Nationwide Inpatient Sample (1998-2005) and multiple electronic databases (Medline, EMBASE, Controlled Clinical Trials Register Database, and the Cochrane Database of Reviews of Effectiveness) to identify articles published between 1985 and February 2008 on bariatric surgery among women of reproductive age. Search terms included bariatric procedures, fertility, contraception, pregnancy, and nutritional deficiencies. Information was abstracted about study design, fertility, and nutritional, neonatal, and pregnancy outcomes after surgery.
EVIDENCE SYNTHESIS:

Of 260 screened articles, 75 were included. Women aged 18 to 45 years accounted for 49% of all patients undergoing bariatric surgery (>50,000 cases annually for the 3 most recent years). Three matched cohort studies showed lower maternal complication rates after bariatric surgery than in obese women without bariatric surgery, or rates approaching those of nonobese controls. In 1 matched cohort study that compared maternal complication rates in women after laparoscopic adjustable gastric band surgery with obese women without surgery, rates of gestational diabetes (0% vs 22.1%, P < .05) and preeclampsia (0% vs 3.1%, P < .05) were lower in the bariatric surgery group. Findings were supported by 13 other bariatric cohort studies. Neonatal outcomes were similar or better after surgery compared with obese women without laparoscopic adjustable gastric band surgery (7.7% vs 7.1% for premature delivery; 7.7% vs 10.6% for low birth weight, P < .05; 7.7% vs 14.6% for macrosomia, P < .05). No differences in neonatal outcomes were found after gastric bypass compared with nonobese controls (26.3%-26.9% vs 22.4%-20.2% for premature delivery, P = not reported [1 study] and P = .43 [1 study]; 7.7% vs 9.0% for low birth weight, P = not reported [1 study]; and 0% vs 2.6%-4.3% for macrosomia, P = not reported [1 study] and P = .28 [1 study]). Findings were supported by 10 other studies. Studies regarding nutrition, fertility, cesarean delivery, and contraception were limited.
CONCLUSION:

Rates of many adverse maternal and neonatal outcomes may be lower in women who become pregnant after having had bariatric surgery compared with rates in pregnant women who are obese; however, further data are needed from rigorously designed studies.