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Pregnancy after WLS

Pregnancy after WLS
12 May 2021 Laura Eggerichs

Pregnancy after WLS

Are you one of the many who has/had a goal of having a baby after bariatric surgery? It’s not a secret that weight loss can improve fertility – for both men and women actually – which is super exciting!  There is also a lot to think about: how long should I wait, what vitamins do I need, are there increased risks?  This month we’ve elicited some answers to these questions from an expert:  Louise Rabe. Louise is one of the bloggers on our Swedish site who had a sleeve in 2017.  She is a midwife and operations manager at Mama Mia in the region of Skåne in southern Sweden, and we are happy to have her expertise to share with you!

Nutrition Basics during Pregnancy after WLS

Before getting to our answers from Louise, we want to discuss a little about some nutrition basics during pregnancy after WLS. It’s very important to get the protein and vitamins/minerals you and your baby need. It’s so important that you should have regular blood tests throughout your pregnancy to make sure your levels are where they need to be.

Some key numbers to be aware of regarding vitamins, minerals, protein, and calories are:

  • Folate/Folic Acid: 400-800mg/day. May need additional (up to 5mg/day) preconception and up to 12 weeks gestation.
  • Vitamin D: 800IU/day. May need more if you have a pre-existing deficiency.
  • Vitamin B12: 500-1000mcg/day
  • Vitamin A: not more than 3,000mcg/day from retinoid-based sources
  • Vitamin B1 (thiamine): Make sure your vitamin has it, and you may need extra if you have excessive vomiting
  • Iron: At least 45-60mg/day.  Some women will need more.
  • Calcium: 800-1500mg/day
  • Protein: at least 60-80g/day
  • Calories: you don’t need many extra calories until the third trimester of your pregnancy as long as you weren’t losing weight before conceiving. During the third trimester, most women should get an extra 200 calories per day.

Baricol contains the base of what you need for your pregnancy after bariatric surgery. However, as always, work with your healthcare provider to make sure you are getting the nutrition you and your baby need and to add additional vitamins or minerals if necessary.

Now on to the main event!  Louise shared some really great information with us about pregnancy after WLS from her experience as a midwife in Sweden. Since recommendations are a little different everywhere, hers may be slightly different than what your provider suggests.

Louise Rabe, Midwife & Operations Manager at Mama Mia in Skåne in southern Sweden.

How long should I wait after surgery before trying to conceive?

The general recommendation is to wait 1 year after you’ve reached a stable weight to become pregnant after WLS. For many, this can mean they have to wait up to 2 years after their bariatric surgery before trying to conceive. This can feel like a very long time for a lot of people. Maybe it’s even the case that you had surgery just to be able to get pregnant? I usually think like this:  During the first 6 months after WLS, it is not appropriate to become pregnant. The body is losing a lot of weight and being able to give good nutrition to a fetus is not possible.  Your body can also release toxins as it breaks down fat, and these can pass over to the fetus.

A good contraceptive is extremely important. Uptake of oral contraceptives, such as birth control pills, is not optimal and can provide impaired contraceptive protection. That’s why we recommend an IUD, implant, patch, or ring.

When you see that your weight loss has begun to slow down, you can start to think about whether you want a pregnancy. But my absolute advice is not to plan a pregnancy until you see that you have stopped losing weight for a few months. It is important to take your vitamins both in preparation for and, of course, during pregnancy.  In particular, in Sweden, we advise that you take at least 400 micrograms of folic acid per day several months before pregnancy – which Baricol Complete has!

Are pregnancies after WLS considered high risk? Why or why not?

No, not everyone is high-risk, but there are some specific things we have to do with pregnancies after WLS.  For example, we take extra blood samples to make sure you don’t have vitamin/mineral deficiencies. You also cannot do a normal oral glucose tolerance test to check for gestational diabetes. This is because the new digestive route cannot tolerate such a large amount of sugar in a short time (i.e. you could get dumping). If you need to check for this, you can instead test your blood sugars often for a couple of days with a normal glucose monitor and send in the results for analysis.

We also offer pregnant women who have had WLS a Growth Ultrasound to see that the fetus is growing normally. My experience is that all babies grow nicely. But if you have a very poor nutrient uptake in the intestine, then the growth of the baby in the womb is also affected.

What risks are involved in pregnancies after WLS?

Risks include having a baby with stunted growth or that is born too small.  You may also have more problems with feeling unwell during your pregnancy. In addition, many women have heartburn with their pregnancy after WLS which increases the need to use antacids during and after pregnancy. One very uncommon risk is that the intestines can be “pushed” by the growing baby/uterus which increases the risk of hernias/ileus (lack of movement) formation. This is very unusual.   Something very important to keep in mind is what can happen psychologically. It can be super hard to suddenly gain weight again and feel big after finally losing weight.  Many people find it helpful to get support for this, so don’t be afraid to ask!

Thanks, Louise!  Remember, if you are planning on having a baby after WLS, make sure you work with your healthcare providers to ensure you and your baby grow strong and healthy!  These things that Louise has described apply to Sweden in general and Skåne in particular. Checks during pregnancy may differ where you are.

 

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