As the number of people having weight loss surgery grows, more and more women of childbearing age will undergo such surgeries. There are many important questions to be answered regarding women’s health (fertility, contraception and pregnancy)

Weight loss surgery can produce a sudden positive change in your fertility. Women with fertility problems linked to obesity who have the surgery can start ovulating regularly for the first time in years. If you have polycystic ovarian syndrome (PCOS), your fertility should also get an improvement after surgery.
Contraception counseling should be provided for all women of reproductive age who are undergoing weight loss surgery. The risk of oral contraceptive failure is increased after weight loss surgery, so non-oral administration should be considered.
After weight loss surgery, your body goes through potentially stressful changes and significant nutritional disturbance, which can cause problems for a growing baby. So, you should wait 12 to 18 months (until your weight almost becomes stable) before getting pregnant so that your baby is not affected by rapid maternal weight loss and you can achieve your weight-loss goals.

If pregnancy occurs before this recommended time, closer observation of maternal weight and nutritional status may be beneficial, and serial ultrasound monitoring of fetal growth should be considered.

Protein, iron, folate, calcium, and vitamins B12 and D are the most common nutrient deficiencies after weight loss surgery especially gastric bypass surgery.

Evaluation for deficiencies of these nutrients should be considered at the beginning of pregnancy, and treatment should be initiated if any deficits are present. If no deficits are noted, a complete blood count and measurement of iron, ferritin, calcium, and vitamin D levels every trimester should be considered. This also requires eating several small meals throughout the day, nutritionist consultation and taking additional vitamin supplements.

Women who become pregnant after weight loss surgery need to make sure they are getting enough of the following nutrients:

  • Folate
  • Vitamin B12
  • Iron
  • Calcium
  • Vitamin D

At any time, with pregnancy, early consultation with a weight loss surgeon is critical to determine whether the gastrointestinal problems that are common in pregnancy (e.g., nausea, vomiting, abdominal pain) are related to the surgery.

Gastric banding surgery is adjustable. The band can even be deflated during pregnancy. Some women who are pregnant require deflation of the band due to severe nausea and vomiting, which can occur during pregnancy and as a result of gastric banding. This is typically an individual decision depending on the women’s medical condition.
Women who have undergone gastric banding before pregnancy may have trouble tolerating prenatal vitamins. They may develop heartburn or the prenatal vitamin may remain in their esophagus where it can cause ulcers. So, it is recommended to take chewable or liquid prenatal vitamins to avoid these unpleasant situations.
Weight loss surgery may actually help protect formerly obese women and their babies from complications including:
  • Pregnancy diabetes.
  • High blood pressure and Preeclampsia
  • Large babies

Actually, becoming pregnant after weight loss surgery is less risky than becoming pregnant while still obese.

Weight loss surgery should not affect the management of delivery. Although rates of cesarean delivery are higher in women who have had weight loss surgery, it is not an indication for cesarean delivery. But there is some debate about why.
Women who become pregnant after weight loss surgery can still breastfeed, provided there are continued nutritional monitoring and supplementation. It is important to make sure you are getting all the nutrition you need and drinking enough water so your milk does not dry up.

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