By Debbie Miller, RN - Doctors Lounge
BACKGROUND: It has been documented that obesity in an expectant mother negatively affects her pregnancy. This can begin even before conception since infertility is a frequent problem associated with excess weight. In addition, pregnancy in an obese woman tends to place her at higher risk than others of normal weight for problems such as diabetes, high blood pressure and mobility limitations.
Weight loss surgery is a good option for the morbidly obese (about 100 lbs. overweight), resulting in excellent long-term results. But, it is important to know the risks involved as they relate to pregnancy.
Because it is major surgery the body needs time to heal. The procedure often results in gastric and/or intestinal alterations and puts the patient into a controlled starvation mode to facilitate rapid weight loss. The nutritional status of the woman may be compromised during the weight loss stage. This is not a healthy state to support a pregnancy and risks include malnutrition of the mother, preterm delivery, and miscarriage. For this reason it is recommended that a woman wait until her weight and health have stabilized before conceiving a child. Eighteen months has been determined to be the ideal minimum period of time between weight loss surgery and conception. Healthy babies have been born to mothers who became pregnant within the first year following their surgery, but waiting can help to ensure the best chance for a successful pregnancy.
If infertility was a problem before surgery, the woman may believe she still cannot become pregnant and may not be diligent in using birth control during the recommended eighteen month period following weight loss surgery. But, the significant weight loss that occurs with this surgery often results in increased or normal fertility in the woman so a surprise pregnancy could occur. Even if birth control was not needed prior to weight loss, it should be used faithfully until weight loss has stabilized and the woman's body has healed, including adequate iron stores, which are sometimes compromised. Many doctors recommend using two reliable forms of birth control.
After becoming pregnant it is important to communicate well with your obstetrician to be sure you are getting the best nutrition and necessary adjustments for your situation. Your doctor may need to be educated in your special needs. Work with your surgeon and dietician to get information about your nutritional needs to your provider. This may include eating smaller, frequent meals with more protein and even making adjustments in the routine glucose screening to avoid dumping syndrome, a common long-term effect following gastric bypass surgery. You may also do better with a vitamin that is specific to your situation rather than the standard prenatal. Sometimes special forms of iron are needed as well.
Once the body is healthy again, following weight loss, pregnancy carries no increased risks than for a normal weight mother-to-be and significantly less risk than she would have had in her obese, pre-surgery state. So, get healthy, then get pregnant!
No conflict of interest.
