As bariatric surgery becomes more commonplace in our society, more and more women of childbearing age are turning to surgery as the long-term solution to their weight loss problems. But how does this life-changing surgery affect your ability to get pregnant and have a normal, healthy baby? Is it even safe for a woman to have a child after weight-loss surgery (WLS)? And how long after surgery should you wait before trying to get pregnant?
Whether you already had your weight loss procedure done or are still considering a bariatric surgery, it’s important to know how WLS can affect your future pregnancy. While some studies can be contradictory on these topics, most agree on some really important observations, and this can be good news for both mommy and baby!
How WLS can Affect the Pregnancy for Mommy
For the most part, studies agree that when comparing obese pregnant patients who have not had WLS to pregnant patients with a history of WLS, the latter group exhibits less maternal complications throughout the pregnancy.
Women who have had bariatric surgery are less likely to develop gestational diabetes (diabetes while pregnant) and pregnancy-induced hypertension, or high blood pressure. One study in particular calculated that the risk of developing these problems while pregnant was reduced by about 50% for women that have had WLS.
As an added bonus, while weight gain with pregnancy is inevitable, the amount of weight gain for women who have had WLS is less than for those who haven’t had the surgery!
Although the effects of WLS are usually positive for the mommy-to-be, it is important to note that some complications may arise during pregnancy. These issues are rare but can include complications you might’ve heard about while learning about your particular procedure, such as damage to your small and/or large intestines. It’s important to talk to your doctor so they can help you determine if you are at a higher risk for these kinds of complications during pregnancy.
Another possible complication arising during pregnancy, which is actually a possible issue related to WLS in general, is anemia. One study, in particular, found that women who were pregnant after bariatric surgery had a greater risk of developing nutrient deficiencies, especially with vitamin A, vitamin D, and several B vitamins (mostly B1, B9, and B12). This same study advises pregnant women to take supplements of iron, calcium, folate, vitamin B12, and vitamin D. The American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines make the specific recommendation for women of childbearing age who have undergone WLS to take 800-1000 mcg of folate.
How WLS can Affect the Pregnancy for Baby
Pregnancy after surgery is not only improved for mommy, but for the baby as well! More specifically, babies born to mothers who have had bariatric surgery are associated with a lower risk of macrosomia (a baby born larger than the average infant).
On the contrary, women who have undergone WLS are more likely to give birth to babies that are small-for-gestational-age. (Gestational age is the number of weeks between conception and birth). But these babies usually catch up to normal babies in size and weight by the time they’re 1 year old.
Similar to the nutritional deficiencies mommy can experience, a growing fetus can lack the vitamins and minerals it needs to develop. These kinds of deficiencies, such as folate deficiency, can lead to neural tube defects, which can really hurt the baby. With more reason, it’s important for the post-WLS pregnant patient to keep up with her intake of supplements to ensure her baby grows healthy and strong.
Of the studies that mentioned fetuses with nutrient deficiencies, most were due to the fact that the mother was not taking their vitamin supplementation as prescribed. But a nutritional deficiency can still occur after bariatric surgery even if a patient is taking all her vitamins, which is why it’s crucial for patients to follow up with her doctors for lab monitoring and to mention to her doctor as soon as she knows she is pregnant or is considering becoming pregnant.
How WLS can Affect the Delivery
This is where the studies out there get a little murky on their conclusions. While some studies conclude that women with a history of bariatric surgery are less likely to have C-sections, others report no difference in C-section rates between women who have had WLS and those who have not. It has been suggested that the inconsistency here is likely due to physician bias.
That being said, how the post-WLS mommy delivers her baby is patient specific and involves a conversation between her and her doctors.
How Long After WLS Should You Wait Before Getting Pregnant?
Keeping in mind that everyone’s body will act differently after surgery, most recommendations advise waiting 12 to 18 months before getting pregnant to lower the risk of developing complications for both mommy and baby. It’s important to give the body time to lose weight and heal from one life-changing surgery to another life-changing event.
The Bottom Line
Pregnancy and having children are a life-event no woman who desires it should have to miss out on, including those women who have undergone WLS. It is extremely important to follow post-surgery directions, especially recommendations concerning nutrition, supplementation, and follow-up appointments as more frequent monitoring might be necessary for pregnant women with a history of bariatric surgery.
All-in-all, the most important thing to do when considering pregnancy, whether it be before or after your WLS, is to talk to your health-care providers and share your concerns. Every patient is different and your doctors can help you decide which course of action will be best for you and your future bundle of joy.
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References
- Galazis N, Docheva N, Simillis C, Nicolaides KH. Maternal and neonatal outcomes in women undergoing bariatric surgery: a systematic review and meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2014;181:45-53. doi:10.1016/j.ejogrb.2014.07.015.
- Hazart J, Le Guennec D, Accoceberry M, et al. Maternal Nutritional Deficiencies and Small-for-Gestational-Age Neonates at Birth of Women Who Have Undergone Bariatric Surgery. Journal of Pregnancy. 2017;2017:1-11. doi:10.1155/2017/4168541.
- Weintraub AY, Levy A, Levi I, Mazor M, Wiznitzer A, Sheiner E. Effect of bariatric surgery on pregnancy outcome. International Journal of Gynecology & Obstetrics. 2008;103(3):246-251. doi:10.1016/j.ijgo.2008.07.008.
- Johansson K, Cnattingius S, Naslund I, et al. Outcomes of Pregnancy after Bariatric Surgery. The New England Journal of Medicine. 2015;372(9):814-824. doi:10.1056/NEJMoa1405789.
- Maggard MA, Yermilov I, Li Z. Pregnancy and Fertility Following Bariatric Surgery. Journal of the American Medical Association. 2008;300(19):2286-2296. doi:10.1001/jama.2008.641.