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Gravidmage efter gastric sleeve

Pregnancy after Bariatric Surgery

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. Below are some key numbers to keep in mind related to vitamin and mineral supplementation as well as protein and calorie intake during pregnancy.

Nutrition Basics during Pregnancy after WLS

  • 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 1mg/day from retinoid-based sources
  • Thiamine (Vitamin B1): 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 do not need to consume that much more energy than usual during pregnancy. The extra energy is used, among other things, for the uterus and placenta to grow, for the blood volume to increase, and, of course, for growing the baby and covering his/her energy needs. The National Food Administration in Sweden usually recommends 100 calories extra per day in the first trimester, then 300 extra in the second trimester, and 500 extra per day in the third trimester.  As someone who has had WLS, those extra calories will likely need to come from having extra snacks or adding some higher calorie foods to your days like nuts or avocado given your limited portions.

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.  You should not increase your dose of Baricol during pregnancy because the Vitamin A level will be too high, therefore, it is recommended that you supplement individual vitamins or minerals as needed according to your healthcare provider.

Now on to the main event!

Profilbild Louise i röd tröja som genomgått och gastric sleeveLouise Rabe is a midwife and operations manager at Mama Mia in Malmö, Sweden. She had a gastric sleeve in 2017 and is one of the bloggers on our Swedish site.  We are happy to be able to share some of her expertise around the most common questions she gets from patients who are expecting after having WLS. Since recommendations are a little different everywhere, hers may be slightly different than what your provider suggests.

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 poor nutrient absorption, 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. This 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. This can increase the risk of hernias/ileus (lack of movement) formation and 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! The subjects that Louise has discussed apply to Sweden in general and Skåne in particular. Checks and recommendations during pregnancy may differ where you are.  Remember, if you are planning on having a baby after WLS, make sure you work with your healthcare providers. This will help to ensure you and your baby grow strong and healthy!