The prevalence of obesity has increased tremendously overt h e last several decades, with 39.7 percent of women of childbearing age currently being affected. This begs
the question; is it safe to become pregnant after having bariatric surgery? The short answer to this question is “yes.” There are some guidelines, however, that a woman of reproductive age should take into consideration prior to seeking pregnancy.
Obesity during pregnancy can lead to many complications, higher rates of miscarriage, fetal growth problems or congenital abnormalities, gestational diabetes, material hypertension, and higher rates of cesarean deliveries. Therefore, losing excess weight prior to conception si always recommended to reduce these risks. Bariatric surgery is often considered the most successful treatment for those with aBMI greater than 40 percent or those with a BMI greater than 35 percent with at least one additional serious co-morbidity. Since most of the weight loss occurs within the first 12 to 18 months after surgery, it is recommended that women wait at least 12 months prior to conception. Pregnancy that occurs within the first year following a bariatric procedure is often associated with higher rates of post surgical complications such as bowel ischemia, bowel obstruction or anastomotic leaking.
Optimal nutrition before, during and after delivery is the key to a healthy pregnancy and post-delivery outcomes, for both mom and baby. It is recommended that a woman seeking pregnancy should continue to consult with her bariatric surgeon in addition to her obstetrician throughout the pregnancy. In addition, working closely with a nutritionist or registered dietitian who can provide ongoing education and dietary guidance is vital in detecting and preventing both micro and macro nutrition deficiencies. Although there are no written guidelines for pregnancy weight gain post bariatric surgery, recommendations by the Institute of Medicine state that a woman with a BMI of 30 or greater should restrict weight gain during pregnancy between 1 and 20 pounds.
In summary, pregnancy after bariatric surgery can be done safely. It is recommended that prior to seeking pregnancy, a woman should pursue preconception consultation with both her bariatric surgeon as well as a maternal-fetal specialist to discuss the risks and benefits of seeking pregnancy post-bariatric surgery verses a pregnancy with obesity. Women who are considering bariatric surgery but are also interested in a future pregnancy should talk to their bariatric surgeon about the least restrictive options. For example, sleeve gastrectomy versus a Roux-en-Y gastric bypass would be preferable, as there appears to be less adverse complications during pregnancy. In addition, a well-prepared plan for preventing nutritional deficiencies and minimizing clinical complications before, during and after pregnancy is vital to ensuring the best outcome for both mom and baby.