Author: S. Bledsoe, M.D.
“I never thought it could happen so quickly!” After 9 years of struggling with infertility, Susan was now 9 weeks out from her sleeve gastrectomy and 8 weeks pregnant. Her 10 year wedding anniversary happened to fall a week after her procedure, and…well…you get the idea. She thought there was no way pregnancy after weight loss surgery could occur so quickly. She was wrong!
In my preoperative counseling, Susan had discussed her goal of pregnancy after weight loss surgery. I told her that the safest thing would be for her to wait until her weight loss stabilized before attempting to become pregnant. This usually takes 18-24 months but waiting at least a year would be the minimum. I even told her that after surgery she would become a “Fertile Myrtle,” so she needed to be extra careful. She just didn’t think it could happen to her. What could I do at that point but congratulate her and encourage her?
There is a good reason to wait for a period of time before becoming pregnant. After weight loss surgery, your body is undergoing some dramatic changes. Some of these changes are stressful both physically and psychologically. Throw on top of these stresses a new pregnancy that has its own dramatic changes taking place, and you can see how this could be a very difficult few months.
Why bariatric surgery increases the chances of pregnancy is a question we will look at in later posts. I will look at two things right now: timing of pregnancy after weight loss surgery and safety of pregnancy after weight loss surgery.
When it comes to timing, the important thing is to wait until your weight loss has stabilized. That means wait at least a year. Even better would be to wait 18-24 months. This will ensure that your body has time to adjust and normalize after the stressor of major surgery prior to taking on a second stressor of pregnancy.
For women of childbearing years, this means to make sure you take appropriate precautions after surgery. While the oral contraceptive is probably adequate, there are no studies that prove the effectiveness of “the pill” after a weight loss procedure. If possible, use two methods of birth control, including a barrier method.
That’s easy enough, but I am often asked about the safety of pregnancy after weight loss surgery. For that person I would say, pregnancy is often safer after weight loss surgery for both mother and child. One of the primary reasons for this is the improved glycemic control after bariatric surgery.
One patient of mine was know to have had gestational diabetes with a previous pregnancy. After a gastric bypass, she became pregnant. To the surprise of her Obstetrician, her blood sugars were normal throughout the pregnancy. This anecdotal story is similar to what is found in large studies such as the one that came out in 2010 in the Journal of the American College of Surgeons. This manuscript documented lower incidences of gestational diabetes and Caesarean section for obese people who had weight loss surgery versus obese people who did not have weight loss surgery.
Another article out of Santa Monica, California in 2008 noted that when compared to patients without surgery, the surgical weight loss patient has nutritional deficiencies are rare, pregnancy outcomes are acceptable, complication rates are equivalent, Ceasarean section rates are identical and there is likely some protection for the post-surgical patient against gestational diabetes, preeclampsia, and pregnancy induced hypertension.
Conversely, obesity is problematic for both the mother and the child. A 2010 manuscript appeared in the Journal of Obstetrics and Gynaecology Canada entitled “Obesity in Pregnancy.” The authors summarize the major findings associated with obese mothers bearing children and made recommendations for the practitioner. As the mother enters pregnancy, her pre-pregnancy BMI should be below 30. Those mothers that are obese when entering pregnancy are at a higher risk for several, some severe, medical issues including cardiopulmonary disease, gestational hypertension, gestational diabetes, and obstructive sleep apnea. The child is at increased risk for congenital abnormalities. Obese mothers also have a higher rate of Caesarean section. Although the paper did not make the connection, I would point out that all of these recommendations and observations are addressed with weight loss surgery.
In my own practice, I have had several patients become pregnant after surgery, some far too early in the process. However, all of them had far easier pregnancies and safer pregnancies than expected. I am happy to report that all mothers and all children are doing well. As for Susan, at the time of this writing, she is approximately half-way through her pregnancy with both mother and child doing well.
A bariatric procedure should always be a carefully considered decision. This is especially true of women who are interested in pregnancy after weight loss surgery, because timing is the key to having a safer pregnancy and healthier child.