For many women, achieving a healthy body weight is just one important life goal. Having a family (or adding to their existing family) is even more important. It’s natural for female patients to wonder how weight-loss surgery (WLS) might affect their chances at having a complication-free pregnancy and a healthy baby. Here are some answers to commonly asked questions:
Is It Safe to Get Pregnant After Bariatric Surgery?
In most cases, the answer is yes. However, you should wait at least two years (or until your surgeon gives you the all clear) before trying to conceive. This time allows you to:
- Let your body adjust to the changes in how eating and digestion occur
- Get any potential nutritional deficiencies sorted out
- Stabilize at a lower body weight that is accompanied by fewer health risks during pregnancy
- Exit the ketosis stage of weight loss that might be harmful to the growing fetus
- Become comfortable with the alteration in your appearance before it starts to change again in pregnancy
- Regain strength (dramatic weight loss after bariatric surgery is often accompanied by fatigue)
If you accidentally become pregnant while you are still in the rapid weight loss phase, you may need additional medical intervention to keep you and your baby safe. It is not known at this time whether procedures such as gastric bypass affect how the body absorbs oral contraceptives. If you are sexually active, you may wish to use a backup contraception method to reduce the risk of getting pregnant too soon after weight-loss surgery.
How Might My Fertility Change After WLS?
For some women with polycystic ovarian syndrome (PCOS), bariatric surgery may help hormone levels to normalize. As a result, they may face fewer challenges in conceiving. Women who have other obesity-related health conditions that are associated with lower fertility also tend to have a better chance at getting pregnant after surgically assisted weight loss. The increase in fertility is similar to what patients could attain with a similar amount of non-surgical weight loss. This potential boost in fertility is another reason to be extra careful with contraception unless you are trying to get pregnant.
Are Pregnancy Risks Lower After Bariatric Surgery?
In many cases, yes. Health conditions such as high blood pressure and Type 2 diabetes often resolve after weight-loss surgery. Women who had a high chance of developing these conditions due to obesity are at much lower risk after losing weight with WLS. You may have a better shot at avoiding complications such as gestational diabetes, hypertension and preeclampsia that can put you and your baby at risk. However, you may still be overweight even after losing a lot of your excess weight. It is important to be monitored throughout your pregnancy to ensure blood sugar and blood pressure levels remain normal. There is nothing inherent in the bariatric surgery procedure that precludes having a vaginal birth rather than a caesarean. This is a decision you should make in consultation with your OBGYN based on your personal preference and medical history.
Will My Baby Get Enough Nutrition While I Am Pregnant?
You will have to monitor and manage your food intake and supplement use very carefully during pregnancy. You may need extra blood tests to ensure you are not deficient in any vitamins or minerals. There is a real risk of malnutrition harming your fetus if you are not eating enough, if you vomit frequently or if your body is unable to absorb nutrients. This last issue is especially likely after gastric bypass or duodenal switch (the bariatric surgeries that reroute the intestines). However, with appropriate supplementation, most women can ensure their body has all the nutrients necessary to promote normal, healthy fetal development.
Will I Regain the Weight I Lost If I Get Pregnant?
Some weight regain may occur with pregnancy (although some WLS patients may continue to lose weight at a slow pace during the early part of the pregnancy). If you are eating appropriately, most of your pregnancy weight gain will not be fatty tissue. You should be able to lose it again without too much trouble after you give birth. It is important not to restrict food out of fear that you will regain weight during your pregnancy. Eating too little may harm your baby.
At the same time, overeating may be a temptation after several years of being careful to eat very small portions. This habit developed during pregnancy may lead to continued weight gain after you give birth. This can happen if you snack all the time or eat so much that your stomach pouch stretches. You will need to work closely with your health care team to ensure that your nutrition plan is adjusted for pregnancy and then goes back to your regular maintenance plan once you no longer need the extra calories.
Can I Breastfeed After Weight-Loss Surgery?
Bariatric surgery should have no impact on your ability to breastfeed normally as long as your nutrition intake and hydration is good. Remember that breastfeeding may require you to eat more calories, so your return to a normal post-WLS diet may need to wait until your baby is weaned. Fortunately, most women who breastfeed find it easier to lose baby weight, so nursing shouldn’t impede your journey to reach your goal weight.
Having cosmetic surgery to lift or reduce your breasts after WLS may interfere with breastfeeding. It’s actually a good idea to postpone most of your post-bariatric surgery skin removal and body reshaping until after your pregnancy. Otherwise, you may lose some of your results or end up with strangely stretched scars. Once you are done adding to your family, you may opt for a “Mommy Makeover” to give you the body you’ve always wanted.