Pregnancy in a Post Bariatric surgery Patient

Obesity is on rise and so are post bariatric surgery patients.I am not sure whether about the whole concept of loosing weight by such drastic surgical means.Being married to a expert bariatric surgeon Dr Shalabh Mohan......I do have a fair amount of knowledge about the physiology,emotional and physical issues faced by these patients both pre op and post op.According to him and the evidences which he has showed me it is a extreme step towards loosing weight but then probably these are the people who if hadn't gone for these surgery would have never lost the weight themselves once morbidly obese, had a miserable social life and would have had their life shortened by diseases like Diabetes,raised blood pressure,heart disease etc..

Now I have started getting women who are pregnant and had Baratric surgery.Two of them have already delivered under my care and few others are currently pregnant.They are quite apprehensive ladies.The clinicians who were taking care of them before me also seemed little panicky in their management of these women.Do we really need to panic?What are the special precautions needed by these women during Pregnancy?Let me summarize it .

Which Procedure ? A Lady desirous of having a pregnancy and opt for Gastric sleeve or bypass.Once it was considered that bypass was a big no no for lady who have yet to conceive as the deficiency of nutrition was considered to be more in bypass.It is a fact but the deficiency is marginally more and not of significance.In bargain the weight loss is more with bypass ( again whether all this is healthy or not I am not commenting on that.It is for you to decide and the Bariatric surgeon to counsel you)

When to conceive? Ideally once the weight loss has has stablized.Mostly the recommended timeframe is 18 to 24 months.Till then Oral contraceptive pills shouldn't be used for contraception as the faliure rate is high due to lesser absorption of the medicine.

Preconceptional Planning? Meet a gynaecologist as well as Bariatric surgeon.These women should be tested of their micronutient levels preconceptionally and then in each trimester.These micronutrients are Iron,ferritin,folate,Vit D,Vit B 12 and serum Protein.
These women should be supplemented with multivitamins,iron,calcium and if deficient in protein on high protein diet.

Diet during Pregnancy? Diet should be same as pre pregnacy diet.If someone has a difficulty in swallowing high fibre diet like green vegetables it can be made semisolid by pureeing in a mixer.

Very sweet food should be avoided just like in prepregnancy food as it can lead to dumping.....sensation of abdominal pain,nausea and vomiting.As one can get abdominal pain,nausea and vomiting as symptom of pregnancy as well a bariatric surgeon should be consulted to rule out dumping as the reason of these symptoms.To compensate for the 300 kcal required extra during pregnancy these women should have frequent small meals.There is a small probabilty that these women can have small for date babies and serial growth ultrasound scan is recommended on a monthly basis.Micronutrients should be supplemented during the pregnancy.In nutshell it isn't much different from a routine pregnancy.

Delivery? Caesarean section is recommended for only obstetric reasons.

Bariatric patients have a lot of preop as well as post major emotional issues and are advised to be in touch with a good bariatric surgeon who can be their counsler and can provide them the much needed support.It will also be a good idea to join a post bariatric surgery support group sessions.