Pregnant After Gastric Sleeve Surgery: Must-Do’s For Mom & Baby

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Getting pregnant after gastric sleeve surgery is usually much safer and easier than getting pregnant while suffering from obesity. Considerations include:

  • Women must wait at least 2 years after surgery before getting pregnant
  • The ability to use birth control may be affected
  • Infertility, hormone imbalances, and other issues are usually “cured” or improved after surgery

Read and click the sections below for everything you need to know about pregnancy after gastric sleeve.

Compared to getting pregnant while suffering from obesity, waiting to get pregnant until after gastric sleeve surgery results in a safer and healthier pregnancy and better health outcomes for both mother and baby. (1)

However, patients should wait at least 2 years after surgery before getting pregnant to:

  • Allow your body and mind to fully adjust to your new stomach
  • Ensure that your nutrition levels are favorable for your baby’s nutritional needs
  • Allow for significant weight loss to occur (most gastric sleeve patients reach their low weight within 2 years). The lower your body mass index, the lower the risk of pregnancy complications

Earlier than 2 years may also be okay. The American Society for Metabolic and Bariatric Surgery recommends waiting 12 to 18 months, and the American College of Obstetricians and Gynecologists recommend waiting a minimum of 12 to 24 months prior to pregnancy (2)(3).

Since you’ll be eating much less as a result of your smaller stomach, you’ll need to make sure you stay on top of your bariatric vitamins both before and during your pregnancy.

The following vitamin supplements have been found to be especially important for bariatric patients during pregnancy:

  • Calcium
  • Iron
  • Folate
  • Vitamin B12

Consult with your medical team regularly before, during, and after pregnancy to:

  • Discuss, plan for, and monitor vitamin levels, diet, and lifestyle habits
  • Discuss emotions caused by the natural changes to a woman’s body during pregnancy

Getting pregnant when you are morbidly obese is much riskier than getting pregnant 2 years after gastric sleeve surgery. Obese pregnancies have the following risks vs gastric sleeve pregnancies:

1. Increased Risk of Minor Complications

Moms with obesity are more likely to suffer from the following conditions than if they wait to pregnant after gastric sleeve surgery:

  • Carpal Tunnel Syndrome – More than 3 times more likely to have
  • Chest Infections – Almost 10 times more likely
  • Depression – Significantly more likely
  • Headaches and Heartburn – More than 2 times more likely
  • Symphysis-Pubis Dysfunction (condition that affects the pelvic joints) – More than 3 times higher risk

2. Increased Risk of Major Complications

The increased chances of serious complications in obese pregnant women include (4) (5) (6):

  • Birthweight above the 90th percentile
  • Delivery by emergency caesarian section
  • Genital tract infection
  • Gestational diabetes
  • Induction of labor
  • Intrauterine death
  • Postpartum hemorrhage
  • Pre-eclampsia
  • Urinary tract infection
  • Wound infection

Mothers with obesity are also more likely to have babies with (7):

  • Anorectal atresia
  • Diaphragmatic hernia
  • Heart defects
  • Hypospadias
  • Limb reduction defects
  • Omphalocele
  • Spina bifida

As the children age, research suggests that they may also have a higher chance of developing an attention deficit disorder (ADHD) (8).

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Compared to obese pregnancies, pregnancy after gastric sleeve surgery has (9):

  • Lower maternal complication rates, including gestational diabetes and preeclampsia
  • Lower risk of developing high blood pressure

Avoiding these problems may also impact the life of your child. For example:

  • The development of gestational diabetes during pregnancy nearly doubles the risk of childhood obesity (10).
  • Children born to previously obese mothers who had weight loss surgery may be less likely to become obese themselves (these children have 3 times lower prevalence of severe obesity vs. obese mothers who did not have surgery, according to one study) (11).
  • Moms who have lost a significant amount of weight after gastric sleeve surgery give birth to babies with fewer cardiovascular risks as compared to siblings born before surgery (12).
  • Better neonatal outcomes such as fewer premature deliveries and a lower rate of low and high birth weight

Pregnancy after gastric sleeve surgery carries a few risks that do not apply to obese pregnancies, including:

  • Increased risk of internal hernias & bowel obstructions – symptoms include abdominal pain, abdominal swelling, or vomiting. Since these closely resemble the normal side effects of pregnancy, notify your doctor immediately if you experience them (13). As long as they’re caught early, a quick surgery should fix either issue and get the expecting mom back on track.
  • Prematurity, Increased neonatal intensive care unit (NICU) admission, and small for gestational age (SGA) – a study has shown that infants born to mothers that had bariatric surgery have an increased risk of prematurity (+5.4%), NICU admission (+3.9%), and SGA status (+4.1%). Importantly, the study also confirmed that each of these possible risks was lessened when the mother had her bariatric procedure at least two years before giving birth (14).

According to a recent report from the Centers for Disease Control, most of the common female contraceptives are considered safe for gastric sleeve patients.

For emergency contraception, the report suggests that an emergency intrauterine device may be more appropriate than emergency contraceptive pills.

See the CDC’s full report here for additional details.

Infertility: Most Male and Female Patients “Cured”

Obese men and women are more likely to have fertility problems than their gastric sleeve patients (15) (16). Following are the ways that fertility is improved after gastric sleeve surgery.

1. Fertility Improvements for Women

One significant fertility issue for obese women is anovulation (when the body does not release a ripened egg each month as a part of the menstrual cycle). Obese women who lose 5% or more of their weight (with or without surgery) are sometimes able to reverse this problem.

Given this knowledge, a study was undertaken to determine specifically how anovulation was affected after bariatric surgery.

Ninety-eight of 195 patients studied were considered “anovulatory” before surgery. Of the 98, 70 (71.4%) got back to a normal menstrual cycle following surgery. The 28 patients who remained anovulatory lost less weight than the “cured” bariatric surgery patients, suggesting that closer attention to bariatric diet and weight loss surgery exercise to improve weight loss could increase the cured rate even more.

Other studies also report a potential improvement in a woman’s ability to conceive and give birth to a healthy child after weight loss surgery.

In addition to improvements in anovulation, they have found other improvements that contribute to increased fertility (17) like:

  • other menstrual irregularities
  • polycystic ovarian syndrome
  • normalization of sex hormones

In another study of 110 obese infertile women, researchers evaluated bariatric surgery’s impact on fertility, including such factors as:

  • Age
  • surgery type
  • presence of diabetes or hypertension
  • amount of post-surgical weight loss
  • body mass index

Among the 110 previously infertile women, 69 became pregnant following surgery. All 69 pregnancies moved forward with no complications and live births.

2. Fertility Improvements for Men

Along with comorbidities like diabetes or hypertension, obese men can suffer from “Male obesity-associated secondary hypogonadism” or MOSH.

MOSH results in low levels of testosterone, along with low levels of certain hormones (called FSH and LH) that help in the production of sperm, and has been reported in up to 40-50% of obese men (18).

Gastric sleeve surgery can help.

A study published in the 2016 volume of The International Journal of Endocrinology found that weight loss surgery can have a large positive effect on MOSH.

At the beginning of the study only 5 out of 29 patients had normal levels of both Total Testosterone (TT) and Free Testosterone (cFT). But, at the 6-month follow-up after surgery, 22 out of 29 patients had returned to normal levels of both TT and cFT.

In other words, after undergoing weight loss surgery, 3 times as many men had normal testosterone levels.

If you still have questions about getting pregnant after gastric sleeve surgery, our experts are happy to answer them. We (and other patients) would also love to hear about your experiences.

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