Pregnancy After Weight Loss Surgery

Pregnancy after weight loss surgery could be safer than it was before surgery, but only if the proper steps are taken…

• Does bariatric surgery cure infertility?
• What are the risks of being obese and pregnant?
• Pregnancy after bariatric surgery vs before surgery
• How long do you have to wait to get pregnant after surgery?
• Update on appropriate contraceptive use following surgery
• Are some types of surgery better than others if I plan on getting pregnant?
• Patient experiences (please share your own as well)

Can bariatric surgery cure or improve infertility?

Yes.

Obese men and women are more likely to have fertility problems than their non-obese counterparts.1,2

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 bariatric surgery. In addition to improvements in anovulation, they have found improvements in other menstrual irregularities and polycystic ovarian syndrome along with a normalization of sex hormones, all of which contribute to increased fertility.3

In another study of 110 obese infertile women,¹³ researchers evaluated bariatric surgery's impact on fertility and whether age, surgery type, presence of diabetes or hypertension, amount of post-surgical weight loss and body mass index had any affect. Among the 110 previously infertile women, 69 became pregnant following surgery. All 69 pregnancies moved forward with no complications and live births.

What are the risks of being obese and pregnant?

Regarding minor pregnancy complications, obese pregnant women have been found to be…

• Almost 10 times more likely to suffer from chest infections
• More than 2 times more likely to suffer from headaches and heartburn
• More than 3 times more likely to have carpal tunnel syndrome
• More than 3 times higher risk of suffering from symphysis-pubis dysfunction (condition that affects the pelvic joints)
• Significantly more depressed

The increased chances of serious complications in obese pregnant women include4,5,6…

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

In addition, babies with spina bifida, heart defects, anorectal atresia, hypospadias, limb reduction defects, diaphragmatic hernia and omphalocele were significantly more likely to have obese moms.7

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

Pregnancy After Weight Loss Surgery vs.
Before Surgery

There are some things you’ll need to do differently during pregnancy after weight loss surgery, but in general, pregnancy and childbirth are much safer following surgery than they are for obese women who do not have the surgery.

Compared to obese pregnancies, pregnancy after weight loss surgery has9…

• Lower maternal complication rates, including gestational diabetes and preeclampsia
• Better neonatal outcomes such as fewer premature deliveries and a lower rate of low and high birth weight
• 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

However, there are a couple of bariatric surgery complications to be on the lookout for, namely internal hernias and bowel obstructions. The symptoms, which include abdominal pain, abdominal swelling or vomiting can closely resemble the normal side effects of pregnancy, so if any of these are experienced your doctor should be notified immediately.11

As long as they’re caught early, a quick surgery should fix either issue and get the expecting mom back on track.

When is contraception or pregnancy after weight loss surgery safe?

Most women should wait least one year to 18 months after bariatric surgery before getting pregnant. This is the timeframe when many patients experience the biggest amount of weight loss, and it is the most difficult period for keeping your body’s nutritional needs in line.

Many bariatric surgery procedures prevent patients from getting the vitamins their bodies need from the foods they eat. So even after you’ve waited the 12 to 18 months, 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

The bottom line?

Pregnancy after weight loss surgery is usually safe… much safer, in fact, than before the surgery for both obese women and their babies.

But it’s important that you work closely with your bariatric surgeon, primary care physician, nutritionist or dietitian and obstetrician and that you follow their advice to the letter. You’ll probably need to wait 12 to 18 months before you get pregnant, so talk with your bariatric doctors about appropriate contraception to make sure it doesn't happen sooner.

If you are considering bariatric surgery, be sure to talk about your desire to become pregnant in discussions with your surgeon.

Comparing procedures for pregnancy after weight loss surgery

While nutritional deficiencies may be more likely in some procedures than others (malabsorptive procedures come with a higher risk for malnutrition than restrictive procedures), a study that specifically evaluated whether some surgeries are safer than others found that there were no serious differences between surgeries.12

They evaluated laparoscopic adjustable gastric banding (LAGB or lap band surgery), vertical banded gastroplasty (VBG), and Roux-en-Y gastric bypass surgery (RGB) and found that…

• Patients following lap band surgery had significantly higher body mass index (BMI) before delivery (see our BMI Formula page for more about body mass index).
• Following lap band surgery, patients had higher weight gain during pregnancy compared to the VBG and gastric bypass groups.
• The interval between operation and pregnancy was shorter in the lap band group (22.8 months) compared to the VBG group (42.1 months) and was significantly higher in the gastric bypass group (57.4 months).
• Birth weight was significantly higher among newborns of patients following gastric bypass surgery compared to the restrictive procedures.
• No significant differences in low birth weight or macrosomia or perinatal mortality were noted between the groups.

Your pregnancy after weight loss surgery

- Which surgery did you have?

- How long did you wait before getting pregnant?

- How long did it take you to get pregnant after you started trying? Did you have difficulty conceiving?

- Did you experience any problems or complications during your pregnancy or labor?

- What has it been like raising a child post-surgery?

Please share your experiences to help other weight loss surgery patients understand the pregnancy-related risks and benefits of surgery...

Other visitors' experiences with pregnancy after weight loss surgery

Click below to see contributions from other visitors to this page...

References for Pregnancy After Weight Loss Surgery

1. The Endocrine Society Press Release: Obesity linked to problems that can cause male infertility. Available at: http://www.endo-society.org/media/ENDO-07/research/
   Obesity-linked-to-problems-that-can-cause-male-infertility.cfm. Accessed: October 6, 2009.
2. Obesity and infertility. Mandakini Parihar. Reviews in Gynaecological Practice - September 2003 (Vol. 3, Issue 3, Pages 120-126, DOI: 10.1016/ 1471-7697(03 00061-3)
3. Teitelman M, et al. The Impact of Bariatric Surgery on Menstrual Patterns. Journal Obesity Surgery 0960-8923 Volume 16, Number 11 / November, 2006 Pages 1457-63.
4. Some Pregnancy-related Complications Minimized for Women Who Have Had Weight-loss Surgery. Press Release, November 18, 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2008/barsurgpr.htm
5. The University of Edinburgh Press Release: Obesity increases pregnancy complications. July 2009.  Available at: http://www.ed.ac.uk/news/all-news/pregnancy-220709.
6. Lopez-Duran N. Maternal Obesity During Pregnancy Increases Risk for ADHD Symptoms. Aug 2009. Child Psychology Research Blog. Available at: http://www.child-psych.org/
   2009/08/maternal-obesity-during-pregnancy-increases-risk-for-adhd.html. Accessed: October 10, 2009.
7. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001 Aug;25(8):1175-82.
8. Melinda A. Maggard; Irina Yermilov; Zhaoping Li; Margaret Maglione; Sydne Newberry; Marika Suttorp; Lara Hilton; Heena P. Santry; John M. Morton; Edward H. Livingston; Paul G. Shekelle. Pregnancy and Fertility Following Bariatric Surgery: A Systematic Review. JAMA. 2008;300(19):2286-2296. 
9. Agency for Healthcare Research and Quality Press Release: Some Pregnancy-related Complications Minimized for Women Who Have Had Weight-loss Surgery. Nov 2008. Available at: http://www.ahrq.gov/news/press/pr2008/barsurgpr.htm.
10. Pamela Power Scanlon, M.S. A link between gestational diabetes and childhood obesity is reason for leading a healthy pregnancy. Aug 2009. Family Health Examiner. Available at: http://www.examiner.com/x-14665-Family-Health-Examiner~y2009m8d6-
    A-link-between-gestational-diabetes-and-childhood-obesity-is-reason-for-leading-
    a-healthy-pregnancy. Accessed: October 10, 2009.
11. Mirza MS, et al.  Large bowel obstruction in pregnancy: a rare entity, an unusual cause. Journal Archives of Gynecology and Obstetrics Volume 279, Number 2 / February, 2009 Pages 177-178.
12. Sheiner E, et al.  Pregnancy Outcome in Patients Following Different Types of Bariatric Surgeries. Journal Obesity Surgery Volume 19, Number 9 / September, 2009. Pages 1286-1292.
13. Impact of bariatric surgery on obesity-related infertility. Mario Musella, Marco Milone, Marcello Bellini, Loredana Maria Sosa Fernandez, Maddalena Leongito, Francesco Milone. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 7 October 2011 (Article in Press DOI: 10.1016/j.soard.2011.09.021)

[Last editorial review/modification of this page: 11/8/2011]