Life After Weight Loss Surgery

Pregnancy After Weight Loss Surgery – All You Need to Know

Pregnancy is usually much safer and easier after weight loss surgery for both mother and baby. In addition, infertility, hormone imbalances, and other issues are usually “cured” or improved after surgery.

However, due to the ways surgery can change the way your body absorbs nutrients, you need to wait at least 2 years before getting pregnant. When you do become pregnant, you’ll need to take extra precautions to ensure you’re getting all of the nutrients you need.

Read the sections below for everything you need to know about getting pregnant after weight loss surgery.

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01.

Pregnancy After Bariatric Surgery Vs. Pregnancy While Morbidly Obese

SECTION SUMMARY:

  • Pregnancy after bariatric surgery is usually much safer than being pregnant while morbidly obese
  • You must wait at least 2 years after undergoing weight loss surgery to become pregnant

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.

Most women should wait at least 1 to 2 years 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 full 2 years, 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

It’s important that you work closely with your team which will probably include a:

  • Bariatric Surgeon
  • Primary Care Physician
  • Nutritionist or Dietitian
  • Obstetrician

Although pregnancy after weight loss surgery is usually safer than an obese pregnancy, there are also some possible downsides. Below are lists of the benefits and downsides of weight loss surgery as it relates to pregnancy.

02.

Risks of Being Pregnant While You're Morbidly Obese

SECTION SUMMARY:

  • There is an increased risk of minor complications for mom like chest infections, symphysis-pubis dysfunction, headaches, and heartburn
  • There is an increased risk of major complications for mom like emergency C-section, pre-eclampsia, postpartum hemorrhage, infection, birthweight above 90th percentile, and intrauterine death
  • There is an increased risk of issues for your baby like heart defects, spina bifida, limb reduction defects, and ADHD

An obese pregnancy can be more risky than a normal weight pregnancy, or a pregnancy after weight loss surgery. If women wait the recommended 1 to 2 years after weight loss surgery before getting pregnant, they can avoid many minor and major complications associated with an obese pregnancy:

1.  Increased Risk of Minor Complications

Below is a list of complications mothers are more likely to suffer if they have an obese pregnancy vs. a pregnancy after weight loss surgery:

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

2.  Increased Risk of Major Complications

The increased chances of serious complications in obese pregnant women include (1) (2) (3):

  • 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 (4).

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) (5).

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03.

Benefits of Getting Pregnant After Weight Loss Surgery

SECTION SUMMARY:

  • Bariatric surgery usually cures infertility
  • There are lower maternal complication rates
  • The risk of developing high blood pressure goes down
  • There is a lower risk of gestational diabetes
  • Your children may be less likely to become obese themselves
  • Your child will have a lower risk of cardiovascular issues
  • There are better neonatal outcomes

Compared to obese pregnancies, pregnancy after weight loss surgery has (6):

  • 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 (7).
  • 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) (8).
  • Moms who have lost a significant amount of weight after bariatric surgery give birth to babies with fewer cardiovascular risks as compared to siblings born before surgery (9).
  • Better neonatal outcomes such as fewer premature deliveries and a lower rate of low and high birth weight
04.

Downsides of Pregnancy After Weight Loss Surgery

SECTION SUMMARY:

  • There is a higher risk of moms having internal hernia or bowel obstruction
  • The possibility of lower birth weight and vitamin deficiency
  • There is a higher risk of prematurity, NICU admission, and SGA

Pregnancy after weight loss surgery carries a few risks that do not apply to obese pregnancies. They include:

  • 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 (10). As long as they’re caught early, a quick surgery should fix either issue and get the expecting mom back on track.
  • Lower birth weight & nutrient deficiency – There is evidence that babies born after a gastric bypass surgery have a lower birth weight on average. Babies of gastric bypass moms weigh about 0.75 pounds (0.34 kg) less than obese moms. A portion of these mothers and their babies were also deficient in key nutrients for pregnancy, like calcium and zinc (11).
  • 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 (12).
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05.

Contraception After Weight Loss Surgery

SECTION SUMMARY:

  • Contraception is usually safe for “restrictive” procedures
  • Contraception is usually NOT safe for “malabsorptive” procedures
  • Study indicates that 42% of women (or their partners) are not protecting against pregnancy during period deemed "unsafe" for childbirth

The University of Pittsburgh ran a study on 710 women 18 months after bariatric surgery. Subjects were provided a questionnaire on their reproductive behaviors, with results indicating that 42% of women were not using contraceptives. Study co-author Anita Courcoulas, M.D., M.P.H., F.A.C.S. commented, “This study clearly shows that early conception rates and contraceptive practices after bariatric surgery are not ideal.

Regardless of which procedure you had or plan to have, talk with your doctor before moving forward with any contraceptive method following surgery.

According to a recent report from the Centers for Disease Control, most of the common female contraceptives are considered safe for patients who received restrictive procedures.

However, for the following methods of contraception, the risks have been found to outweigh the advantages for malabsorptive procedures (in other words, do NOT use the following methods if you had the Gastric Bypass or Duodenal Switch Procedures):

  • Combined oral contraceptive
  • Progestin-only pill

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 for additional details, or the table below, for a summary (13):

Tap here to expand a chart of Contraception

Click the arrows to see more columns

Swipe Left/Right to View More Columns

Type of Contraception Medical Eligibility Category After restrictive Weight Loss Surgery Medical Eligibility Category After malabsorptive Weight Loss Surgery Definition of Medical Eligibility Category
Intrauterine contraception 1 1 Category 1: no restriction for use of the contraceptive method
Progestin implant 1 1 Category 1: no restriction for use of the contraceptive method
DMPA 1 1 Category 1: no restriction for use of the contraceptive method
Contraceptive patch/vaginal ring 1 1 Category 1: no restriction for use of the contraceptive method
Combined or progestin-only pill 1 3 Category 3: the theoretical or proven risks usually outweigh the advantages of using the method
Progestin implant 1 3 Category 3: the theoretical or proven risks usually outweigh the advantages of using the method
06.

How Bariatric Surgery Affects Infertility & Hormones

SECTION SUMMARY:

  • Bariatric surgery usually “cures” infertility for women with obesity
  • After weight loss surgery, 7 out of 10 female patients return to a normal menstrual cycle
  • Other improvements after surgery include resolution of polycystic ovarian syndrome and normalization of sex hormones
  • Weight loss surgery normalizes testosterone levels in men

Infertility: Most Male and Female Patients “Cured”

Obese men and women are more likely to have fertility problems than their non-obese counterparts (14) (15).

“71.4% of female patients got back to a normal menstrual cycle following bariatric surgery.”

The weight lost as a result of bariatric surgery can have a positive impact on fertility for both men and women:

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 bariatric surgery.

In addition to improvements in anovulation, they have found other improvements that contribute to increased fertility (16) like:

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

In another study of 110 obese infertile women (17), researchers evaluated bariatric surgery’s impact on fertility, including such factors as:

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).

There is good news though.

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.

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07.

How Different Types of Weight Loss Surgery Affect Pregnancy

SECTION SUMMARY:

  • There is no serious differences in terms of procedural safety or risks
  • The malabsorptive procedures like bypass and DS carry higher risk of malnutrition for mom and baby

While nutritional deficiencies may be more likely in some procedures (malabsorptive procedures come with a higher risk for malnutrition than restrictive procedures), a study that specifically evaluated whether some surgeries are safer (with respect to pregnancy) found that there were no serious differences between surgeries (19).

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.

A separate study of 42 pregnancies evaluated gastric bypass and lap band surgery and drew similar conclusions: “no significant difference exists in the obstetric and birth outcomes between women who have undergone LRYGB (gastric bypass) and those who have undergone LAGB (lap band)” (20).

08.

Patient Community & Expert Advice

SECTION SUMMARY:

  • Patient experiences
  • Ask the expert

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…

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09.

Find a Top Weight Loss Surgeon

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote
  • You can attend a free in-person seminar or an online webinar offered by a local weight loss surgeon
  • You should schedule a phone or in-person consultation (both often free), if you are interested in learning more about weight loss surgery

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* Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. Read More