Pregnancy after Bariatric Surgery

Introduction

Bariatric surgery is an effective treatment option to reduce risks of weight-related co-morbidities and provide additional benefits in terms of fertility and pregnancy outcomes in women of childbearing age. However, it is recommended that you avoid pregnancy for at least 18 months after bariatric surgery as during this period you will be experiencing rapid weight loss. Therefore, you are most at risk of nutritional deficiencies which may cause both maternal and fetal complications during the pregnancy. In view of this, you are recommended to use contraception during the first 18 months post-surgery. Oral contraception may not provide sufficient protection after bariatric surgery (particularly in malabsorptive procedures such as gastric bypass) as lower absorption rates are suspected. Thus, it is recommended that you use an alternative method of contraception. You will need to discuss this with your GP or gynaecologist.

What happens when I find out I am pregnant after 18 months post-op?

• Speak to your GP about referral to an obstetrician at your local hospital. Your GP will need to inform the obstetrician of the importance of serial ultrasound examinations every 4 - 6 weeks to evaluate fetal growth from the 24th week of gestation, especially in women with poor weight gain as there is a possible increased risk of intrauterine growth restriction (IUGR) and small for gestational age (SGA) in post-bariatric surgery pregnancies.
• Contact the Bariatric Service immediately and inform them of your pregnancy so that follow-up appointments can be arranged with the bariatric dietitians.
• We will invite you to attend regular follow-up appointments with the bariatric dietitians at least every trimester. It is important for us to ensure you are eating the correct balance of nutrients and identify any nutritional deficiencies at an early stage so we can manage or treat them. You will be required to undergo regular nutritional blood tests at a minimum of every trimester taken either at the hospital or at your GP practice.

Nutrition during pregnancy

Management of nausea

Nausea and vomiting are common in pregnancy. Early management with dietary advice and/or clinically approved anti-emetics is recommended to avoid or treat complications. Dietary and behaviour changes to improve nutritional intake when nauseous include:

• Eating small and often meals
• Avoiding foods with strong odours
• Choosing cold food options
• Taking anti-emetics (if prescribed by your GP)
• Taking a short walk before meals
• Listing foods that particularly cause nausea and avoiding these for a period of time

Severe or prolonged nausea and vomiting may result in decreased nutritional intake, increased nutrient losses or poor nutrient absorption. This can increase the risk of thiamine deficiency. Therefore you may be required to take additional supplementation (Thiamine). If you are experiencing severe nausea and vomiting then please discuss with your dietitian and/or doctor.

Healthy eating

• It is important to eat a good variety of foods during pregnancy. These food groups include: protein rich foods, fruits and vegetables, dairy and dairy alternatives and starchy carbohydrates such as bread, rice, pasta, potatoes.
• Continue to prioritise protein containing foods such as chicken, red meat, fish, beans, lentils, tofu, soya, eggs, dairy and dairy alternatives.
• Aim to fill half of your plate with protein rich foods, and the remaining two quarters of the plate with vegetables or salad and carbohydrates. Remember your daily protein requirement: 70-100g per day.
• Choose healthy protein rich snacks in between meals such as a handful of nuts, hummus with carrot sticks, low-fat cheese and crackers, a protein bar, high protein yogurt, glass of skimmed/semi-skimmed milk, cooked chicken or ham slices, low-fat custard, rice pudding.
• Avoid snacks high in fat and sugar to prevent dumping syndrome symptoms and avoid excessive weight gain.
• Aim to drink at least 1.5-2L of fluids throughout the day (avoid sugary and fizzy drinks, and avoid alcohol).
• If you feel nauseous and cannot manage a meal, then try to have a protein shake or protein yoghurt as you may be able to tolerate this better.
• Continue to follow the golden rules; eating slowly, chewing thoroughly, separating eating and drinking, and stop eating when you feel full.
• Continue to use your side plate and small cutleries

Foods to avoid during pregnancy

Fish and shellfish: