It is recommended that you avoid pregnancy for at least 12 to 18 months following bariatric surgery, as this period involves rapid weight loss, making you most at risk of nutritional deficiencies and may result in maternal and fetal complications (e.g., increased risk of intrauterine growth restriction (IUGR) and small for gestational age (SGA) in post-bariatric surgery pregnancies).
It is important that you let your Midwife know at your first booking appointment if you have had a gastric bypass, sleeve or band. You will be referred to an Obstetrician, who will recommend regular blood tests for your iron and vitamin levels and scans to monitor the growth of your baby. These usually start at 32 weeks of pregnancy, unless you have other risk factors for a small or growth restricted baby.
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 advised to take additional supplementation (Thiamine). If you are experiencing severe nausea and vomiting, please discuss with your dietitian and/or GP / Obstetrician. For more information, visit the NHS website
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Vitamin and mineral supplementations during pregnancy following gastric bypass or sleeve gastrectomy
Regular nutritional blood tests including ferritin, folate, vitamin B12, calcium and fat soluble vitamins should be taken at least every 6 months. These will be taken either at the hospital or at your GP practice.
Folic acid: All women who are planning for pregnancy should take a Folic Acid supplement for at least 3 months before trying for a baby, and throughout the first trimester. The dose for post-bariatric surgical patients is 5mg per day on prescription from your GP. If you haven’t started taking it early, you should take it as soon as you know you are pregnant. This is important as it reduces the chance of birth defects of the brain, spine, or spinal cord (neural tube defects).
Multivitamins / A-Z vitamins: Some standard A-Z multivitamins are unsuitable for pregnancy because of the type of Vitamin A they contain. Forceval Capsules are safe to take during pregnancy and will not need to be changed, continue to take one a day. Other multivitamins will need to be changed to Forceval Capsules, or over-the-counter pregnancy multivitamins (e.g., Pregnacare, Boots Pregnancy Support, 7-Seas Pregnancy Care). Discuss this with your GP or local pharmacy if you are unsure. Make sure your multivitamin contains 2mg copper. If it contains only 1mg of copper, please take 2 tablets a day.
Calcium and Vitamin D3: Continue with your Calcium D3 supplements, according to your prescription (e.g., AdcalD3, CalcichewD3, CacitD3, AccreteD3, EvacalD3).
• Iron supplements: If you are already taking Ferrous Fumarate or Ferrous Sulphate tablets, continue taking them according to your prescription. If not, you may need to start taking iron supplement by the start of the third trimester. The iron needs of the baby increase during this growth phase and can result in iron deficient anaemia, especially when dietary intake of iron is insufficient.
B12 injections: Please continue your three-monthly B12 injections, according to your prescription.
Considerations following a gastric band
If you have a gastric band and become pregnant you will need to contact the specialist bariatric nurse to discuss whether your band will need be adjusted during your pregnancy. If the band is not adjusted accordingly, it may cause an increase in the symptoms of nausea, vomiting, intolerance to foods and abdominal pain. Please note excessive vomiting may increase the risk of band slippage.
Weight gain during pregnancy
Because there are uncertainties around optimal weight change in pregnancy, focus advice on starting or maintaining a healthy diet and physical activity during the pregnancy. There are different factors that can affect weight change during pregnancy, for example, weight of the baby, weight of the placenta, maternal increase in blood volume, amniotic fluid, breast tissue expansion and body fat, and how these (especially the weight of the baby) vary between individuals and affect weight differently.
There is a lack of evidence about what the optimal total weight change in pregnancy or weight change in each trimester should be and there is not enough evidence to suggest that any particular nutritionally balanced diet is better than another in helping to achieve optimal weight change in pregnancy.
Breastfeeding
Here are some additional points to consider following bariatric surgery:
- There are no known contraindications for mother’s breastfeeding after bariatric surgery.
- Breast milk is unique and meets a baby’s nutritional requirements. The World Health Organization (WHO) recommends exclusive breastfeeding for six months. From six months of age, babies require additional nutrition provided by solid foods (weaning), alongside breastfeeding.
- Breastfeeding normally uses around 500 calories a day once established. You do not usually need to eat extra calories for this (unless you have lost a lot of weight or are underweight). Continue to have regular protein rich meals and snacks, and foods rich in calcium such as dairy foods and dairy alternatives throughout the day to ensure that you and your baby are receiving adequate nutrition.
- You are not required to take additional vitamins and minerals other than the usual post-operative recommendations summarised above. If you do not take your vitamins and minerals routinely, this may cause vitamin and mineral deficiencies that may affect the quality of your breast milk.
For more information about breastfeeding visit our Feeding your baby page
Contraception
Both gastric bypass and sleeve gastrectomy can affect the absorption of oral contraceptives containing an oestrogen component.
Therefore, you should avoid oral contraceptive pills (especially combined ones) as they are generally less effective post-bariatric surgery due to absorption issues.
The best options are long-acting methods (implant, IUS, IUD) and injectable contraceptives.