Obese women have been found to have a higher incidence of polycystic ovarian syndrome (PCOS), a condition that is often responsible for the inability to achieve pregnancy in them. Obesity and its associated disease conditions may also lead to adverse pregnancy outcomes. Thus, after gastric sleeve surgery (or other bariatric surgeries) the weight loss is usually associated with improvement in these conditions and pregnancy may follow.
The fact that significant portion of those undergoing bariatric surgeries is women of reproductive age, one cannot rule out getting pregnant after the surgery. It is therefore important to be aware of potential effects of the surgery on pregnancy outcomes.
- Is it safe to get pregnant after gastric sleeve surgery?
- When can one get pregnant after gastric sleeve surgery?
- What are the risks of getting pregnant after gastric sleeve surgery?
- What special care should be given to pregnant women who have had gastric sleeve surgery?
Is it safe to get pregnant after gastric sleeve surgery?
Following bariatric surgery, most pregnancies have been found to have successful outcomes with reduction in the incidences of pregnancy induced hypertension, gestational diabetes and low birth weight babies.2
When can one get pregnant after gastric sleeve surgery?
Weight loss after gastric sleeve surgery is most significant during the first 12-1 8months. For malabsorptive bariatric surgeries, this period is also characterized by various forms of nutritional deficiencies. There is general assumption that pregnancy during this period may have adverse outcome. However, a study comparing pregnancy before and after the first 12months post-surgery found no significant difference between the two in terms of hypertension, diabetes, malformations, and birth weight.
For gastric sleeve surgery in which there is no malabsorptive component, pregnancies during the first year of operation can be expected to have the same outcome as those after the first year. Some authorities do not recommend waiting especially if pregnancy is seriously desired.
However, because it may be difficult for most people to differentiate pregnancy symptoms from those of surgical complications, many authorities, therefore, recommend that pregnancy should be avoided during this critical period for weight to stabilize and for any nutritional deficiency to be corrected.
For those that prefer to delay pregnancy, effective contraception is recommended. There is no consensus on the best form of the contraceptive device. Following malabsorptive procedures, oral pills should be avoided or supported with a barrier method, due to the likelihood of poor absorption. However, for gastric sleeve surgery, any form of contraception can be used.
What are the risks of getting pregnant after gastric sleeve surgery?
The primary concern for pregnancy following bariatric surgery is nutritional deficiencies. This commonly follows malabsorptive procedures such as duodenal switch and gastric bypass. The commonly involved micronutrients include iron, folic acid, vitamin B12, albumin, and calcium. This may aggravate anemia during pregnancy with subsequent fetal growth restriction. But for gastric sleeve surgery, there is a low incidence of nutritional deficiency making pregnancy after this procedure relatively safe.
Although the incidences of pregnancy induced hypertension and gestational diabetes mellitus during pregnancy, after bariatric surgery, is higher when compared to those of non-obese individuals, it is significantly lower than in obese pregnant women who never had bariatric surgery. This may be because most patients were still obese as at the time of getting pregnant.
Increased rate of cesarean delivery has also been noticed among pregnant women following bariatric surgery in some studies while other studies have reported a reduction in the rate of cesarean delivery. Those that reported increased incidence found a direct relationship between cesarean delivery rate and the degree of obesity at the time of delivery.
Lapolla et al. reported no significant increase in the risk of delivering low birth weight babies among those that had laparoscopic adjustable gastric banding (a restrictive surgery like gastric sleeve surgery) when compared with the average population.
What special care should be given to pregnant women who have had gastric sleeve surgery?
Apart from the routine antenatal care, women who got pregnant after gastric sleeve surgery should be given a multidisciplinary care that involves the surgeon, the obstetrician, and the nutritionist. They should be educated on the need to adhere to dietary plan in order to prevent nutritional deficiencies. The obesity associated disease conditions must be optimized with drug dosages adjusted as required and certain drugs that are unsafe during pregnancy should be substituted.
Further care depends on the type of bariatric surgery and other conditions peculiar to the patient. Therefore regular antenatal visits and adherence to caregivers’ advice have no substitute in ensuring a successful outcome.
In conclusion, gastric sleeve surgery and other bariatric surgeries induce weight loss and in turn improve fertility. The general recommendation is to avoid pregnancy within the first 12-18 months of bariatric surgery. Many studies, however, have shown no adverse effect if pregnancy occurred during this period. Therefore those desirous of pregnancy can do so without the fear of unwanted pregnancy or perinatal outcome.
- Kaska L, Kobiela J, Abacjew-Chmylko A, et al. Nutrition and Pregnancy after Bariatric Surgery. ISRN Obesity. 2013;2013:492060. doi:10.1155/2013/492060.
- Kominiarek MA. Preparing for and Managing a Pregnancy After Bariatric Surgery. Seminars in Perinatology. 2011;35(6):356-361. doi:10.1053/j.semperi.2011.05.022.
- Sheiner E, Edri A, Balaban E, Levi I, Aricha-Tamir B. Pregnancy outcome of patients who conceive during or after the first year following bariatric surgery. American Journal of Obstetrics and Gynecology. 2011;204(1):50.e1-50.e6. doi:10.1016/j.ajog.2010.08.027.
- Lapolla A, Marangon M, Dalfrà M et al. Pregnancy Outcome in Morbidly Obese Women Before and After Laparoscopic Gastric Banding. Obesity Surgery. 2010;20(9):1251-1257. doi:10.1007/s11695-010-0199-7.