Obesity is not only an undesirable condition but also a very unhealthy state, which if not managed, can cause a lot of health problems. Obesity is considered a disease of excess body fat, where the BMI of a person is more than 30. Obesity also has three levels:
- Level 1: BMI level up to 35
- Level 2: BMI level up to 40
- Level 3: BMI level of 40 and above
While diet, exercise, lifestyle changes, and several other non-invasive methods including mediations fail to reduce the weight and the related health problems – the only resolution remains is that of a weight-loss surgery or medically known as bariatric surgery. Bariatric Surgery aims to reduce body fat by making changes in the digestive system of the body. In bariatric surgery, the doctor will modify the digestive system to limit the intake of food by making the stomach smaller; thus making one feel fuller even after a small meal. It may also involve making changes in the small intestines to limit the absorption of nutrients and calories from food.
Bariatric Surgery is the most sought after method in cases where diet and exercises have failed to produce results and obesity has been causing severe health complications such as:
- High blood pressure
- Heart problems
- Chronic digestive disorders including GERD
- Type 2 Diabetes
Hence, weight loss surgeries have become a very sought-after medical procedure, especially for women; and most women who undergo bariatric surgery are in their reproductive ages. Hence, it becomes very critical to evaluate the effect of weight loss surgery on pregnancy. In general, weight-loss surgery aims to resolve the problem of obesity – which is one of the major causes of infertility in women. Therefore, in a consensus, a pregnancy after weight-loss surgery is healthy and safe, provided it managed well. It is fit for both the baby and the mother as compared to pregnancy in obese woman. That said, some of the significant benefits and risks involved should be known so that women can make an informed choice.
Benefits of pregnancy after a weight-loss surgery
- Prevents women from gestational diabetes
- Minimizes risk of preeclampsia – a condition that raises the blood pressure and causes damage to organs post 20 weeks of pregnancy
- Enhances fertility – improves polycystic ovary syndrome, anovulation, irregular menses, etc.
- Resolves hormonal imbalances
- Improved neonatal outcomes
- Normal breastfeeding
- Improves hypertension
Risks of pregnancy after a weight-loss surgery
While the dangers of a pregnancy post a bariatric surgery vary from case-to-case; yet some general hazards that have been observed in women include:
- Risk of the baby being deprived of essential nutrients such as protein, iron, folate, calcium, Vitamin B12 and D
- Low birth weight
- Acute gastrointestinal problems during pregnancy, such as nausea, vomiting, abdominal pain, bleeding, etc.
- Abdominal cramping and bloating
- Risk of Hyperinsulinemia and hypo-glycemia leading to tachycardia, palpitations, anxiety, etc.
- Risk of malabsorption
- Increased chances of a caesarean delivery
- Chances of stillbirth
- Fetal neural tube defects
- Intestinal obstruction/hernia
- Gastric ulcers
- Band/staple line complications
- Higher chances of premature birth
- Higher chances of congenital anomalies
- Miscarriage (rare cases)
- Impair foetal development
- Foetal and neonatal complications
That said, weight loss surgery post-pregnancy is a highly risky pregnancy with many potential complications that may arise during pregnancy. Hence, detailed considerations must be taken into account and also all conditions should be thoroughly discussed with the doctor, before going ahead with the pregnancy.
However, women who conceive post a weight loss surgery can mostly manage with pre-emptive attention, care and regular guidance. Some of the necessary steps that must be undertaken to ensure a healthy pregnancy for both the mother and child – post a weight loss surgery are:
- Pregnancy should only be considered if the weight stabilizes post a weight loss surgery. Typically weight supports in approximately 12 to 24 months after surgery. This prevents the foetus from being adversely affected by dramatic weight loss
- Regular monitoring of the baby’s growth and health should be undertaken. Foetal ultrasound during the third trimester is advised to assess growth.
- Closer surveillance of the maternal weight and nutritional status of the pregnant woman should be undertaken.
- During the lactation period, regular assessments every three months, are recommended in women after bariatric surgery
- Nutritional supplements – such as folic acid, vitamin B-12, vitamin D, iron and calcium – as advised by the doctor based on the type of weight-loss surgery and specific nutritional needs, should not be missed.
- In case no deficiencies are noted, a full blood count along with measurement of iron, ferritin, calcium, and vitamin D levels should be conducted every trimester of the pregnancy.
- Glucose level of the mother should be consistently monitored, especially for women who have undergone restrictive/malabsorptive surgery.
- Oral drug administration must be cautiously watched in women who have undergone a gastric bypass surgery
- Extreme caution must be taken while consuming non-steroidal anti-inflammatory drugs during postpartum to avoid gastric ulceration.
In all, the risks outweigh the benefits of a pregnancy post a weight loss surgery. However, there have been many successful cases with no complications. Also, as per research and evidence, pregnancy post a weight-loss surgery is healthier for the baby and mother, as compared to a pregnancy complicated by obesity. Yet, all cases must be individually evaluated and discussed with the specialized medical practitioner before making a final decision.