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Weight Loss Surgery and Fertility

By Katie Conrad, BSN, RN

Weight Loss Surgery and Fertility

If you’re considering weight loss surgery before conceiving a child, or if you’ve recently had such surgery and want to try to get pregnant, you’re not alone.

Weight loss surgery can affect how your body absorbs nutrients, your fertility and your risks for pregnancy and birth complications. Being at a stable, normal weight is important for a healthy pregnancy and baby. Since more American women than ever before are either overweight or obese before conceiving, whether you should lose any weight before conceiving is a great conversation to have with your healthcare provider.

I’ve Had Surgery

Wait before conceiving post-surgery
Every year, half of all women who undergo weight loss surgery are ages 18-45, according to the Journal of the American Medical Association. For those who want to have a baby, the #1 question is: When is it safe to get pregnant after surgery?”

Most experts recommend that you avoid conceiving for at least 1 year after weight loss surgery so that your body and your weight can stabilize. This includes gastric bypass surgery or gastric banding surgery. Most women continue to lose weight for up to a year after surgery, some even experience sudden, rapid weight loss, and your body may struggle with absorbing nutrients from the food you eat.

Waiting at least a year post-surgery decreases some of the risks that can emerge in pregnancy immediately following weight loss surgery, such as birthing baby too small for its age or even fetal death.

Prepare for pregnancy
If you’ve had weight loss surgery, talk to your healthcare provider about whether you need additional vitamin supplements.

Because weight loss surgeries, particularly gastric bypass, stop food from traveling through the area between your stomach and upper small intestine, where much of the nutrition you eat gets absorbed, you could have deficiencies in vitamins and minerals essential for a healthy pregnancy, particularly vitamins A, K and B12, as well as iron, calcium and folic acid.

If you have a folic acid deficiency your baby’s risks for having neural tube defects, such as spina bifida, are increased. Taking a daily prenatal vitamin and any additional supplements your provider recommends is essential.

Surgery-related complications
The physical stress of pregnancy, post-surgery, includes greater risks of an intestinal blockage or hernia. Half of all people who have gastric bypass develop gall stones, which could lead to inflammation of your pancreas. If left untreated, these health issues could lead to life-threatening complications.

During pregnancy, as your expanding uterus puts extra pressure on surrounding organs—to the point of shifting them around—you’re also more prone to vomiting with banding. Your bariatric surgeon will need to monitor and adjust the band throughout pregnancy so that you and your baby can eat enough for normal weight gain and fetal growth.

I’m Thinking About Surgery

Obesity and infertility
Obesity reduces your chances of conceiving because it affects both your body’s metabolism and menstrual patterns, particularly if you have been diagnosed with polycystic ovarian syndrome (PCOS). This condition causes infertility by increasing insulin resistance in your body, which ultimately impairs your ability to mature an egg for fertilization.

Ovulation may be hampered or even stopped. If you’re overweight and have irregular periods, ask your healthcare provider if you’re at risk for PCOS. Losing weight, through diet or surgery, can help restore normal menstrual cycles and reduce PCOS.

Obesity and pregnancy
If you’re obese now and pregnant, you already have increased risks for gestational diabetes and high blood pressure, as well as having a baby born too small or too large. You’re also at greater risk for having problems with your placenta and preeclampsia, a form of high blood pressure in pregnancy that requires immediate birth of the baby to stop it. Being overweight or obese also increases your risks for cesarean, which is major abdominal surgery.

Getting to a healthy weight decreases these potential risks and increases your chances of having a natural, vaginal birth. Talk to your healthcare provider if you need to lose weight prior to conceiving—if you’re obese now, it may be worth considering weight loss surgery when compared to the risks of conceiving and carrying a pregnancy while obese.

What is weight loss surgery?

Two of the more common weight loss surgeries are Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. Bypass surgery does what it sounds like—food bypasses major sections of your stomach and intestines so that you feel full sooner, and eat less, and you absorb less of the calories (nutrition) in the food you do eat.

With gastric banding, a band is put around the upper portion of your stomach and altered via saline injections, thereby creating a faster sense of fullness and reduced capacity for eating. The FDA recently advised consumers to make sure they fully understand their risks in contrast to weight loss claims they may see advertised with lapband surgery.

Katie Conrad, BSN, RN, is a clinical nurse on an advanced care unit at Miami Valley Hospital in Dayton, OH. Anne C. Russell, PhD, RN, CNS-BC, is an assistant professor at Wright State University-Miami Valley College of Nursing & Health in Dayton, OH. Kathy J. Keister, PhD, RN, CNE, is an associate professor at Wright State University-Miami Valley College of Nursing & Health in Dayton, OH.

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