It is generally recommended that women avoid pregnancy the first 12 to 18 months after bariatric surgery because of the dramatic weight loss. Once pregnant, patients should be monitored to be sure appropriate weight gain is occurring. Prenatal care is coordinated with the obstetrician, the bariatric surgeon and dietitian (1).

Energy needs

• You will need to increase calories by 300 to 500 calories for a total of 1,500 to 1,800 calories per day in the second and third trimesters. You will need to ensure that you get 71 grams of protein per day. This is not the time to lose additional weight. Ideally, you should gain the recommended weight (15 to 20 pounds) in order to develop a healthy fetus (2).
• Fat: Dietary source of Docosahexaenoic Acid (DHA) is desirable; evaluate cold water fish intake and consider a DHA supplement if consuming less than two servings per week. This recommendation meets the Food and Drug Administration safety guideline to limit the fish consumption to two 6-oz. servings (12 oz. total) during pregnancy and lactation (2).
• To avoid nausea, eat small meals throughout the day and separate solid meals from liquids (3).
• To assure adequate calories and protein, patients may need to consume three meals and three snacks per day (2).
• A liquid protein supplement can be used in addition to oral intake to help meet daily caloric and protein needs, especially if nausea is a concern (3).

Vitamin & mineral needs

It is important to supplement to optimize fetal growth. Continue with our recommended vitamin and mineral supplement list with the following tips:

• Take a complete sugar-free multivitamin/ mineral two times per day. A prenatal vitamin is not necessary (2).
• Be sure your vitamin A is less than 10,000 IU per day. Check the amount in your multivitamin (4).
• Ferrous Fumerate is found to be the best tolerated and most effective iron supplementation when the duodenum is bypassed. Take 30 to 65 mg of ferrous fumerate with vitamin C (1).
• Calcium supplements are needed for mineralization of the fetal skeleton. We recommend calcium citrate 1,200 to 1,500 mg/day (1).
• Take folic acid supplements to avoid neural tube abnormalities. Add together dosage in multivitamins, B complex, and supplement to a total dose of 400 mg at minimum. You may need to get a prescription from a physician (1).
• Take B12 1,000 mcg per day sublingually (2).
• Take B-Complex ensuring at least 100 mg Thiamine (B1) per day (2).

Important Points

• Glucose tolerance testing should not be performed. The test is potentially dangerous after surgery, the results are difficult to interpret and useless (1).
• Use of vitamin and mineral supplements is very important (1).
• Nutritional deficiencies can be avoided with good medical and pre-natal care (1).
• Consider breastfeeding as the best option to keep your baby/child at a healthy weight for life (4).

References

1. Alston, Jane A., Hamad, Giselle. Bariatric Times. Management and Outcomes of Pregnancy Following Bariatric Surgery. May 2008.
2. Biesemeier, Christina K., Garland, Jennifer. ADA Pocket Guide to Bariatric Surgery. Pregnancy After Weight-Loss Surgery. 2009; 125; 143-150.
3. Lito, Kathryn. Today’s Dietitian. That Bump’s a Baby Now: Pregnancy After Weight Loss Surgery. December 2008; 48-51.
4. Ward, Elizabeth M. Expect the Best. The American Dietetic Association. 2009; 46; 145.