From the Guidelines
It is strongly recommended to wait 12-18 months after gastric sleeve surgery before becoming pregnant, as this allows for weight stabilization and reduces the risk of nutritional deficiencies and complications during pregnancy. This waiting period is crucial in ensuring that the body has adapted to the significant weight loss that typically occurs during the first year post-surgery, and that adequate nutrition is maintained before conception 1. During this time, reliable contraception should be used to prevent unplanned pregnancy.
When conception is planned, it is essential to work closely with both the bariatric surgeon and an obstetrician experienced in high-risk pregnancies. Specialized prenatal vitamins and careful monitoring of nutrient levels, particularly iron, folate, vitamin B12, vitamin D, and calcium, are necessary as the gastric sleeve reduces the ability to absorb certain nutrients 1. Regular blood tests will be necessary throughout pregnancy to check for deficiencies.
Some key points to consider during pregnancy after gastric sleeve surgery include:
- Women with a BMI < 29.9 kg/m2 should take an additional 400 micrograms/day folic acid prior to conception until the 12th week of pregnancy, while those with type 2 diabetes mellitus or a BMI > 30 kg/m2 should take 5-mg folic acid until the 12th week of pregnancy 1.
- Vitamin B12 deficiency should be checked before starting folic acid supplements, and vitamin A should be replaced with beta-carotene form or taken as preconception or pregnancy-specific vitamin and mineral supplements 1.
- Pregnant women should undergo nutritional screening during each trimester, including ferritin, folate, vitamin B12, calcium, vitamin D, and vitamin A levels 1.
- A more frequent review with a specialist bariatric dietitian may be required, especially for women who have had long-limbed bypass or BPD/DS procedures, who may be at risk of low vitamins E and K levels 1.
Pregnancy after gastric sleeve surgery is generally considered safe when properly managed, and many women experience fewer pregnancy complications compared to obese women who haven't had bariatric surgery 1. However, the surgery's restriction of food intake and potential nutrient malabsorption make nutritional monitoring essential for both maternal health and fetal development.
From the Research
Pregnancy after Gastric Sleeve
- Pregnancy after gastric sleeve surgery is a growing concern, with studies indicating that patients who have undergone bariatric surgery are at high risk for nutritional deficiencies before and after surgery if no proper supplementation and close follow-up are maintained 2.
- A retrospective case-control study found that laparoscopic sleeve gastrectomy was associated with reduced rates of gestational diabetes mellitus, excessive fetal growth, and cesarean delivery, but an increased rate of small-for-gestational-age (SGA) and low-birth-weight neonates 3.
- The study also found that patients who had undergone laparoscopic sleeve gastrectomy had lower hemoglobin levels in early pregnancy and after delivery, and a higher proportion of patients were treated with intravenous iron supplementation during pregnancy 3.
- Nutritional needs for patients who have undergone bariatric surgery and become pregnant are different from those of patients with obesity or a non-bariatric population, and require close monitoring and supplementation to prevent deficiencies 2.
- The available evidence suggests that gastric sleeve surgery can have significant effects on pregnancy outcomes, and highlights the need for careful management and monitoring of patients who become pregnant after undergoing this type of surgery 2, 3.