From the Guidelines
Women with a history of gastric sleeve surgery require special attention during pregnancy due to potential nutritional deficiencies. I recommend regular monitoring of specific labs including complete blood count, iron studies, vitamin B12, folate, calcium, vitamin D, and protein levels throughout pregnancy. These should be checked at the first prenatal visit and then quarterly. Nutritionally, these patients should take a prenatal vitamin with additional supplementation as needed:
- 1000-2000 IU vitamin D daily
- 1000-1200 mg calcium daily (calcium citrate preferred for better absorption)
- 40-65 mg elemental iron daily
- 350-500 mcg vitamin B12 daily
- Protein intake should be prioritized at 60-80 grams daily
- Small, frequent meals (5-6 per day) are recommended to prevent dumping syndrome and maintain adequate nutrition
- Liquid calories should be minimized and separated from meals by 30 minutes. These recommendations are based on the guidelines provided by the Obesity Reviews journal, which emphasizes the importance of nutritional monitoring and supplementation in pregnancy after bariatric surgery 1. Additionally, the Advances in Nutrition journal provides recommendations for nutritional care in bariatric patients, including supplementation and dietary advice 1. It is essential to consult with both a maternal-fetal medicine specialist and a dietitian with bariatric expertise for optimal management. Some key points to consider include:
- Avoiding vitamin and mineral preparations that contain vitamin A in the retinol form during the first 12 weeks of pregnancy
- Taking additional folic acid to reduce the risk of fetal neural tube defects
- Monitoring vitamin B12 levels during the preconception period
- Increasing fluid intake and consuming a balanced diet to prevent dehydration and nutritional deficiencies. By following these recommendations, women with a history of gastric sleeve surgery can minimize the risk of nutritional deficiencies and ensure a healthy pregnancy.
From the Research
Gastric Sleeve History
- The gastric sleeve, also known as sleeve gastrectomy, has become a popular surgical procedure for weight loss over the last few years, likely to surpass gastric banding in popularity 2.
- The procedure involves removing a large portion of the stomach, leaving a narrow sleeve-like stomach, which can lead to nutritional deficiencies if not properly managed.
Nutrition Plan
- After sleeve gastrectomy, patients are at risk of developing nutritional deficiencies, including vitamin B12 deficiency, which was found to be present in 20% of patients in one study 2.
- A multidisciplinary approach is recommended to ensure adequate nutrition, counseling, and screening before and during pregnancy for women with a history of bariatric surgery, including sleeve gastrectomy 3.
- Routine iron supplementations may reduce anemia after sleeve gastrectomy, but the dosages recommended by current guidelines may be insufficient, and more strict monitoring schedules and supplementation strategies should be established 4.
Lab Checks in Pregnancy
- Women with a history of bariatric surgery, including sleeve gastrectomy, are at risk of developing nutritional deficiencies during pregnancy, which can lead to complications such as low birth weight and fetal growth restriction 3.
- Regular lab checks are necessary to monitor for nutritional deficiencies, including vitamin B12, iron, and folate, and to adjust supplementation as needed 2, 5, 4.
- A study found that the prevalence of ferritin deficiency steadily increased from 6% at baseline to 27% at 60 months after sleeve gastrectomy, highlighting the need for long-term monitoring and supplementation 4.