From the Guidelines
Women who have undergone gastric sleeve surgery require several modifications to their prenatal care, including taking higher doses of prenatal vitamins, specifically with 5mg of folic acid daily, and monthly monitoring of vitamin levels, particularly iron, vitamin B12, folate, calcium, and vitamin D, with supplementation as needed, as recommended by the British Obesity and Metabolic Surgery Society guidelines 1.
Key Modifications to Prenatal Care
- Women should take an additional 5mg of folic acid daily prior to conception and throughout the first trimester, especially if they have a BMI > 30 kg/m2 or type 2 diabetes mellitus 1.
- Nutritional screening should be performed every trimester, including ferritin, folate, vitamin B12, calcium, vitamin D, and vitamin A levels 1.
- Women who have had long-limbed bypass or BPD/DS procedures may be at risk of low vitamins A, E, and K levels, and these should be monitored during pregnancy if clinically indicated 1.
- A more frequent review with a specialist bariatric dietitian may be required to ensure adequate nutrition and supplementation 1.
Additional Recommendations
- Women should avoid vitamin and mineral preparations containing vitamin A in the retinol form during the first 12 weeks of pregnancy, and instead use supplements containing beta-carotene form or preconception/pregnancy-specific vitamin and mineral supplements 1.
- The risk of internal hernias should be considered when evaluating abdominal pain, and weight gain goals may need to be modified to 11-20 pounds total during pregnancy 1.
- Women should be screened earlier for gestational diabetes, typically at 16-18 weeks, and may require more frequent ultrasounds to monitor fetal growth 1.
Importance of Specialist Care
- Women who become pregnant after bariatric surgery should be treated as a specialist obstetric population with specific needs, including access to specialist dietetic support and close monitoring of nutrition 1.
- Reference ranges for nutritional parameters may change during pregnancy, and it is essential to use pregnancy-specific reference ranges when interpreting blood results 1.
From the Research
Changes to Prenatal Care in Women with Gastric Sleeve
- Women who have undergone gastric sleeve surgery may require closer monitoring and specialized prenatal care due to the potential for nutritional deficiencies and other complications 2, 3.
- The risk of anaemia is lower in women who have had gastric sleeve surgery compared to those who have had gastric bypass surgery 3.
- Women who have had gastric sleeve surgery may be at a higher risk for small for gestational age (SGA) neonates, but the risk of large for gestational age (LGA) neonates is lower compared to non-operated controls 4.
- The average weight gain during pregnancy in women who have had gastric sleeve surgery is around 8.9 kg, and the risk of gestational diabetes is around 5.7% 4.
- Prenatal care for women with gastric sleeve surgery should include regular check-ups and monitoring for potential complications such as vitamin deficiencies and hypoalbuminemia 5, 6.
- The time interval between gastric sleeve surgery and conception may not have a statistically significant impact on maternal or neonatal outcomes, but further research is needed to confirm this 4.