From the Guidelines
Women who have undergone gastric sleeve surgery require specialized prenatal care, including more frequent nutritional monitoring and higher supplementation needs, to minimize the risk of nutrient deficiencies and optimize maternal and fetal health, as recommended by the American College of Obstetricians and Gynecologists (ACOG) 1.
Key Modifications to Prenatal Care
- More frequent nutritional monitoring, with comprehensive laboratory assessments each trimester to check for deficiencies in iron, vitamin B12, folate, vitamin D, and calcium 1
- Higher supplementation needs, often requiring separate iron (65 mg elemental iron daily), vitamin B12 (1000 mcg daily), calcium (1200-1500 mg daily), and vitamin D (1000-2000 IU daily) 1
- Weight gain expectations are modified, with a recommended gain of 15-25 pounds for normal BMI patients, rather than the standard 25-35 pounds 1
- Glucose screening should be individualized, as traditional oral glucose tolerance tests may cause dumping syndrome; alternatives include home glucose monitoring or hemoglobin A1C testing 1
- Gastrointestinal symptoms like nausea and vomiting require careful management to prevent malnutrition and dehydration 1
Preconception Care
- Women with a history of gastric sleeve surgery should receive specialized care regarding their reproductive health, including preconception counseling and care 1
- Preconception care should include nutritional counseling and supplementation to optimize nutrient levels before pregnancy 1
- Women should be advised to take a multivitamin and mineral supplement daily, containing folic acid, iron, calcium, vitamin D, and other essential nutrients 1
Nutritional Monitoring and Supplementation
- Nutritional monitoring should be performed every trimester, including assessments of iron, vitamin B12, folate, vitamin D, and calcium levels 1
- Supplementation needs should be individualized based on nutritional monitoring results and may require higher doses of certain nutrients, such as iron and vitamin B12 1
- Women should be counseled on the importance of maintaining a balanced diet and avoiding nutritional deficiencies during pregnancy 1
From the Research
Prenatal Care in Women with Gastric Sleeve
According to the American College of Obstetricians and Gynecologists (ACOG), prenatal care for women with a history of gastric sleeve surgery requires special consideration. The following points highlight the key aspects of prenatal care in this population:
- Nutritional deficiencies: Women with a history of gastric sleeve surgery are at risk for nutritional deficiencies, including iron, vitamin B12, folate, and copper deficiency 2. These deficiencies can have significant implications for both the mother and the fetus.
- Supplementation: Routine mineral and multivitamin supplementation is recommended for women with a history of gastric sleeve surgery 3. Additionally, prevention of gallstone formation with ursodeoxycholic acid during the first 6 months after surgery is also recommended.
- Pregnancy outcomes: Studies have shown that women with a history of gastric sleeve surgery may have lower rates of gestational diabetes and large for gestational age (LGA) neonates, but higher rates of small for gestational age (SGA) neonates compared to non-operated controls 4.
- Monitoring: Regular monitoring of maternal and fetal health is crucial in women with a history of gastric sleeve surgery. This includes monitoring for nutritional deficiencies, gestational diabetes, and hypertension.
- Multidisciplinary care: A multidisciplinary approach to care, involving obstetricians, nutritionists, and other healthcare professionals, is essential for optimizing prenatal care in women with a history of gastric sleeve surgery 3, 5.
Key Considerations
Some key considerations for prenatal care in women with a history of gastric sleeve surgery include:
- Close monitoring of nutritional status and supplementation as needed
- Regular prenatal visits and monitoring of maternal and fetal health
- Multidisciplinary care involving obstetricians, nutritionists, and other healthcare professionals
- Awareness of the potential risks and complications associated with gastric sleeve surgery and pregnancy, such as nutritional deficiencies and gestational diabetes.