From the Guidelines
For pregnant women with a history of gastric sleeve surgery, a folate dose of 4-5 mg daily is recommended, particularly for those with a BMI > 30 kg/m2, to prevent neural tube defects and ensure adequate maternal and fetal health. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of adequate folate supplementation in women with a history of bariatric surgery, including gastric sleeve surgery 1. The study suggests that a dose of 0.4 mg daily may be sufficient for most patients after bariatric surgery, but for those with a BMI > 30 kg/m2, a higher dose of 4-5 mg daily is recommended during the periconception period and throughout the first trimester 1.
Key Considerations
- Folate supplementation should begin ideally before conception and continue throughout pregnancy to ensure adequate levels for both maternal health and fetal development.
- Regular monitoring of folate levels and other nutrients, such as vitamins B12, D, iron, and calcium, is crucial during pregnancy to identify potential deficiencies and adjust supplementation as needed.
- A prenatal vitamin specifically formulated for women with bariatric surgery may be beneficial, but should be discussed with a healthcare provider to determine the best course of treatment.
- The British Obesity and Metabolic Surgery Society guidelines also recommend a higher dose of folic acid for women with a BMI > 30 kg/m2 or those with type 2 diabetes mellitus, supporting the recommendation of 4-5 mg daily 1.
Additional Recommendations
- Women with a history of gastric sleeve surgery should undergo nutritional screening during each trimester to monitor for potential deficiencies and adjust supplementation as needed 1.
- The importance of folic acid supplementation in preventing neural tube defects is well-established, and women with a history of bariatric surgery should be aware of the potential risks and benefits of supplementation 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... 0.8 mg for pregnant and lactating women, but never less than 0. 1 mg/day. The recommended folate dose for pregnant women, including those with a history of gastric sleeve, is 0.8 mg daily 2.
From the Research
Folate Dose for History of Gastric Sleeve in Pregnancy
- The required folate dose for individuals with a history of gastric sleeve in pregnancy is not explicitly stated in the provided studies.
- However, study 3 suggests that bariatric vitamin supplements containing 800 μg of folic acid daily can help maintain blood folate concentrations in women who have undergone sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB).
- Study 4 reports that less than 2% of patients who underwent SG or RYGB had folate deficiencies, indicating that folate deficiency may not be a common issue in these patients.
- Study 5 found that folic acid deficiency occurred in 4.5% of individuals who underwent bariatric surgery, including gastric bypass and adjustable gastric banding.
- Study 6 emphasizes the importance of folic acid supplementation in preventing birth defects, but does not provide specific guidance on folate dosing for individuals with a history of gastric sleeve in pregnancy.
- Study 7 highlights the need for further investigation into the prevalence of folate deficiency and its impact on anemia in bariatric surgery patients, but does not provide recommendations on folate dosing.