Interesting news for anyone considering weight loss surgery before trying get pregnant.
Even though you’ll have lost the weight, you still won’t escape the ‘high risk’ bracket, and will likely receive much of the same treatment that you would if you were still big. Furthermore it seems that a number of things could go wrong, a significantly increased risk of miscarriage being one of them, if you get pregnant within 18 months of the surgery (31% of pregnancies occurring within 18 months of surgery, as opposed to 18% of pregnancies occurring 18months+ after surgery).
Which looks at different research, some of which compared pregnancies after different types of weight loss surgeries against each other, some against those of obese patients who haven’t undergone surgery, and some against ‘healthy weight’ women.
The text (and sub-text) is quite interesting:
“Case–control studies demonstrate increased fertility following bariatric surgery, although these studies lack complete data and statistical significance due to small sample sizes.”
It would be interesting to see whether this is due to the positive effect of weight loss on Poly Cystic Ovary Syndrome in particular, which is known to affect fertility the heavier you are, or whether in general it improved fertility for larger women.
“Post-LAGB [Laparoscopic adjustable gastric banding] pregnancies are not without complications. Band slippage and migration can result in severe vomiting. Band leakage is reported in 24% of cases.”
“Mild nutritional deficiencies are frequent after bariatric surgery”.
“Significant malabsorption in the mother can affect the energy content of breast milk and may affect the postnatal growth of the baby”.
The solution given for this is to supplement breast milk with formula. But mixed feeding with both bottle and breast is a significant indicator for stopping breastfeeding sooner.
“Aside from nutritional deficiencies, case reports have documented risks of intestinal hernia (most commonly reported), intestinal obstruction, perforation and death in pregnant women post-RYGB [Roux-en-Y gastric bypass].”
Hmm. Again, tempting.
If you are considering gastric surgery because you were concerned about having a caesarean or induced labour:
“Overall, bariatric surgery does not appear to reduce the risk of CD [caesarean delivery].”
“Another study showed higher labour induction rates as compared with non-obese comparison groups.”
There may also be reasons not to consider certain types of bariatric surgery if planning to get pregnant. One study reported:
“higher congenital malformation rates following BPD [Biliopancreatic diversion].” and
“Miscarriage rates following BPD [Biliopancreatic diversion] may be higher.”
“There is no strong evidence that adverse neonatal outcome rates are higher following LAGB and gastric bypass procedures as compared with obese groups”.
So reading between the lines, there is evidence that outcomes for babies aren’t as good following surgery, just not strong evidence?
But my personal favourite is:
“maternal and fetal outcomes are acceptable with LAGB and gastric bypass”.
Acceptable? What does that mean?
On the positive side:
“Most studies report a reduced incidence of GDM [gestational diabetes mellitus] in
patients following bariatric surgery.”
“Studies comparing pre- and postbariatric surgery pregnancies consistently show that the incidence of PIH [pregnancy induced hypertension or high blood pressure] and pre-eclampsia is lower following surgically induced weight loss than the risks in obese women.”
The study concludes:
“In light of current evidence available, pregnancy after bariatric surgery is safer, with fewer complications, than pregnancy in morbidly obese women”.
Hmm. I’m struggling to be convinced. 21% of post-surgery pregnancies reported problems according to one study. Though I can’t find a comparable statistic for obese women who have not had weight loss surgery, that doesn’t seem like great odds. Presumably the reduction in serious complications like pre-eclampsia are significant enough for the authors to reach this conclusion.
As always, it’s for you to make up your own mind, but at least here’s some information for you to get started.