The Complications of Pregnancy in Obese Women

The Complications of Pregnancy after Gastric Bypass

It is important to recognize that there are risks to both the mother and the child in patients who have undergone surgery for obesity.  Most of these appear to be related to nutritional deficiencies that can be prevented or treated with simple vitamin and mineral supplementation.

Advice to the patient considering pregnancy after gastric bypass surgery

"Early prenatal care is essential for pregnancy dating and nutritional evaluation. It is important to determine the baseline nutritional status early in the course of the pregnancy. Laboratory data assists in this assessment. If there are deficiencies, they are best corrected early in the pregnancy Ideally, the time to correct nutritional problems is pre-conception, making pregnancy planning the most sensible approach. Vitamin and iron supplementation is important in all pregnancies. It is even more important for post-bariatric surgical patients. The prenatal vitamins should be given in addition to the patient's usually prescribed vitamin supplementation and not instead of that supplementation."

"We have found ferrous fumerate to the best tolerated and most effective iron supplement when the duodenum is bypassed, although a prospective, randomized study is needed to better evaluate this recommendation. Prenatal care is best accomplished with careful coordination between the obstetrician and the bariatric surgeon. There are significant differences between the restrictive operations (such as the operation studied in this paper) and those that cause malabsorption. There are also combinations of the two types which generally take on the risks of the malabsorption procedure. The bariatric surgeon will best understand the physiologic changes induced by the anatomic manipulations. These surgeons also better understand the disease of morbid obesity and the behaviors that are important to follow after RYGB." (Pregnancy Following Gastric Bypass for Morbid Obesity, Wittgrove et. al., Obesity Surgery, 8, 1998, 461-464)

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Warning: Gastric Bypass Surgery is a MAJOR surgical procedure. It can be associated with significant risks and complications, up to and including death. Weight loss surgery is a rapidly developing area of medicine. Bariatric surgery is filled with controversy. It is very important to take a careful and deliberate approach to considering surgery for the treatment of obesity.  

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