Pregnancy and Bariatric Surgery

You must avoid getting pregnant for at least 12 months after surgery. During this period you will be experiencing rapid weight loss and you are most at risk of vitamin and mineral deficiencies which may be harmful to the baby. The effectiveness of the pill may be reduced after surgery so you should seek advice on alternative methods of contraception.

If you do become pregnant after the first 12 months following surgery then your vitamin and mineral supplements may need to be adjusted. Pregnant women should undergo nutritional blood screening every trimester.

Healthy women, planning for pregnancy, should take an additional 400 mcg/day folic acid prior to conception until the 12th week of pregnancy however in women with obesity or diabetes, the recommendation is 5 mg folic acid until the 12th week of pregnancy as there may be an increased risk of neural tube defect affected pregnancy.

Women, as part of preconception care, are advised to avoid vitamin and mineral preparations which contain vitamin A in the retinol form in the first 12 weeks of pregnancy. Supplements containing retinol may increase the teratogenic risk especially in the first trimester. There are vitamin and mineral supplements containing no vitamin A which are specifically aimed at preconception and pregnancy e.g. Pregnacare, Seven Seas Pregnancy and Centrum Pregnancy Care; however avoidance of supplements containing vitamin A may place women more at risk of low vitamin A levels especially if they have had a distal bypass or BPD/DS. The health care professional should check that any supplements contain vitamin A in the beta carotene and not retinol form.

Patients who become pregnant following bariatric surgery should undergo nutritional screening every trimester. This should include ferritin, folate, vitamin B12, calcium and fat soluble vitamins. Pregnant patients, especially those who have had distal bypass or BPD/DS procedures, may be at risk of low vitamin A levels and possibly vitamins E and K. Vitamin A levels (and possibly vitamin E and K levels) should be monitored during pregnancy. A more frequent review with the specialist bariatric dietitian may be required.

 

Vitamin and mineral Supplements after gastric bypass/sleeve gastrectomy in pregnancy

Vitamin and minerals recommended

Multivitamin and mineral supplement

One daily Forceval (soluble and capsule).  It is safe to continue with Forceval as vitamin A is in beta carotene form however can consider a pregnancy multivitamin and mineral e.g. Seven Seas Pregnancy, Pregnacare, Boots Pregnancy Support

Iron

45 to 60 mg daily

200 mg ferrous sulphate, 210 mg ferrous fumarate or 300 mg ferrous gluconate daily.

Folic acid

Encourage consumption of folate rich foods.
Additional folic acid (5 mg), preconception and first 12 weeks of pregnancy.

Calcium and Vitamin D

Ensure good oral intake of calcium and vitamin D rich foods. Continue with maintenance doses of calcium and vitamin D as identified preoperatively. Patients are likely to be on at least 800 mg calcium and 20mcg vitamin D daily - Adcal D3, two daily (either two OD or one BD).

Vitamin B12 

Intramuscular injections of 1mg vitamin B12 three monthly. N.B. sleeve gastrectomy patients may need less frequent injections

 

 

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