Education
Pregnancy in a New Body
Valerie Ross Homan, MA, MS, LCSW
Coordinator, Clinical Support Services, New York Bariatrics
Lori Sperling Nevins, MSW, LCSW
Program Administrator, New York Bariatrics
The professional medical literature has well documented that morbid obesity affects health in numerous ways, including impacting the female reproductive system. Increasingly, many women seek weight loss surgery with the hope of resolving infertility that is related to conditions such as polycystic ovary syndrome (PCOS), or failure to conceive without diagnosed pathology. Our bariatric center has had dozens of such patients present for weight loss surgery over the past six years.
During the pre-operative evaluation period, patients are informed that it is unsafe for both patient and fetal health for pregnancy to occur in the first 18-24 months following gastric bypass surgery. This is the time period corresponding to rapid weight loss and possible nutritional insufficiencies. Some patients who have tried unsuccessfully to conceive, sometimes for years, are frequently distressed to learn of this additional delay to their well laid plans. Other patients are concerned about their ability to carry a pregnancy and deliver a healthy baby after weight loss surgery. On a very positive note, the good news is that post-operative gastric bypass patients who closely follow the recommendations of their bariatric surgery team and knowledgeable obstetricians can have a pregnancy and delivery free of complications resulting in a healthy baby. According to William P. Homan, M.D., Director of New York Bariatrics, the guidelines to a healthy pregnancy following gastric bypass are quite clear: 1) use reliable contraception and do not become pregnant too soon; and 2) prepare for pregnancy by becoming (and staying) nutritionally well-balanced.
On the issue of the timing of your pregnancy, Dr. Homan states that the 18-24 month waiting period is crucial. "Patients are losing weight at a rapid rate in the first months after surgery. The very window of opportunity that makes the surgery so effective for weight loss is potentially disastrous to the developing fetus." Dr. Homan describes a presentation at the 17th Annual Meeting of the American Society of Bariatric Surgery in
June 2000 in which investigators presented the findings of births to women who had become pregnant in the early months following gastric bypass surgery. All of the babies had very low birth weight and there were a variety of complications reported, some of them very serious. Dr. F. Michael Shaw, an obstetrician in White Plains, New York who has followed the pregnancies of several bariatric surgery patients, concurs with Dr. Homan's stringent guidelines. "The first trimester is critical to the development of the neurological and other organ systems of the baby." Dr. Shaw adds that early pregnancy with its rapid weight loss and compromised nutrition increases the risk for miscarriage, which could bring emotional consequences for women already feeling vulnerable about infertility issues.
Two of our patients exemplify the optimal experience of pregnancy and delivery after gastric bypass: Sylvia, a bariatric patient from May 2001, came to the program at 367 pounds and a BMI of 59. She had not achieved pregnancy in nine years of marriage but had no diagnosed pathology. She became pregnant at 2 years, 9 months post-op. Beverly, who had surgery in August 2001 at about 300 pounds and a BMI of 51, had had a child prior to weight loss surgery and became pregnant with twins 2 years, 6 months after surgery. Her experience with a second pregnancy was quite different than the first, not only because she became pregnant at a healthy weight but also because she was carrying two babies. A main concern for the both patients' pre-natal care was the issue of malabsorption since the gastric bypass patient has had her digestive system "rewired" so to speak. Both Sylvia and Beverly were followed by Dr. Shaw, who consulted frequently with Dr. Homan. Dr. Shaw states, "We consider our bariatric surgery patients to be high risk because of the potentially compromised nutritional status of these patients during pregnancy. They are at high risk for fetal growth restriction and need to be closely followed for this." At the beginning of their pregnancies, Sylvia and Beverly met with our dietitian, Denise Addorisio, R.D.,C.D.N., who reviewed their food diaries and made adjustments for them to follow throughout their pregnancy. Both women were encouraged to add additional protein to their diets. Denise also carefully reviewed the vitamin and mineral supplements that need to taken during pregnancy.
With consistent care and careful monitoring of the developing fetuses by Dr. Shaw, Beverly delivered, albeit prior to the delivery date, a healthy set of fraternal twin boys at 36 weeks gestational age. The boys weighed 4 lbs. 11 oz. and 4 lbs. 8 oz. Despite the fact that she was on total bed rest for a number of weeks, Beverly shares the experience of a less burdensome second pregnancy. She attributes this to the cessation of asthma attacks from which she suffered in the first pregnancy when she was morbidly obese. Sylvia describes "an easy and totally uneventful" pregnancy, under the careful monitoring of Dr. Shaw. She delivered her healthy baby girl, weighing 5 lbs. 11 oz., at 38 weeks gestational age.
Both Sylvia and Beverly have similar responses when sharing memories of their pregnancy experiences. While pregnant, both women knew that their significant pre-pregnancy weight loss would make it much easier to care for themselves and their newborns once they were home from the hospital. Sylvia shares that before her daughter was born she was confident she would be able to deal with the pressures of caring for a newborn and make it work somehow because "I was no longer struggling with the obesity that affected my mood and ability to accomplish daily tasks." Beverly states that she had striven to provide the best care for her first son, but now, after achieving a healthy weight and all that comes with it, she feels that she was able to "uncompromisingly walk the walk" in the care of her twins.
Pregnancy for the bariatric patient can be an emotionally charged issue on a number of levels. As can be expected, one of those issues is weight gain. Current recommendations are that a patient be as close to goal weight as possible prior to pregnancy, another reason for waiting the required 18 months to 2 years before getting pregnant. Healthy weight gain during pregnancy is required to ensure proper fetal development. Beverly gained 35 lbs., lost 25 lbs. immediately following delivery and added exercise to lose the last 10 lbs. Sylvia gained 34 lbs., lost all of the weight within two months, and then went on to lose another 15 lbs. over the following year.
Today, Beverly is back at work full-time. She also serves as the Patient Advocate for New York Bariatrics. With so much to try to balance, she and her husband sometimes feel harried. However, most of the time, Bev and her husband are the happy, proud parents of three very active boys. Sylvia, a clinical social worker, is back at work part-time. She and her husband are delighted to announce that they will be welcoming their second child into the world in February 2006.
WLS Lifestyles - www.wlslifestyles.com - Copyright 2007