Now I have started getting women who are pregnant and had Baratric surgery.Two of them have already delivered under my care and few others are currently pregnant.They are quite apprehensive ladies.The clinicians who were taking care of them before me also seemed little panicky in their management of these women.Do we really need to panic?What are the special precautions needed by these women during Pregnancy?Let me summarize it .
Which Procedure ? A Lady desirous of having a pregnancy and opt for Gastric sleeve or bypass.Once it was considered that bypass was a big no no for lady who have yet to conceive as the deficiency of nutrition was considered to be more in bypass.It is a fact but the deficiency is marginally more and not of significance.In bargain the weight loss is more with bypass ( again whether all this is healthy or not I am not commenting on that.It is for you to decide and the Bariatric surgeon to counsel you)
When to conceive? Ideally once the weight loss has has stablized.Mostly the recommended timeframe is 18 to 24 months.Till then Oral contraceptive pills shouldn't be used for contraception as the faliure rate is high due to lesser absorption of the medicine.
Preconceptional Planning? Meet a gynaecologist as well as Bariatric surgeon.These women should be tested of their micronutient levels preconceptionally and then in each trimester.These micronutrients are Iron,ferritin,folate,Vit D,Vit B 12 and serum Protein.
These women should be supplemented with multivitamins,iron,calcium and if deficient in protein on high protein diet.
Diet during Pregnancy? Diet should be same as pre pregnacy diet.If someone has a difficulty in swallowing high fibre diet like green vegetables it can be made semisolid by pureeing in a mixer.
Delivery? Caesarean section is recommended for only obstetric reasons.
Bariatric patients have a lot of preop as well as post major emotional issues and are advised to be in touch with a good bariatric surgeon who can be their counsler and can provide them the much needed support.It will also be a good idea to join a post bariatric surgery support group sessions.