Pregnancy After Weight Loss Surgery
Many post-op patients are concerned about pregnancy after
weight loss surgery, especially the Duodenal Switch procedure
which includes significant malabsorption. To follow is information
from a Duodenal Switch surgeon and testimonials from post-DS
weight loss surgery moms on their experience with post-op pregnancy.
Do not get pregnant until your weight has stabilized after 18
to 24 months post-op and use at least TWO forms of birth control
until cleared by your surgeon.
Pregnancy After Gastric Reduction Duodenal Switch
Ara Keshishian, MD, FACS
Dawn R. Keshishian, RN, CCRN
Weight Loss E-Newsletter –
April 27, 2009
Article reprinted with permission.
Due to the nutritional imbalances that may follow all weight
loss surgical procedures it is imperative to make certain
that your weight loss has stabilized and you have made it
past your 18-month to 2 years postop anniversary. During
the weight loss period a patient is in a negative nutritional
balance not getting enough calories are absorbed to support
the patient’s own weight and therefore would not be able to
support the addition of a growing healthy fetus. There is a
possibility of birth defects if you become pregnant prior
to weight stabilization and your 18-month to 2-year anniversary.
The decision absolutely needs to be discussed with your weight
loss surgeon prior to any attempts to conceive. After all the
above questions have been dealt with and resolved and you have
been cleared by your surgeon to attempt to conceive there are
extra steps needed for a post weight loss surgery pregnancy.
We will inform you of these steps during the decision process
with your surgeon. You always have to keep in mind that you
anatomy has been changed and how your body works also has been
changed. You should also start your preparation to become
pregnant several months prior to attempting to conceive.
You will need to be more diligent with follow-up with your
OB/GYN and your weight loss surgeon during your pregnancy.
Our office will work closely with your OB/GYN in your monitoring
your lab work and the progression of your pregnancy.
Testimonials from Post-Op DS Moms
By Sarah P.
Well, having the DS gave me the opportunity to do something
that I have always wanted to do ever since I was pregnant
with my first child – have a baby for someone else! There
would have been no way in hell a reproductive endocrinologist
would have approved someone with a BMI of 48 as a surrogate,
no matter how healthy she was otherwise. So, two years after
having the DS, I was at a good, stable weight with good,
stable labs. My surgeon gave me the green light, and off I
went to find a set of intended parents to have a child for.
I found my couple, they knew from the get go about my surgery.
I already had a perinatologist lined up who knew about the
particular concerns that having WLS can pose, and he was very
supportive of me. I met my couple’s RE, and got the go ahead
from him – apparently my uterus is a very pretty pink! So,
we were off! In preparation for getting pregnant, I had upped
my B vitamins, particularly my folic acid, my D, my calcium
and my iron.
In December of 2008, we transferred three embryos into my uterus.
On Christmas day, we got confirmation that we were pregnant!
Talk about a gift to give someone. By the middle of January,
we had confirmed that it was TWINS! This is where the fun
The hardest part of being pregnant with twins was gaining enough
weight. By the end, I really hadn’t gained enough, but part of
that was because I spent the last two months in the hospital due
to Premature Preterm Rupture of Membranes and lost nearly 20
pounds in 10 days. Ugh. I only managed to gain back 10 of those
lost pounds, but it was better than nothing.
The easiest part of being pregnant after the DS was keeping
up with being compliant with protein and vitamins. Knowing
that you’re responsible for someone else’s two babies is a
heavy load, and I watched every little thing that I did. Even
when I felt I couldn’t eat any more, I made certain to get in
more protein just so our little men would do well.
In the end, I really do feel that everything I did paid off.
Even though we were threatened with the early birth of the
boys at 26 weeks gestation with the PPROM, I managed to hang
in for 7 more weeks to finally give birth at 33 weeks, 2 days.
Not too bad for twins at all. The boys were 4 lbs, 1 oz and
3 lbs, 8 oz. Again, not bad for pre-term twins.
Neither the boys nor I were malnourished. Eating 200 grams of
protein per day plus all the other possible carbohydrates
that I could stuff into my pie hole made certain of that.
It was hard, but doable. The only thing that I came up short
on was my iron, and that was a result of having a C-section.
My iron scores actually went up during the pregnancy, but
then went crashing down afterwards. Typical even in “normies”.
I couldn’t have been happier with the choices that I made and
the decision to have the boys. And, I may possibly do it again.
I have had two very healthy post-DS babies. My oldest is 4
in May, my youngest turned 2 a week ago. I had very, very
normal pregnancies, gained no weight with first (only 18
months out when I got pregnant), and about 15 with my second.
Had some iron issues with both, but fine. My iron did truly
tank about 6 months ago, and I got iron infusions, so all is fine now.
Both of my little ones were full term, but little (6.5 and
6.12 lbs) and grew slowly and under the “norms” until 18-24
months, but now are “normal” or even maybe slightly larger.
No health issues, and both active, happy kiddos.
I had some trouble breastfeeding exclusively, I think because
I couldn’t eat enough to fuel it, but I supplemented successfully
with both for 8 and 10 months, respectively. From what I
understand, that is not terribly common, but depends on a
number of factors, so I wouldn’t assume that would be the case.
Bottom line: I probably would not have kids if I had not had the
DS. Either I wouldn’t have been able to conceive, would have had
health issues or they would have. I am blessed. I WOULD NOT TRADE
IT FOR ANYTHING. I wanted to have kids pre-DS, but we waited for
me to be healthy to carry to term a healthy baby. And now that
I have active toddlers, I am so glad I can run and chase them!!!
At 335, that would have been impossible. Now, I encourage active play.
I had my DS in 2003. I’ve had 2 children post op (2005 and 2007).
My iron and calcium were both a little low prior to pregnancy.
My doctors increased my supplements for both early on. Everything
else was normal going in. I had issues with malnutrition during
both pregnancies, and was hospitalized and put on bed rest both
times. Both babies spent several weeks in the NICU. My oldest
was only in the 5th percentile for weight until he was about 3.
He was tiny (in 12 month clothes at 3 yrs old). Then he had a
growth spurt. He’ll be 5 next month, and he’s pretty much caught
up with the other kids (in 5T clothes now). My 2 year old had
issues with larger than normal skull openings and an extra soft
spot in the back of his head. After tons of genetics and other
testing, they attributed it to my vitamin deficiencies. Both boys
had delays in rolling, walking, etc., but they are both doing
great now and are very bright little boys. If I had to do it all
over again, I would in a heartbeat. My main motivation for
having surgery was being told by my doctor that I might not ever
have children if I didn’t get the weight off. So, having 2
beautiful, healthy, happy little boys makes it all worth it.
Hope my story doesn’t frighten you, just wanted to be honest
about my experience. Others have had perfectly normal pregnancies.
I had a very normal pregnancy and I got pregnant 6 months
post op (by accident). I did have iron problems the last
month but that’s pretty much it. My son was small but within
a few months he is well above average for weight and height.
He’s 11 months old wearing clothes for 24 months and weighing
26 lbs already.
I am currently 27 weeks pregnant. The size of my baby is
great and she seems to be growing normally. I got pregnant
10 months out from surgery using birth control. You will
get people a bit angry at you for not “being more careful”
but they are usually just trying to be helpful and warn other
new post-ops. I experienced this with my “wow, I’m pregnant!”
post. There are a lot of nice people that will be along to
give you some great advice. Try not to get too stressed out
but keep a safe sense of worry about the baby as far as
vitamins, water and food.
Now, onto the health of the baby…no, don’t stop taking
your vitamins and get into your appointment sooner, rather
than later! It would be helpful if you listed your labs levels
and what you are currently taking. Go by your latest blood
work levels. The baby is taking everything first and you
need to keep up your levels as much as possible. I replaced
my multis with prenates giving me double the dosage of folic
acid. My A and D had been going lower since surgery and I
had been upping it to 150K iu per day for each. I was afraid
of A toxicity to the baby, but keep in mind that your blood
serum level is an indication of what you are actually absorbing
and the baby takes from that, not the high dosages each day.
Some docs will worry about the high dosages, but I’ve found
that it’s the same nod and smile routine as before pregnancy,
since most of them don’t understand our malabsorption. My
hemogloblin has slowly been going down during the pregnancy,
so make sure you are okay on iron or start taking iron if you
need it. I’m sure you are already getting labs done every 3
months for the first year anyway, but keep on top of it.
Also, let your surgeon know ASAP. I have my PCP, Surgeon
and OBGYN all in the loop and they communicate between each
other and fax labs back and forth. At first I was told by many
on the board that I’d have to go to a high risk specialist.
However, my medical team thinks I am not high risk compared
to how I would’ve been at 286 lbs. Increase your complex
carbs to keep out of ketosis, which is harmful to the brain
development of the baby. Since getting preggo, I’ve lost an
additional 12 lbs but tried to stop the weight loss with added
complex carbs. Each visit to the doc, the nurses are stumped
as to why I’ve lost a little weight and not gained any. Stay
up on your protein too, it is very important! I’m eating ALL
THE TIME, healthy things, but I still feel like a machine
trying to get in as much as possible to the baby.