So You Want to Have a Baby
Nothing can replace the joy of bringing a new baby into the world. Unfortunately, obesity often hinders a couple’s ability to conceive. It also poses increased risks to mother and child during pregnancy and delivery. Don’t despair, there is hope! Weight loss surgery, the only successful long-term weight loss treatment, can increase fertility and improve odds of having a healthy pregnancy and uneventful delivery.
Some women with obesity specifically seek weight loss surgery in order to be able to conceive. Others are on a mission to improve their own health and well-being and happen to have children after. No matter what your situation, if you’re a woman of child-bearing years, you’ll want to learn about having a baby after weight loss surgery.
“I believe the choice to become a mother is the choice to become one of the greatest spiritual teachers there is.” —Oprah Winfrey
Obesity and Pregnancy
Fertility
Just getting pregnant can be difficult with obesity. One way obesity hinders pregnancy is through excess estrogen production. In addition to ovaries producing the female hormone estrogen, fat cells do too. If the body has an abundance of fat cells, chances are estrogen levels are high. This becomes a problem when the body reacts as if it is already pregnant or taking estrogen containing birth control—ovulation slows or stops and periods become irregular or discontinue altogether.
Another barrier to getting pregnant is polycystic ovarian syndrome (PCOS) — one of the most common hormonal complications in women of reproductive age. PCOS is associated with obesity, but it’s not clear if PCOS leads to obesity or obesity leads to PCOS. Women with PCOS may have irregular cycles and difficulty getting pregnant due to the production of excess androgens, a male hormone. PCOS also causes a malfunction in another hormone, insulin, making it very difficult to lose weight. This creates a vicious cycle where high insulin levels make weight gain likely and weight gain makes PCOS symptoms worse. It’s hard to break free from that cycle and increase fertility.
Obesity and Pregnancy/Delivery Difficulties
If a woman is able to get beyond fertility challenges and become pregnant, there are extra risks for both her and baby. There’s a greater risk of miscarriage, diabetes, and hypertension during pregnancy. Delivery may be more difficult with a larger baby and greater likelihood of a C-section.
Baby is at greater risk for neural tube defects (such as spina bifida), heart defects, low blood sugar, and larger body size. As baby grows into a child, he or she is more likely to develop obesity, type 2 diabetes, and high cholesterol.
Gestational Diabetes
Obesity increases the risk for gestational diabetes mellitus (GDM) which causes high blood sugar levels that can harm both the mother and the baby’s health. GDM increases the risk for excessive birth weight, early delivery, and low blood sugar in the baby. Although GDM usually resolves after delivery, it does increase the risk of the mother developing Type 2 diabetes in the future.
Preeclampsia
The risk for high blood pressure during pregnancy, preeclampsia, is 3 times greaterfor obese mothers. If left untreated, preeclampsia can cause severe problems for both mother and baby.
After Weight Loss Surgery
How Weight Loss Surgery Helps
Here’s the good news! Fertility, pregnancy and delivery issues can be improved or resolved with weight loss surgery.
- Research studies show a higher pregnancy rate and lower occurrence of miscarriage for those who’ve had bariatric surgery. (1)
- Type 2 diabetes is greatly improved or resolved. (2)
- PCOS resolves in a large percentage of those having weight loss surgery. (3)
- Menstrual periods typically normalize. (3)
It’s all in the Timing
Women with compromised fertility before weight loss surgery need to be aware that fertility increases quickly after surgery—even before there has been significant weight loss. Bariatric experts recommend waiting until excess weight is lost and weight has stabilized—typically 2 years after surgery.
Why so long? During those first two years after surgery, nutrient consumption is very limited and nutrient imbalances that could be harmful to a developing baby are a risk. The 2-year time period gives the body a chance to restore optimal nutritional balance while adjustments to new, healthy eating habits are made. This allows mom to better support a healthy pregnancy and reduces the risk of a small birth weight baby.
“The moment he wakes up from a nap.… Just a gummy mouth, no teeth, just a big smile, happy that you’re alive and you’re just looking at him. That’s probably the most magical.” —Jessica Biel
Oral Glucose Tolerance Tests
A routine screening test for gestational diabetes mellitus (GDM), the oral glucose tolerance test, is done during pregnancy. Pregnant moms are asked to drink a sugary glucose solution with blood sugar labs drawn at specific times to assess how well their body is handling the sugar load. After gastric bypass surgery this test has a high likelihood of triggering dumping syndrome and should not be performed. Your doctor can have you monitor blood sugar levels at home and/or have a long-term blood sugar test called an A1C done in place of the glucose tolerance test.
Vitamin and Mineral Supplements
Supplementation of vitamins, minerals, and trace elements after bariatric surgery, especially during pregnancy, is essential to avoid deficiencies in mother and child. Both the bariatric surgeon and obstetrician can help work out an individual supplement protocol to meet individual needs.
Bonus Benefit for Children
Did you know that bariatric surgery benefits unborn children too? Children born to a mother who has had weight loss surgery have a lower risk of obesity later in life, thanks to the activation of specific genes while in the womb that improve insulin sensitivity and lipid profiles. (5)
Children that were born before a woman had weight loss surgery miss out on this genetic perk, but they still reap the rewards of a healthy mom setting example after example of how to live a fit life. Being able to be a positive role model to your children is a priceless gift.
The Bottom Line
Pregnancy after weight loss surgery may be one of the greatest rewards of going through the process and committing to yourself to reach your goal. Healthy babies begin with healthy moms. Wise planning and working closely with your health care providers is the key to a safe pregnancy for you and baby alike.
