Posts categorized "Baby, Babies, Pregnancy after Weight Loss Surgery" Feed

Our first injury. I think. Maybe. Probably not. Not mine anyway.

People like to make fun of first-time parents.  They run to the emergency room with their babies littlest concerns.  Sometimes that is true.  20 years ago we probably took a baby to the ER for a head bump once or twice for no real cause, and now?  Well, look at this poor nose.

 

A video posted by Beth Sheldon-Badore (@mmbbgc) on

What happened?

Dad came home and realized he needed something outside in the car -- the mailbox -- somewhere. He opened the baby gate, failed to click it shut, and went out the side door, and did not shut that. Someone who now walks Very Fast, followed him while I was five feet away and I did not notice. The baby was in the presence of THREE ADULTS and none of us noticed that he took off after Daddy. He was gone maybe ten seconds, went through the baby gate, down a step and onto the walkway bricks. Boom on the hands and nose.

Someone who now walks Very Fast, followed him while I was five feet away in the kitchen and I did not notice. The baby was in the presence of THREE ADULTS and none of us noticed that he took off after Daddy. He was gone maybe ten seconds, went through the baby gate, down a step and onto the walkway bricks. Boom on the hands and nose.  He was fine, a red clown nose, and now a scabby scrape.  BUT IT COULD HAVE BEEN AWFUL.  

Toddlers are dangerous people, guys.  I spend so. much. time. per. day. keeping this child from killing himself un-intentionally.  


A scale with no batteries.

We moved house on Halloween, and in the process, my scale lost it's batteries.  

I have avoided quite successfully, replacing the batteries to the scale.  The scale, with it's cracked plastic face, still weighs and measures quite accurately and is that what I am afraid of?  It hasn't been very long since I checked in with that scale.  And my eating hasn't changed much at all, as it never does.  I eat what doesn't kill me, and occasional OH MY GOD I MIGHT DIE BECAUSE I ATE THAT YOU SHOULD HAVE WARNED ME foods.  I have been one of the most boring-est eaters since weight loss surgery you might ever know.  

What I do know is that I am in need of clothes, it's nearly winter and I was wearing maternity clothes in a bigger size last year, and I have nothing right now that fits me appropriately and I really did not want to start this season in my kids' hand me downs.  I am in that NO YOU CAN'T GAIN ANYMORE range, I know it.  I don't need a scale to tell me that I can hold up a pair of size 14 jeans on my regain butt. 

Then again, I'm also okay at this size, because it's also where I land every time I just simply eat what I feel like having without drama. Does that make any sense to you?  I feel like if I just added exercise to my current-state-of-toast-and-protein, I would trickle back to my tighter self.  Honestly, it's the lack of Doing, not the Poor Eating.  I am a decent, not super, decent, better than many, eater.  A few days a week of moving my ass would really do the trick.

Could someone just sell that as an edible product  -- motivation?  Because I don't have it.  Aside from running a 13 month old up and down stairs, it's just not happening.  All the advice in the world, I'll find excuses.  

off to find some batteries and weigh-in

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Like a weed, as they say.

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For reference, the top photo is baby, day one at home with Dad at just under five pounds.

The second photo is baby, this week, with me, but you can't see my head, because he's grown a bit. 

Babies have a tendency to do this.  Mine, usually grow right off the growth chart. 

He has a check-up next week and we'll see if he's finally on the chart -- because -- he wasn't for a while.  Both of my post weight loss surgery babies started out smaller than my pre weight loss surgery babies.  Elliott, above here, is also the first baby I gestated while on a huge amount of anti epileptic medications, and I often wondered if he would be effected by marinating in toxins like my brain did (and still does... )

I will always wonder.

 


Bariatric surgery can lead to premature birth

Study -

Bariatric surgery can lead to premature birth.

Babies born of women who have undergone bariatric (weight-loss) surgery are more likely to be premature and to be small for gestational age, according to a large registry study carried out at Karolinska Institutet in Sweden and published in the BMJ. The researchers believe that these pregnancies should be considered risk pregnancies and that prenatal care should monitor them extra carefully.

Continue reading "Bariatric surgery can lead to premature birth" »


Super Obese Moms don't need to gain weight during pregnancy.

Extremely obese women may not need to gain as much weight during pregnancy as current guidelines suggest, according to a new study presented today at the Society for Maternal-Fetal Medicine annual meeting. (February 14, 2011)

I have been pregnant as a morbidly obese woman three times, and once as an obese woman.  Each time I was counseled to "not worry" about weight gain, or to "only gain 15 pounds."  

Let's not discuss what I actually did.  

Just after baby #2, '99...

  • 1997 - Baby #1 - Delivered via induction, after gaining QUITE a bit of excess weight, pre-eclamptic, tachycardic, bed-rest.
  •  1999 - Baby #2 - Delivered via induction, more weight gain, pre-eclamptic, tachycardic, bed-rest.
  • 2002 - Baby #3 - Delivered via induction, more weight gain, peak weight, saw my highest weight after this point, 320 lbs.
  • 2006 - Baby #4 - Delivered early via induction, at lower weight because I was post gastric bypass, anemic, having odd neurological symptoms, highest pregnant weight 210 lbs.

Regardless of the suggestions, I failed to listen, and ate my way through pregnancies 1-4.  

Even with severe morning sickness through much of all of the pregnancies, I used this as an excuse to live on bags of oyster crackers.  "I'm eating for two."

The advice now for super obese women -- you don't need to gain anything.

Severely obese women who gained less than the recommended amount of weight during the second and third trimester of pregnancy suffered no ill effects, nor did their babies. In contrast, obese and non-obese women who gained less weight in the second and third trimester had undesirable outcomes, including a higher likelihood of delivering a baby that is small for gestational age - smaller than the usual weight for the number of weeks of pregnancy.

"The study suggests that even the recommended amounts of weight gain might be more than is needed for the most obese women," said Eva Pressman, M.D., director of Maternal Fetal Medicine at the University of Rochester Medical Center.

In 2009, the Institute of Medicine released new guidelines for how much weight a woman should gain during pregnancy, taking into account changes in the population, particularly the increase in the number of women of childbearing age who are overweight and obese.

"At some point, there may be even more tailored guidelines than what exists right now for women with different levels of obesity," said Danielle Durie, M.D., M.P.H, lead study author from the Department of Obstetrics and Gynecology at the Medical Center.

The study sought to determine the impact of weight gain outside recommended ranges during the second and third trimester of pregnancy on women and their babies. Women were grouped according to pre-pregnancy body mass index (BMI) as underweight, normal weight, overweight, and obese classes I, II, and III. Obese classes II and III include women considered severely and morbidly obese.

Gaining less weight than recommended in the second and third trimester was associated with increased likelihood of having a baby that is small for gestational age in all BMI groups except obese class II and III. Gaining more weight than recommended in the second and third trimester was associated with increased likelihood of having a baby that is large for gestational age in all BMI groups.

Newborns that are very large or very small may experience problems during delivery and afterwards. Small babies may have decreased oxygen levels, low blood sugar and difficulty maintaining a normal body temperature. Large babies often make delivery more difficult and may result in the need for a cesarean delivery, which increases the risk of infection, respiratory complications, the need for additional surgeries and results in longer recovery times for the mother.

In addition to weight gain rates outside the recommended ranges, increasing BMI alone was associated with negative outcomes for mothers and newborns as well. For all BMI groups above normal weight, the likelihood of cesarean delivery, induction of labor and gestational diabetes increased.

The study included 73,977 women who gave birth to a single child in the Finger Lakes Region of New York between January 2004 and December 2008. Of the study participants, 4 percent were underweight, 48 percent normal weight, 24 percent overweight and 24 percent obese (13 percent class I, 6 percent class II and 5 percent class III).

Researchers from Rochester also reported that overweight and obese women undergoing labor induction may benefit from higher doses of oxytocin, a medication used to induce labor by causing contractions. They tested the effectiveness of two oxytocin protocols - one including a lower dose every 45 minutes and another using a slightly higher dose every half hour - in women based on BMI.

Overweight and obese women administered the lower, less frequent dose were less likely to deliver vaginally - the preferred method of delivery - than overweight and obese women administered the higher, more frequent dose.

"If you give more oxytocin to overweight and obese patients they may be more likely to delivery vaginally, which is what we want, as opposed to having a cesarean section, which can introduce more complications," according to Pressman, an author of the study. "The study is important because the effect of BMI on induction has not been well described before."

The oxytocin protocols tested in the study are relatively standard and were used to induce labor in nearly 500 women who delivered at the University of Rochester Medical Center between October 2007 and September 2008. Study participants were induced for a variety of reasons, including going a week or more past the estimated due date, when there is no longer any benefit to the fetus from remaining inside the womb.

Source: Medical News Today

http://www.medicalnewstoday.com/articles/216370.php

 


WLS in Teenage Girls May Raise Birth Defect Risk

Teenage girls who have weight loss surgery before pregnancy -- have higher risks of having babies with birth defects.  Why?  Weight loss surgery creates malabsorption of nutrients -- PARTICULARLY THE B VITAMINS -- and teenagers do not follow through with their vitamin supplementation as well as adults do.  

It seems that this issue should be obvious, as we knew that the vitamin absorption in bypassed patients was not particularly great?  

But, obviously, it's appearing more BABIES now.  Babies of the bypassed.

(And, yes, we are totally aware that obesity brings risks to pregnancy.  I was a statistic too, even at my very young age, pregnancies with super high blood pressure, bed rest and fun!)

My "bypass baby" -- I swore she would have a neural tube defect.  

Neural tube defects (NTDs) are one of the most common birth defects, occurring in approximately one in 1,000 live births in the United States. An NTD is an opening in the spinal cord or brain that occurs very early in human development. The early spinal cord of the embryo begins as a flat region, which rolls into a tube (the neural tube) 28 days after the baby is conceived. When the neural tube does not close completely, an NTD develops. NTDs develop before most women know they are even pregnant.

Neural tube defects are birth defects of the brain and spinal cord. The two most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn't close completely during the first month of pregnancy. There is usually nerve damage that causes at least some paralysis of the legs. In anencephaly, much of the brain does not develop. Babies with anencephaly are either stillborn or die shortly after birth.

Getting enough folic acid, a type of B vitamin, before and during pregnancy prevents most neural tube defects. Treatments for neural tube defects vary depending on the type of defect.

NIH: National Institute of Child Health and Human Development

Yes, I thought it.  I thought it DAILY until we saw the ultrasound.  In fact, I was pregnant and miscarried previous to her gestation, and I was counseled to abort -- because of my "nutritional status."

Bottom line - TAKE YOUR VITAMINS.  If you want to have a healthy baby in the future -- don't skimp NOW -- TAKE YOUR VITAMINS.  Even if you're 18, 21, or 25 and babies aren't in your near future -- and you're not worried -- TAKE YOUR VITAMINS.  And?  Take your vitamins.

(PS.  My baby was/is fine.  I wasn't so much.)

Bloomberg -

Teenage girls who’ve undergone obesity surgery may not absorb enough of a vitamin needed to have healthy babies, raising the risk of bearing children with spine and brain birth defects, a study suggests.

While more adolescents are having gastric bypass surgery, little is known about long-term consequences of the procedure, said Diana Farmer, who presented the study today at the American Association of Pediatrics meeting in San Francisco. “The possibility of future birth defects may outweigh the benefit of this bariatric procedure” for adolescent girls, said Farmer, chief of pediatric surgery at Benioff Children’s Hospital at the University of California, San Francisco.

Farmer’s report focuses on two converging trends -- rising rates of adolescent obesity and gastric bypass surgery to combat it. Since 2001, the number of gastric bypasses and other bariatric procedures has risen sixfold, with 220,000 of them done in 2009, according to the American Society of Metabolic and Bariatric Surgery in Gainesville, Florida. About 17 percent of children and adolescents ages 2 to 19 are obese, according to the Centers for Disease Control and Prevention in Atlanta.

“I am not saying the procedure should be ruled out or that obesity is not a problem,” Farmer said in a telephone interview Oct. 1. “But no kids are dropping dead at the age of 18 from obesity.”

Gastric bypass surgery involves sidestepping the upper intestine, which limits the amount of food a person can consume. Other bariatric surgery includes gastric banding that restricts the size of the opening from the esophagus to the stomach.

Vitamin Supplements

Farmer’s report highlights a consequence of gastric bypass surgery that leads to insufficient absorption of Vitamin B9, or folic acid, which occurs in the upper intestine. Folate, or folic acid, is a key element in the prevention of spina bifida and other neural tube defects. Patients who undergo the procedure are placed on vitamin supplements to counteract the reduction. Limited research shows adherence to the supplements by teens is 14 percent, according to Farmer’s presentation.

“You can’t just write off these birth defects because they are rare,” said Bruce Wolfe, a Portland, Oregon, surgeon and president of the bariatric surgery association. “But there are adverse effects from the obesity as well. So the practical and ethical dilemma is at what point do you deny a tremendously beneficial procedure.”

To contact the reporter on this story: Pat Wechsler in New York at pwechsler@bloomberg.net

  • http://www.aap.org/

Prenatal vitamin levels a concern after weight loss surgery

Pregnant?  Had weight loss surgery?  Thinking about getting pregnant? TAKE YOUR VITAMINS. 

As a mom who had severe anemia and other deficiencies during pregnancy - including brain twitch - I am so thankful my baby was healthy.

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July 22 - Healthday News -

"The study authors documented the case of a woman who had biliopancreatic diversion surgery for obesity seven years before the birth of her child. At nine weeks' gestation, the mother was diagnosed with severe deficiencies of vitamins A, D and K, as well as iron-deficiency anemia. Despite treatment, the woman's vitamin A level remained critically low throughout her pregnancy.

Her son was born with significant malformations of both eyes, and his vision remains poor despite treatment, the researchers reported. They noted that the first eight weeks of gestation are the most critical period in the development of organs, including formation of the visual system.

The article was released in the June issue of the Journal of AAPOS, the publication of the American Association for Pediatric Ophthalmology and Strabismus.

"The mother's description of night blindness, recurrent low vitamin A levels during the pregnancy, and demonstrated vitamin A deficiency in the neonate support vitamin A deficiency as the cause. This case illustrates that vitamin A is very important for normal eye development in the fetus, particularly for pregnant women who have undergone gastric bypass surgery in order to improve their fertility," lead investigator Dr. Glen Gole, of the department of ophthalmology at Royal Children's Hospital and Discipline of Pediatrics and Child Health, University of Queensland, Brisbane, said in an AAPOS news release.

"Weight-reduction surgery is becoming more common, especially with the potential for health benefits that result from reducing obesity," commented journal editor-in-chief Dr. David G. Hunter, in the news release. "Unfortunately some forms of this surgery cause vitamin deficiency, and in this case the problem led to a birth defect that caused blindness in one child. We are not aware of any other cases of this particular problem, but it is important for any woman who has had this form of gastric bypass surgery to be checked for vitamin deficiency -- and have it corrected -- before considering having a baby."


Obese Mothers Cost MORE + MORE RISK.

One out of five moms to be are OBESE when they become pregnant.  O-o  

Present company included.  I was obese FOUR OUT OF FOUR TIMES, even AFTER BARIATRIC SURGERY!  Go me.  I weighed in at 175-185 at my first prenatal visit with Tristan in 2006, after losing 170 lbs and regain some weight back.  In fact, when I miscarried, I was "of normal weight."  By body likes to carry babies when I am FAT.  

But, being obese + pregnant is NOT recommended.  It's risky.

New York Times -

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

Hospitals, especially in poor neighborhoods, have been forced to adjust.

They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.

(Great.)

NYT -

Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth. About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data. Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.

(Awesome.)




Birth defects associated with deficiency in bariatric surgery patients

The following cases are exactly what I was terrified of happening to my post weight loss surgery baby.  You must be on top of your own nutrition and supplementation post surgery, and take PRECAUTIONS in avoiding pregnancy too soon -- or if your body is already seriously compromised.  (Says the girl who did not.)

Source -

The January 2010 issue of SOARD reports on 2 cases of birth defect that appear to have resulted from severe maternal vitamin deficiency after malabsorptive bariatric surgery.

The first case was of a baby born at 33 weeks to a 27 year old mother 16 months post-op from a biliopancreatic diversion (BPD). The mother was deficient in vitamin A, D, K, protein, selenium and zinc. The infant was delivered prematurely with multiple defects including bone malformation, cleft palate, facial hypoplasia, and respiratory insufficiency. The baby died at 3 months of age.

The second case was of a full-term infant born to a 26 year old mother 11 months post-op from a roux-en-y gastric bypass. The infant was born with multiple defects of bone and cartilage as well as hearing loss which were attributed primarily to maternal vitamin K deficiency.

While most of the recent reports of pregnancy after weight loss surgery have been positive in terms of both fetal and maternal health, these cases should remind us that nutritional deficiency in pregnancy can lead to grave results.

Both of these patients had been counseled about waiting 18 months to 2 years before becoming pregnant, one even having signed a consent form prior to bariatric surgery. Because of the significant impact that massive weight loss can have on fertility, it is likely that more young, obese women will opt for bariatric surgery to not only improve their overall health, but also to assist with pregnancy. Clinicians and patients alike need to be made aware of the problems that can arise when women who are not adequately nourished become pregnant.

Reference: Kang L , Marty D, Pauli RM, Mendelsohn NJ, Prachand V, Waggoner D. Chondrodysplasia punctata associated with malabsorption from bariatric procedures. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):99-101. Epub 2009 May 23.

Abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND
Chief of Scientific Affairs
Bariatric Advantage


ACOG Issues Guidelines on Managing Obesity in Pregnancy, Pregnancy AFTER Bariatric Surgery Guidelines

Finally, a little more guidance about pregnancy after weight loss surgery.

Source:  Medscape from ACOG

The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin to summarize the risks for obesity in pregnancy and outcomes of pregnancy after bariatric surgery as well as to provide recommendations for management during pregnancy and delivery after bariatric surgery. The new guidelines are published in the June issue of Obstetrics & Gynecology.

"Obesity is associated with reduced fertility primarily as a result of oligo-ovulation and anovulation," write Michelle A. Kominiarek, MD, and colleagues from the ACOG. "The increased risks for gestational diabetes, preeclampsia, cesarean delivery, and infectious morbidity associated with obesity are well established....Obese patients are more likely to be admitted earlier in labor, need labor induction, require more oxytocin, and have longer labor."

To identify pertinent articles published in the English language between January 1975 and November 2008, the guidelines authors searched the MEDLINE database, the Cochrane Library, and ACOG's own internal resources and documents. The reviewers gave priority to articles reporting findings from original research and also consulted review articles and commentaries, but they did not consider abstracts of research presented at symposia and scientific conferences. Using the method outlined by the US Preventive Services Task Force, the reviewers evaluated the identified studies for methodologic quality.

Recommendations from professional societies including ACOG and the National Institutes of Health were also reviewed. Reference lists from identified articles were used to help identify additional studies. When reliable research findings were not available, the reviewers used expert opinions from obstetrician-gynecologists as a basis for their recommendations.

Specific conclusions and clinical recommendations based on limited or inconsistent scientific evidence (level B) are as follows:

• Because pregnancy rates after bariatric surgery in adolescents are twice that in the general adolescent population, contraceptive counseling is especially important in these patients.

• Administration of hormonal contraception by nonoral routes should be considered in patients with a significant malabsorption component after bariatric surgery because these patients have an increased risk for oral contraception failure.

• Testing drug levels may be necessary for medications in which a therapeutic drug level is critical to ensure a therapeutic effect.

Specific conclusions and clinical recommendations based primarily on consensus and expert opinion (level C) are as follows:

• There should be a high index of suspicion for gastrointestinal tract surgical complications when pregnant women who have had bariatric procedures present with significant abdominal symptoms.

• Bariatric surgery should not be performed with the intention of treating infertility, although fertility may improve in association with rapid postoperative weight loss.

• Bariatric surgery in and of itself does not mandate cesarean delivery, although the rate of cesarean delivery in these patients may approach 62%.

• Despite the lack of consensus regarding the treatment of pregnant patients who have had an adjustable gastric banding procedure, it is suggested that these patients have early consultation with a bariatric surgeon.

• For patients who have had bariatric surgery that may be associated with malabsorption and/or dumping syndrome, alternative testing for gestational diabetes should be considered.

• After conception, consultation with a nutritionist may facilitate adherence to dietary regimens and allow the patient to cope with the physiologic changes of pregnancy.

• For women who have had bariatric surgery, a wide-spectrum assessment for micronutrient deficiencies should be considered at the beginning of pregnancy.

As a proposed performance measure, the guidelines authors suggest documentation of counseling regarding weight gain and nutrition in pregnancy.

Additional points made by the authors of the practice bulletin include the following:

• Specific complications of obesity in pregnancy include doubling to quadrupling of the risk for stillbirth.

• Waiting 12 to 24 months after bariatric surgery before conceiving may be helpful to avoid exposing the fetus to an environment of rapid maternal weight loss and to allow the patient to achieve full weight loss goals.

• If pregnancy occurs earlier than 12 to 24 months after bariatric surgery, closer surveillance of maternal weight and nutritional status, including ultrasound for serial monitoring of fetal growth, may be beneficial and should be considered.

• After bariatric surgery, there is a reduced risk for hypertension, pregestational diabetes, gestational diabetes, and preeclampsia, as well as of large-for-gestational-age infants and macrosomia.

• After bariatric surgery, the risk for premature rupture of membranes is increased, but the risk for preterm delivery, congenital anomalies, and perinatal death is not increased.

"As the rate of obesity increases, it is becoming more common for providers of women's health care to encounter patients who are either contemplating or have had operative procedures for weight loss, also known as bariatric surgery," the guidelines authors write. "The counseling and management of patients who become pregnant after bariatric surgery can be complex. Although pregnancy outcomes generally have been favorable after bariatric surgery, nutritional and surgical complications can occur and some of these complications can result in adverse perinatal outcomes."

Obstet Gynecol. 2009;113:1405-1413.


T Runs On?

T runs on Dunkin.

Hold your calls to DSS.  The espresso was nearly gone, when you drink a cappuccino, that goes first, and what is left is foam, she got the skim milk foam, which I do not like.

THEN WTF DO  YOU DRINK IT, WOMAN?!  Well, BECAUSE?  I have to get milk in me somehow, right?  I have no Vitamin-D in my body, and milk is chock-fulla the stuff, so when we go out and Mr. MM gets his cup full of fat from DD?  I get a cappuccino made with dairy milk, it's the only time I use MILK.


The nugget.

Tristan had her six month well baby check up the other day.  She's a perfectly healthy, if robust, baby!  She weighed in at 18 lbs. 9 oz. and was 26.5 inches tall.  The pediatrician asked if I had any concerns for her, and I replied that I have no concerns, as she's the easiest child I've had by far (perhaps because she's number four) but, I thought she was overweight.  The doc said that she doesn't think she's too big now - that (her words, she's old skool) she's better off being chubby now while she's partly immobile because she'll thin out when she's refusing food as a toddler (she apparently, doesn't know my kids).  I laughed, because, the baby is fat.  She's buddha-licious.  You can't tell me she's not overweight, but it's cute when you're six months old.