Pregnancy after Gastric Bypass?

"Is it safe to get pregnant after gastric bypass surgery?"

It appears that pregnancy after gastric bypass is comparable to getting pregnant as a morbidly obese woman, assuming you are healthy enough to carry a fetus after your gastric bypass procedure.  Most of problems that do arise appear to be related to nutritional deficiencies that can be prevented or treated with  vitamin and mineral supplementation.

-38 weeks pregnant, October 2006, after my 4/2004 roux en y gastric bypass.

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American Journal of Obstetrics and Gynecology Volume 197, Issue 6, Supplement 1, December 2007, Page S116  Society for Maternal-Fetal Medicine: 2008 28th Annual Meeting - The Pregnancy Meeting Source:  MedPage Today.

Pregnancy after gastric bypass surgery appears to involve no more risk than might be expected from morbid obesity, revealed a small study reported here. 

Obstetric and neonatal outcomes were similar in gastric bypass patients and matched controls who had not undergone the procedure, said Jacquelyn Blackstone, D.O., of the Maine Medical Center in Portland, at the Society for Maternal-Fetal Medicine meeting. 

The comparison showed no differences in preterm labor, preterm delivery, gestational diabetes, induced labor, or Caesarean delivery. Similarly, neonatal outcomes did not differ in birth weight, Apgar score, NICU admission, or congenital anomalies.

"They have mostly done very well, equally as well as our other patients, but they have had very, very close surveillance," she added. "They would see us sometimes twice a week near the end of pregnancy."
Interest in pregnancy outcomes after bariatric surgery grew from recognition that about half of the 100,000 procedures performed each year involve reproductive-age women. The medical literature contained little information on bariatric surgery and pregnancy.

Dr. Blackstone and colleagues evaluated outcomes in 38 women who conceived after Roux-en-Y gastric bypass. Outcomes were compared with those of two consecutive pregnancies involving age- and Caesarean-matched patients with no history of gastric bypass surgery.

Despite the surgery, the gastric bypass patients weighed significantly more (P<0.001) than did the women in the control group. Additionally, 26 (68.4%) of the bariatric surgery patients were obese (BMI ≥30 kg/m²) at first pregnancy visit compared with 20 of 76 (26.3%) in the control group (P<0.001).

The proportion of patients with delivery at less than 37 weeks, less than 32 weeks, or more than 41 weeks was similar in the groups. The frequency of preterm premature membrane rupture, gestational diabetes, and oligohydramnios was not significantly different between groups. Hypertension occurred more often in the gastric bypass group (29%) than among controls (7.9%, P=0.05), but that difference became nonsignificant after adjustment for BMI at delivery.

The findings are consistent with the bariatric surgery literature, according to Kelvin Higa, M.D., of the University of California San Francisco. Published studies have provided no reason for concern about pregnancy complications arising from gastric bypass surgery.

"Actually, there is literature to the contrary," said Dr. Higa, who also is president of the American Society for Metabolic and Bariatric Surgery. "Multiple retrospective studies and large series have not shown an increased risk to the mother or the fetus after gastric bypass."

"The risk of complications is either so low that it's not being picked up, even in case reports, or it's nonexistent," he added. "I think we can safely say that it's okay to get pregnant after gastric bypass as long as you are healthy after gastric bypass."

However,  this reply from a doctor, which is more like my own experience with roux en y and post op gastric bypass:

John R. Su, MD, PhD, MPH - Feb 07, 2008
It's important to remember that there's a malabsorptive component to Roux-en-Y bypass. The developing fetus will absorb nutrients from the mother that the mother will not readily reabsorb. 

The mother might therefore develop deficiencies post-pregnancy. I've seen at least one case where the mother, post-bypass, delivered a term baby without complication -- but developed a marked iron-deficiency anemia (Hb around 6.5, Hct around 30%) that required parenteral iron to correct. 

Not surprisingly, the mother was also markedly compromised in her ability to complete activities of daily living. The accumulating data in the literature is reassuring in that there's nothing inherently risky about undergoing Roux-en-Y bypass and then becoming pregnant. 

However, providers would do well to monitor the mother's nutritional (and functional) status throughout pregnancy and post-delivery in case there's need for more aggressive nutritional supplementation such as I've described.