This past Sunday in the New York Times, there was a wonderful article written by an OB-GYN talking about all the difficulties and dangers of being significantly obese and having a baby. Obesity is certainly a national problem and currently over one-third of Americans are classified as obese. In my practice, I see it as a growing problem in patients.
Obesity is associated with a long list of health problems, including type 2 diabetes, hypertension, cardiovascular problems and joint pain -- just to name a few. These medical problems present a challenge during pregnancy, so it's becoming more popular for women with significant weight problems to opt for weight loss surgery to minimize their risk of medical complications.
Certainly the safety of bariatric surgery still has to be considered, since in many cases it means an abdominal operation where the stomach is stapled and there is some intestinal rearrangement. In medical centers that specialize in these types of surgeries and do them regularly, most potential complications seem to be well under control.
However, one of the hallmarks of this procedure is that it limits the patient's ability to absorb calories from food, including some very essential nutrients. Because of this, it is recommended that if you are considering having a baby after bariatric surgery, that you wait least 18 months after the operation, since very rapid weight loss during pregnancy could deprive the baby of vital nutrients.
For patients who have recently undergone bariatric surgery and become pregnant, it's important to know that vitamins and minerals like vitamin B12, calcium, iron and folic acid are essential for a healthy pregnancy and need to be supplemented orally. In addition to vitamin supplements, these patients may need additional supervision by their OB-GYN by monitoring the growth of the baby via ultrasound throughout the pregnancy to ensure proper weight gain. Your doctor would also be looking out for anemia and may need to supplement more iron through infusions.
Many patients that have bariatric surgery also eventually have an abdominoplasty, or tummy tuck, to remove all the excess skin that can result from extreme weight loss. These are surgeries an OB-GYN needs to know about because there is always a possibility during delivery for an emergency c-section. You want to make sure your surgeon is well versed in safely dealing with abdominals that have been previously operated on.
Bariatric surgery does bring its share of challenges, but it can reduce the chance of diabetes and hypertension in mothers and help avoid overweight babies.