Most women who get pregnant after weight-loss surgery have an uncomplicated pregnancy and birth.
If you become pregnant after weight-loss surgery, your pregnancy will depend on how long it has been since the operation and what type of surgery you had. It’s best to wait to get pregnant for at least 12 to 18 months after surgery and once your weight has stabilised . However many women have babies safely before 12 months.
Obesity is associated with higher rates of cardiometabolic comorbidities and mortality and is increasing worldwide since decades. Effective weight loss approaches are necessary to overcome the negative long-term effects of obesity. Among lifestyle and medical treatment, bariatric surgery is a commonly used method in severely obese patients, which was demonstrated to result in good weight loss outcome. These surgeries are performed in about 80% in women and about half of them in women of reproductive age.Surgeries are performed in women between 18 and 45 years of age, a significant under representation of non-Caucasian women and one-third of women having menstrual dysfunction. Pregnant women after bariatric surgery have to be controlled regularly by a specialized team with specialists of various fields familiar with the management after bariatric procedures. The special needs of these pregnant women are to be addressed individually. Supplementation of vitamins, minerals, and trace elements after bariatric surgery as well as during pregnancy is essential to avoid deficiencies and further arising complications in mother and child.
Obese women planning to conceive have a lower likelihood to become pregnant compared to lean women. This decrease in fertility is primarily based on menstrual irregularities or anovulation. Overweight and obesity are associated with menstrual irregularities in a cross-sectional study reporting 30–47% of overweight/obese women presenting with menstrual anomalies, which correlates with increasing BMI. Dissatisfaction with their sexual life was reported in about 50% of severely obese female and male patients. Next to these findings, a longer duration of menstrual cycles was observed. This might be caused by increased circulatory androgen concentrations (testosterone, DHEA-S), which are raised due to decreased hepatic SHBG production. Hepatic SHBG production is negatively influenced by hyperinsulinemia, which is more prevalent in obesity. Additionally, hyperinsulinemia triggers LH-mediated androgen production in ovarian theca cells. These factors and their pleiotropic effects on other hormones cause an imbalance resulting in infertility. After weight loss surgery, a steep increase of SHBG and decline of testosterone, androstenedione, and DHEA-S levels were observed in obese women, which might help to overcome menstrual anomalies and infertility. The quality of sexual life improves significantly over time in men and women after weight loss surgery due to significant increases in body image satisfaction.
Pregnancy and Obstetric Management
In general, bariatric procedures should not be regarded as a contraindication to deliver naturally. Nevertheless, increased rates of C-section in operated women are reported with some recent publications showing no differences . However, huge variations in C-section rates were found in the literature ranging from about 18 to 60% section rate in operated women compared with 14–29% in control groups. Explanations were found in a recent review, which discusses former C-section as the main issue, next to other aspects as maternal obesity, selection of the mother, the fetal position, and perceptions of treating clinicians.
In general, a higher risk in obese pregnant women is well known for gestational diabetes, hypertension, preeclampsia, miscarriage, caesarean section, and stillbirth. In postbariatric surgery pregnancies, decreased risk for maternal complications was reported with approximation to risks of normal-weight women and improved neonatal outcomes compared with obese women without intervention . In pregnancy, lower risk of gestational diabetes mellitus, hypertension, preeclampsia, and miscarriage was detected in operated women compared with obese women.