Colorado Bariatric Surgery Institute

Weight-Loss Surgery (WLS) is becoming more and more common in our society. According to the U.S. Centers for Disease Control and Prevention (CDC), the number of WLS’ in the U.S. increased nine-fold from 1996 to 2004. There are many things to consider prior to having WLS, all of which need careful and deliberate consideration and consultation with your doctor. However one of the most important questions one should ask prior to pursuing this life altering procedure is “how will this surgery impact my pregnancy?” Here are four facts you should know about having a baby after weight loss surgery.

1. You may get a boost in fertility
WLS can produce a sudden positive change in your fertility. A report in the Journal of Obstetric, Gynecologic, and Neonatal Nursing from November, 2005, found that women with fertility problems linked to obesity who had WLS can start ovulating regularly for the first time in years. Additionally the study showed that if a patient has been diagnosed with polycystic ovarian syndrome (PCOS), their fertility could also get a boost following WLS. A separate study published in the Journal of Clinical Endocrinology and Metabolism from December, 2005, found that post-surgery weight loss for women with PCOS improved their metabolic and reproductive abnormalities.

Note: This newfound fertility can raise the chances of accidental pregnancy if you are not utilizing approved contraceptives. This could lead to complications if a patient is in the initial 18-month post-surgery period. Additionally, there is considerable debate as to the “ideal” birth control method after WLS. Oral contraceptive pills are poorly absorbed following WLS, and transdermal (skin patch) contraceptives have decreased efficiency in patients weighing greater than 200 pounds. Please discuss the best birth control option for you with your obstetrician.

2. You should wait 18 months before getting pregnant
It is safe to get pregnant after WLS — once weight stabilizes. During the initial period following surgery, patients’ bodies go through potentially stressful changes and significant nutritional upheaval, all of which can pose problems for a growing baby.

To protect mothers and their babies from potential malnutrition problems, doctors recommend that women avoid pregnancy until 18 months following WLS. A report in the Journal of Obstetric, Gynecologic, and Neonatal Nursing from November, 2005, explained that a pregnancy within this 18 month time span following WLS could lead to a "potential for maternal and fetal malnutrition” resulting in “small-for-gestational-age infants." Following the 18 month mark however, a patient should have reached a stable weight and be able to provide enough nutrition to avoid complications for herself and her baby.

3. You'll need to monitor your nutrient intake closely
The primary nutritional concerns include possible iron, vitamin B12, folate, and calcium deficiencies after gastric bypass surgery (GBS). Your obstetrician will want to monitor your labs closely throughout your pregnancy and vitamin and mineral supplementation should remain the same, unless any identifiable deficiencies arise. Vitamin supplements can be adjusted on a case by case basis after careful consultation with your doctor. As always routine follow-up and lab monitoring with your bariatric team and obstetrician is important throughout pregnancy.

After WLS involving an Adjustable Gastric Band (AGB), patients have a little more flexibility in managing your nutrient intake. Patients experiencing excessive nausea and vomiting during the first trimester of pregnancy can have some fluid removed. Fluid can then be put back once the nausea and vomiting is resolved. The AGB can help prevent excessive weight gain during pregnancy. Vitamin and mineral recommendations include switching from a multi-vitamin to a prenatal vitamin. Additionally calcium citrate should remain the same at 1200 mg daily, unless otherwise directed by your bariatric team or obstetrician.

4. Your risk of complications drops, but doesn't go away
A 2005 study in the journal Obstetrics and Gynecology found that women who had WLS developed pregnancy-induced high blood pressure and gestational diabetes at rates similar to those of healthy-weight women who'd never been obese or had bariatric surgery.


Information obtained from Bariatric Times (volume5, number5)

As a group, women with polycystic ovary syndrome (PCOS) are at risk for diabetes in greater numbers and at an earlier age than the general population. PCOS may also increase the risk associated with high blood pressure and high cholesterol, especially among obese women. Linking these risks together in an assessment of metabolic syndrome provides a more complete approach to identify women with PCOS who may need therapies to reduce serious long-term health hazards.

Definitions of metabolic syndrome vary somewhat among organizations, but all current definitions include measures of central obesity, glucose intolerance, hypertension( high blood pressure), and dyslipidemia ( high cholesterol). These 4 common elements have been closely associated with the development of both coronary heart disease and peripheral vascular disease. According to the US census in 2000, about 47 million residents had metabolic syndrome at that time. The problem is growing; the data show that the age-adjusted prevalence of metabolic syndrome increased in women by 23% during the last decade of the 20th century. The risk of metabolic syndrome rises with age, but the incidence is also increasing among American teenagers. Ethnicity also influences the prevalence of metabolic syndrome, which is found more frequently in black and Mexican-American women.

Some common signs of PCOS include irregular periods ( especially lack of period related to lack of ovulation), infertility, endometrial cancer, acne, hirsutism ( growth of hair on face), difficulty losing weight, early-onset diabetes and cardiovascular disease. Blood pressure should be monitored monthly and medication may be needed. Because more than 60% of US women are overweight or obese, measurement of waist circumference is being recommended in addition to the customary “weigh-in.” For women of northern European descent, a circumference of more than 88 cm defines central obesity, but women of other ethnicities have different cutoffs.

If you suspect that you may have some symptoms of PCOS see your primary care practitioner or women’s health practitioner and they will run some labs including cholesterol levels, hormone levels ( testosterone, FSH, LH, estradiol), glucose tolerance tests and possibly insulin. They will also take your blood pressure and determine your BMI. Treatment will vary based upon the symptoms you have.


THERAPEUTIC LIFESTYLE CHANGES

Because lifestyle interventions improve all elements of the metabolic syndrome, they constitute first-line therapy and should be included in all treatment plans. The focus of these therapeutic lifestyle changes is weight loss, with an emphasis on diet and physical activity. A 10% weight loss will often reduce insulin resistance, improve high-density lipoprotein cholesterol (HDL-C), and lower low-density lipoprotein cholesterol (LDL-C) and triglycerides. Menstrual cycles and ovulation cycles can return with modest (10% to 15%) weight loss.

Weight Loss
The efficacy of proper diet is undisputable. The risk of cardiovascular disease (CVD) can be reduced by more than 50% by maintaining a healthy body weight while engaging in regular physical activity. In addition, reducing body weight by only 7% yields a 58% reduction in the risk of type 2 diabetes. However, PCOS women have unique challenges achieving and maintaining healthy weights. Because they consume less energy metabolizing their food, they often require a lower-calorie diet than other women do to lose weight.
Bariatric surgery has been found to be immensely helpful in the resolution of PCOS. It can eliminate type 2 Diabetes by 93%, reduce hirsutism by 79% and 100% resolution of menstrual dysfunction. ( see picture below)

“Metabolic Woman”
Bariatric surgery is known to be one of the most effective and longest lasting treatments for morbid obesity. It can also positively affect the following obesity-related conditions:

Exercise
Exercise must be strongly recommended to help maintain long-term weight loss even after bariatric surgery. The addition of exercise to calorie restriction improves body composition. Patients with metabolic risk should be advised to engage in moderately intense physical activity for at least 30 minutes a day (preferably 45 to 60 minutes) for at least 5 days per week.

If you suspect you may have PCOS follow up with your health care provider. If you have been diagnosed with PCOS and are struggling to lose weight with a BMI of 35 and higher, bariatric surgery may be an option to consider. If you have any questions feel free to call our office to set up a consult to learn more about the lap band or bypass to help resolve your PCOS.

Labels: PCOS