Prepregnancy BMI
BMI (kg/m2) (WHO)
Total weight gain range (lbs)
Rates of weight gain in second and third trimesters (mean range in lbs/week)
Underweight
<18.5
28–40
1 (1.0–1.3)
Normal weight
18.5–24.9
25–35
1 (0.8–1.0)
Overweight
25.0–29.9
15–25
0.6 (0.5–0.7)
Obese (includes all classes)
≥30.0
11–20
0.5 (0.4–0.6)
It is important, however, for the clinician caring for the pregnant post-bariatric patient to understand that using the patient’s procedure to minimize weight gain, while achieving a healthy pregnancy and delivery, is ideal. Postpartum return to healthy weight should be an expectation established early in the pregnancy. Frequent post-delivery follow up with a supportive bariatric provider will often facilitate this, and should be emphasized and encouraged.
11.7 Breastfeeding
Breastfeeding is encouraged. However, close monitoring of the mother’s nutritional status is needed to insure the neonate is getting adequate micronutrients. Signs and symptoms of failure to thrive, anemia, and developmental delays can occur as a result of mother’s micronutrient deficiencies (Table 11.2) [40, 53].
Table 11.2
Micronutrient recommendations: post-bariatric surgery pregnancy
One prenatal vitamin daily that includes or should be supplemented by: | |
Calcium citrate | 1000–2000 mg daily |
Vitamin D | 50–150 μg daily |
Ferrous iron | 40–65 mg daily |
Cobalamin SL | 350 μg daily or 1000 μg IM monthly |
Folic acid | 4 mg daily |
Zinc | 15 mg daily |
11.8 Conclusion
Loss of excess body weight following bariatric surgery improves fertility as hormones normalize. Pregnancy in the post-bariatric surgery patient is shown to be as safe as the non-bariatric patient, when nutritional status and weight are closely monitored by the patient’s obstetrician, primary care provider, and bariatric surgeon.
Successful management of a pregnant post-bariatric surgery patient is dependent on their clinician’s knowledge of their previous bariatric surgery procedure and associated potential health risks. Nutritional status will be dependent on the procedure, and management should include identification and treatment of nutritional deficiencies early in and throughout the pregnancy.
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