Pregnancy After a Gastric Sleeve: Timing, Nutrition and Monitoring

Pregnancy after a gastric sleeve is possible, but it needs planning and close monitoring. Wait until your weight has stabilized, and let your surgeon advise on timing. The American Society for Metabolic and Bariatric Surgery (ASMBS) tells patients to avoid pregnancy for 12 to 18 months after surgery. Expect adjusted supplements, blood tests each trimester and scans of the baby's growth.

How long to wait before trying to conceive

The early period after a sleeve is when weight loss is fastest and food intake lowest. The concern is that a baby growing during that time may not get enough nutrients. Two sources give the usual advice:

• ASMBS advises patients to have a birth control plan before surgery and to avoid pregnancy for 12 to 18 months afterward, so that they reach their lowest weight and have adequate nutrition.
• An international consensus statement on pregnancy after bariatric surgery (Shawe and colleagues, Obesity Reviews, 2019) advises postponing pregnancy until weight is stable, which it describes as typically one year after a sleeve or a gastric bypass.

The evidence behind the waiting period is limited. The Shawe statement calls it scarce: one study linked a shorter interval to more premature and small babies, while others found no difference. So if you become pregnant sooner than planned, do not panic. Call your obstetrician and the surgeon's office promptly so that supplements and monitoring can start early.

Fertility and contraception after a sleeve

Bariatric surgery can make it easier to become pregnant, ASMBS notes, even for women who had trouble before. That means an unplanned pregnancy is possible in the months when you least want one.

The Shawe consensus says women should be counseled about contraception before surgery. It advises avoiding combined birth control pills containing estrogen after bariatric surgery, because absorption may be reduced, and encourages long-acting reversible methods, such as an intrauterine device or an implant, as the first choice. Discuss the method with your gynecologist or primary care doctor before your operation, not after.

Supplements before and during pregnancy

You are already taking supplements after a sleeve; our page on vitamins and lab tests after a sleeve lists the published amounts. Pregnancy changes some of them. The points below come from the Shawe consensus and a 2020 review in Annals of Translational Medicine (Osland and colleagues). Your obstetrician and surgeon set the actual doses.

• Folic acid. The Osland review lists 800 to 1,000 mcg a day for women of childbearing age after surgery. The Shawe consensus recommends 0.4 mg a day before conception and through the first trimester, and a higher dose of 4 to 5 mg for women who have obesity or diabetes. These differ, so ask which applies to you before you stop contraception.
• Vitamin A. The Shawe consensus says vitamin A should be in the beta-carotene form in pregnancy. Ask your surgeon and OB-GYN which form and dose to take, and check the label of your bariatric multivitamin with them.
• Iron. The consensus lists 45 to 60 mg of elemental iron a day.
• Calcium and vitamin D. The consensus lists 1,200 to 1,500 mg of calcium a day in divided doses, counting food, with vitamin D adjusted to keep the blood level at the target your doctor sets.
• Vitamin B12. Continued throughout, by mouth or by injection, with the level checked.
• Thiamin (vitamin B1). The consensus recommends extra thiamin if you have prolonged vomiting, and through a vein if vomiting is too severe for tablets.

Monitoring during pregnancy

Tell your obstetrician at the first visit that you have had a sleeve gastrectomy, and when. Several parts of routine prenatal care are handled differently.

Blood tests each trimester

The Shawe consensus recommends checking nutrients at least once per trimester, including a full blood count, ferritin and iron studies, folate, vitamin B12, vitamin D and calcium, with further tests in the first trimester. Ask whether your surgeon or your obstetrician will order them.

Screening for gestational diabetes

The standard test is an oral glucose tolerance test, in which you drink a concentrated sugar solution. After a sleeve this drink can cause dumping symptoms such as nausea, sweating and faintness, and the result may be less reliable. The Shawe consensus suggests an alternative for women who have had a sleeve or a bypass: checking finger-stick glucose at home for one week, or wearing a continuous glucose monitor, between 24 and 28 weeks.

The baby's growth

Surgery does not simply improve pregnancy outcomes. It changes the risks. In Swedish registry data (Johansson and colleagues, New England Journal of Medicine, 2015), covering bariatric surgery in general and not only sleeves, pregnancies after surgery had less gestational diabetes than matched pregnancies (1.9% vs 6.8%) and fewer large babies (8.6% vs 22.4%). But they had more small babies (15.6% vs 7.6%) and slightly shorter pregnancies, by about 4.5 days. Stillbirth or neonatal death was 1.7% vs 0.7%, a possible increase that was not statistically significant.

The Shawe consensus states that most types of bariatric surgery roughly double the risk of a small baby, with a higher risk after bypass than after a sleeve or a band, and recommends that ultrasound monitoring of growth be offered to all women with a history of bariatric surgery.

Weight gain

The consensus advises following the standard Institute of Medicine weight-gain ranges for pregnancy, based on your body mass index before pregnancy. If you are not gaining enough, your diet should be reviewed and the baby's growth watched carefully.

When to call

Go to an emergency room or call 911 if

• You cannot keep liquids down
• You have severe or persistent pain in the abdomen or chest
• You are vomiting blood or have black stools
• You have confusion, double vision or trouble walking after days of vomiting
• You have heavy vaginal bleeding, or you notice the baby is moving much less

Tell the staff that you are pregnant and have had a sleeve gastrectomy. Do not assume that severe vomiting or pain is ordinary morning sickness.

Call your obstetrician and the surgeon's office if

• You have a positive pregnancy test, at any time after surgery
• Nausea is stopping you from taking your supplements or eating protein
• You are losing weight during pregnancy
• Heartburn is new or much worse; see acid reflux after a gastric sleeve

Frequently asked questions

What if I get pregnant in the first year after my gastric sleeve?

Tell your obstetrician and your surgeon's office straight away. The studies reviewed in the Shawe consensus are mixed on whether timing changes outcomes, but closer follow-up is sensible while you are still losing weight. Ask about early blood tests, a review of your supplements and growth scans. Do not stop your vitamins on your own.

Can I breastfeed after a sleeve gastrectomy?

Generally, yes. The Shawe consensus states that breastfeeding can be recommended to women who have had bariatric surgery, and it advises closely monitoring the mother's nutrition while nursing, with blood tests and added supplements when needed. Keep taking your bariatric vitamins, eat enough protein, and tell your baby's pediatrician about your surgery.

Does a gastric sleeve mean I will need a cesarean?

Not by itself. A sleeve is an operation on the stomach and does not change the uterus or the birth canal. How you deliver is decided with your obstetrician for the usual obstetric reasons. Tell the delivery team about your surgery so that medicines and eating plans after birth take it into account.

Should I have a sleeve before pregnancy or wait until my family is complete?

It is a personal decision to make with your surgeon and obstetrician. Surgery first means a waiting period before conceiving and closer monitoring, along with the changes in risk described above. A sleeve cannot be reversed. Our page on Lap-Band versus gastric sleeve for future pregnancy compares the options in more detail.

Talk with Dr. Davtyan in Rancho Cucamonga

Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, is a bariatric surgeon with Davtyan Medical Weight Loss & Wellness at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. Call 909-355-2525 or toll free 877-9-BE-SLIM (877-923-7546), or use our contact page. The first consultation is complimentary, and Hablamos Español. More topics are in our Rancho Cucamonga gastric sleeve guide.

Sources

• Shawe J, et al. Pregnancy after bariatric surgery: consensus recommendations for periconception, antenatal and postnatal care. Obes Rev. 2019;20(11):1507-1522
• Johansson K, et al. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015;372(9):814-824
• ASMBS. Life After Bariatric Surgery
• Osland E, et al. Micronutrient management following bariatric surgery: the role of the dietitian in the postoperative period. Ann Transl Med. 2020;8(Suppl 1):S9

More in the Gastric Sleeve in Rancho Cucamonga guide

Start at the Gastric Sleeve in Rancho Cucamonga page, or go straight to a topic.

Understanding the sleeve

• Staple-Line Leak After Gastric Sleeve: Signs, Timing and Treatment
• Gastric Sleeve Stricture (Stenosis): Symptoms, Tests and Treatment
• Acid Reflux and GERD After Gastric Sleeve Surgery
• Hiatal Hernia and Gastric Sleeve Surgery
• Gallstones After Gastric Sleeve Surgery
• Hair Loss After Gastric Sleeve Surgery
• Nausea, Dehydration and Constipation After Gastric Sleeve Surgery
• Gastric Sleeve Emergency Warning Signs: When to Go to the ER
• Weight Regain After Gastric Sleeve: Why It Happens and What Can Be Done
• Vitamins and Lab Tests After a Gastric Sleeve
• Alcohol After a Gastric Sleeve: What Changes and What the Evidence Says
• Pregnancy After a Gastric Sleeve: Timing, Nutrition and Monitoring

Weighing your options

• Gastric Sleeve With a BMI of 30 to 34.9
• Gastric Sleeve With a BMI of 50 or More
• Gastric Sleeve Surgery After Age 60
• Gastric Sleeve and Type 2 Diabetes: What the Trials Show
• Tests Before Gastric Sleeve Surgery
• The pre-surgery liver diet before a gastric sleeve
• Insurance requirements for a gastric sleeve: how insurers decide
• What affects the cost of gastric sleeve surgery
• Converting a gastric sleeve to a gastric bypass
• Gastric sleeve in Mexico or near home: what to weigh
• Second opinions on gastric sleeve surgery: when and how
• Questions to ask a gastric sleeve surgeon

Getting care in Rancho Cucamonga

• Sleeve done elsewhere: how to move your follow-up care
• Gastric sleeve revision: reasons, tests and options
• Your first gastric sleeve consultation: what happens and what to bring
• From consultation to gastric sleeve surgery: the steps in order
• Gastric sleeve surgery day and the hospital stay
• Returning to work, driving, lifting and exercise after a gastric sleeve
• Gastric sleeve follow-up schedule: visits, labs and support
• Gastric sleeve care for Ontario, CA residents
• Gastric sleeve care for Fontana, CA residents
• Gastric sleeve care for Upland and Claremont residents
• Gastric sleeve care for Riverside and Corona residents
• Gastric sleeve care for San Bernardino and Redlands residents