Pregnancy after WLS. Advice please?

[DoomaYula]

First of all, I did not have the "typical" weight-loss surgery -- a RNY. I had a more complicated procedure called a Biliopancreatic Diversion with a Duodenal Switch. It involves a LOT of malabsorption. I do not absorb much fat, so I'm deficient in all my fat based vitamins (A, D, E, K), as well as Calcium, B vits, iron. Additionally I take zinc, copper, a multi, a probiotic, and C.

So, now I'm unexpectedly pregnant, about 18m after surgery. I'm planning a homebirth, but my midwife suggested shadow care with a OB because she thinks I should have regular growth scans.

I'm adding RRL, Nettles, and another good mult to my vitamin regime.

Any other thoughts?

[MidwifeErika]

Do you still have contact with your surgeon? If so, does he/she have any additional recommendations for you nutritionally? How closely do you follow your vitamin levels? Do you respond well to taking additional vitamins or does it do essentially nothing for you?

[Charmie981]

Can you find a HB friendly OB or are you going to have to weed the medicine out of your pregnancy?

I think with absorption issues, IUGR is definitely a potential problem. How would you deal with it, though? When would you be okay with starting growth scans? All things to think about...

Oh, and CONGRATS!

[Beccadoula]

You might want to contact a naturalpath doctor - there are food suplements that spacifically address absobption issues...I know cause I've had to be on them. NOTHING worked for me at all - and then I found a good naturalpath and got my whole system back on track but it took a lot of trial and error. Just a thought...

[DoomaYula]

Originally Posted by Charmie981

Can you find a HB friendly OB or are you going to have to weed the medicine out of your pregnancy?

I'm going to see a midwife, but do shadow-care with a homebirth-tolerant OB. Friendly is a stretch, but I told her off the bat I'm planning a homebirth and she said great. She scanned me once because I haven't had af in so long, I had no idea how far along I am. I'm 8w. I feel GREAT; my only symptom was exhaustion. I actually went to several doctors -- hemotologist, endocrinologist -- before I figured it out. The OB wants to scan every 8w. I can live with that. Three more scans, maybe four.

A local midwife suggested I eat as if I'm pregnant with twins (again). I'm just eating protein and veggies like crazy, and keeping up with my supplements.

Originally Posted by Charmie981

Oh, and CONGRATS!

Thanks! I'm not "out" on facebook yet, but I'll tell people in a few weeks.

[HeatherB]

Congrats!!

No advice, but it sounds like you're doing well with that, anyway.

[soso-lynn]

I used to have a roomate who had the exact same surgery you had. She had ben told to wait until her weight had stabilized and her vitamin levels were back to normal before thinking about pregnancy. She had a few fainting spells after doing too much so make sure you get plenty of rest.

I don't think that the surgery would affect the birth itself if things were ok at that point but I would definitely get further care throughout pregnancy from a doctor with some expertise on your surgery. On top of the risks to the baby from lack of nutrients (perhaps injectable vitamins might work better for you?), you should make sure that your digestive tract reacts properly to the expanding uterus moving things around. After 18 months, things should be healed but it would still worry me a little.

I hope things work out and the pregnancy is not too difficult (I can only imagine how horrible morning sickness could be in your situation).

[DoomaYula]

Yes, I am INCREDIBLY GLAD I do not have any morning sickness, and I can still take my 253235235 vitamins per day.

I feel great. In fact, if I weren't so darn tired, I'd never know I was pregnant.

[curvyred]

Congratulations! I'm two years post lap-band surgery, so totally different experience regarding absorption, but non-surgeons (or non-WLS patients) don't always seem to understand the differences.

I think it's great to keep up with an OB, but I'd also stay in touch with your surgeon. My midwives consulted a peri-natologist before ok'ing me for the birth center (which a single conversation took care of) but you MAY want to try and find a doc with some specific experience with post-WLS patients.

Congratulations and good luck to you!

[Wittyone]

We are seeing a lot of post-WLS patients in our practice, a variety of surgical types. Many of our ladies have metabolic issues that led to the surgery in the first place and often end up with challenging blood sugar issues given their malabsorption and tendency toward insulin resistance/GDM. Not sure if you have talked with the OB or your midwife about screening for GDM but we DO NOT use the oral glucose challenge for post-WLS women - a week of glucometer readings is what we recommend instead. It sounds like you are really on top of monitoring your nutrition and vitamin intake, which is fantastic, and the plan for growth scans every other month seems pretty reasonable. Best wishes for a delightful pregnancy!

[Wittyone]

I just came across this info from Sweet Success (GDM management program) talking specifically about pregnancy after bariatric surgery. It differentiates between types of procedures and issues to be aware of with both. Maybe something in there will be helpful? BTW, the recommended minimum interval between procedure and pregnancy that they quote is 18 months, which you stated you were at.