Pregnancy and the Gastric Band

by Christine on September 23rd, 2010

filed under Gastric Banding Surgery, General Information

Pregnancy and the Gastric Band

When I underwent my gastric banding surgery, I was surprised that there was not more information available about issues concerning pregnancy.  This seems particularly important because the band may severely limit the ability to consume food, perhaps a healthy variety of food, which is important when a woman becomes pregnant.  In fact, with all my consultations with doctors, the only question on this topic that was posed to me was, “do you believe you may be pregnant?”  They confirmed any pregnancy doubts with two pregnancy tests prior to surgery; had I received a positive test, I believe I would have been denied the surgery.

I have one “real life” friend named Andrea that had the gastric banding surgery performed perhaps six years ago. Two years ago she had a baby. When we were talking about the band, I asked her if she had the band taken out when she discovered that she was pregnant. “Oh no!” she said. (I’m paraphrasing here.) “There’s a gross misconception that you need to ‘eat for two’ when you’re pregnant. It’s not true: you only need to eat 10% more than you normally would. So if you eat 1500 calories a day, then you only need to eat an extra 100-150 calories for the baby. That’s totally do-able with the gastric band in place.”

Good point, and it made me realize that I knew very little about pregnancy and the gastric band. I hope this blog article is informative for anyone who has the band who is considering getting pregnant or who has recently discovered that they are pregnant!

What effects does the gastric band have on pregnancy? For instance, does the lack of eating decrease a woman’s fertility rate?

Actually, the gastric band may be able to increase a woman’s ability to get pregnant. According to Ajay Goyal, MD, FACS from the New Jersey Bariatric Center, “being seriously overweight causes an increase in the level of two key hormones related to fertility – estrogen and testosterone…[an increase in these hormones are] directly related to infertility, causing irregular or heavy periods.”  A high BMI increases the risk for pre-eclampsia, gestational diabetes, hypertension, and spontaneous abortions.

The weight loss that comes with gastric banding surgery may actually improve a woman’s fertility by helping her achieve a healthy, regular menstrual cycle.

A recently study in Australia compared birth outcomes for pregnant women in three categories: women that have had gastric banding surgery, morbidly obese women, and a sample of normal-weight women. The study showed that babies produced from banded patients were healthy. Furthermore, women that had the gastric band gained significantly less weight during pregnancy and had significantly lower pregnancy-induced hypertension than obese patients.  The babies’ mean birth rates were comparable in all three subject groups.  This study is good news for women who have had gastric banding surgery and want to get pregnant.

It’s important to note that any weight loss surgery (gastric banding or gastric bypass) itself does not directly impact an individual’s fertility.  Weight loss surgery impacts the stomach and intestines and should not disrupt the functioning of the baby-growing organs in women or the baby-making-seeds in men.

Can you have the surgery if you are planning on getting pregnant in the future?

Absolutely.  Most bariatric centers recommend that you wait at least one year before getting pregnant. This is because surgeons want you to lose weight and increase your ability to have a safe pregnancy. Achieving a healthier weight, which may also eliminate diabetes and heart problems, will help achieve a healthy pregnancy.  Practicing safe sex for this one-year period is very important. (Note that gastric bypass patients may need to discuss oral contraceptives with their surgeons; not all oral contraceptives may be absorbed after the procedure.)

What happens if you get pregnant while you have the gastric band? Will you need to have it taken out? How safe will your baby be if you have the band?

You probably won’t have to get the band or port taken out. Unless you have complications, you should not need to get your band out. However, you may need to make an appointment to see your bariatric surgeon to have a small amount of saline taken out of the band so that you can eat a little bit more.

Despite the assurances of bariatric centers attesting to the safety of the band, the results of at least one Austrian study from 2001 were a little disturbing.  The researchers followed 215 morbidly obese women of reproductive age that had had gastric banding surgery.  Of those women, seven had unexpected pregnancies. Five of those were full term and two women had first trimester miscarriages. Two women had serious band complications (1 intragastric band migration and 1 balloon defect) which required re-operation.

Other studies are more assuring. A 2001 study followed 20 women (who had gastric banding) who had completed a total of 22 pregnancies. All 22 pregnancies were successful and complications were minimal.

One gastric banding patient had a remarkably easier pregnancy after receiving weight loss surgery as compared to her pregnancies before surgery.

I had two miserable pregnancies both resulting in emergency caesareans. In the second one it was difficult to monitor the baby in labour as the fat made it hard to pick up his heartbeat. I had to have an emergency caesarean which was awful. The theatre table was a bit narrow and I was terrified of falling off. The pregnancy was awful too as my diabetes meant the baby got very big. I hated having the growth scans since the scanners struggle to get good pictures and I felt really guilty.

After my gastric bypass I tried pregnancy once again. It couldn’t have been more different. I was more comfortable, less breathless and everything was so much easier. I had a normal sized baby and was thrilled to give birth naturally. (See source)

Will you need to get the band deflated when you find out that you’re pregnant? This is a point of contention in the medical community, but more recent evidence says probably not. Most recent studies have shown that when the band is totally deflated, pregnant women gain more weight than is healthy for the baby, which in turn is linked to an increase in the incidence of fetal macrosmia and gestational diabetes.  Most surgeons these days are recommending that you keep your band inflated, or to take out only a small amount of saline from the band.

However, one UK website said that the band should be emptied at 12 weeks pregnancy.  Another resource said that the band should not be re-inflated until after breastfeeding has fully completed.  These conflicting opinions may be confusing to you, so it’s best if you discuss your options with your bariatric surgeon.

Will I be able to take in enough nutrients for both me and the baby?

Everyone who has had gastric banding surgery should take nutritional supplements. If you are pregnant or planning to get pregnant, this is even more important.  The gastric band means that you eat less; eating less means that you are consuming fewer vitamins and nutrients.  One researcher states:

Key supplements to increase include iron to form new red blood cells, calcium for mineralization of fetal skeleton, folic acid to prevent birth defects, vitamin B1 (thiamine), vitamin B12 and vitamin A. Women should also take protein supplements in the form of protein shakes or protein bars as one cannot take the recommended daily allowance of 60 grams of proteins per day from foods. I recommend taking at least half or 30 grams in supplements and the rest from foods rich in proteins.

The New Jersey Bariatric Center has a very informational list of proteins shakes and protein-rich foods that are recommended for pregnant band patients.  See this website.

One source states that a mother’s weight loss has a beneficial effect on fetal and infant outcomes, such as normal birth weight.

I found out that I’m pregnant! Now what?

1.       Contact your General Physical (GP) immediately to confirm your pregnancy with blood tests.

2.       Contact your bariatric surgeon to let them know and to schedule a time to chat with them about it. Don’t be in a hurry to get the gastric band deflated because you may not need it completely reduced.

3.       Arrange blood tests to assess your nutritional status. You may have nutritional deficiencies because of your surgery. Double-check what your nutritional health is by having a simple blood test done.

4.       Follow your doctor’s instructions regarding nutritional supplements. What you might need for supplements is probably different from what is recommended for non-weight-loss-surgery patients, so make sure you’re not following “blind” advice from a book. Instead, follow the instructions set out for you specifically by your own GP and surgeon.

5.       Do not continue to lose weight during pregnancy. You probably aren’t going to need to pack on 50 pounds for the baby, but it also isn’t going to be healthy to continue to lose weight. You will need to adjust your priorities and mindset; you’ll need to change gears from “weight-loss mode” to “healthy baby mode.”

Resources for Further Reading

Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of pre-pregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet. 2007. 275(1): 39-43.  http://www.ncbi.nlm.nih.gov/pubmed/16967276

Beard et al. Reproductive considerations and pregnancy after bariatric surgery: Current evidence and recommendations. Obes Surg 2008. 18(8): 1023-1027.  http://www.springerlink.com/content/g1wp77705w52m641/

Biensman-Pailleux J and Gaucherand P. Laparoscopic adjustable gastric banding and pregnancy. J Gynecol Obstet Biol Reprod. 2007. 26(8):770-6.  http://www.ncbi.nlm.nih.gov/pubmed/17604570

Coupaye et al. Nutritional consequences of adjustable gastric banding and gastric bypass: A 1-year prospective study. 2008. 19(1): 56-65. http://www.springerlink.com/content/83t810685210612h/

Dixon JB et al. Birth outcomes in obese women after laparoscopic adjustable gastric banding. Obstet Gynecol 2005 Nov; 106:965-72. Abstract online at: http://general-medicine.jwatch.org/cgi/content/full/2005/1122/1

Dixon JB, Dixon ME, O’Brien PE.  2001. Pregnancy after lap band surgery: management of the band to achieve healthy weight outcomes. Obesity Surgery (11) 59-65. Abstract available at: http://www.healthierweight.co.uk/research/gastric-band-articles/lap-band-safe-during-pregnancy/

Jasaitis Y., Sergent F., Bridoux V., Paquet M. Marpeau L., Teniere P. Management of pregnancies after adjustable gastric banding. 2007. 36(8): 764-9.  http://www.ncbi.nlm.nih.gov/pubmed/17512137

Karmon A and Scheiner E. Pregnancy after bariatric surgery: A comprehensive review. Arch Gynecol Obstet 2008. 277(5):381-388.  http://www.ncbi.nlm.nih.gov/pubmed/18299862

Martin lF, Finigan KM, Nolan TE. 2000. Pregnancy after adjustable gastric banding. Obstet Gynecol. 95(6): 927-30.

Realize Gastric Band. http://www.realizegastricbandnj.com/realizeband/pregnancy-after-lap-band-realize-band-surgery.html [accessed 03 May 2010]

Weiss, Helmut, H Nehoda, B Labeck, K Hourmont, C Marth, and  Aigner. 2001. Pregnancies after Adjustable Gastric Banding.  Obesity Surgery. 11(3) 303-306. Abstract available online at: http://www.springerlink.com/content/9m1v493335135338/

Whitehead R.G. Dietary Reference Values. Proceedings of the Nutrition Society. 1992. 51:29-34. http://journals.cambridge.org/action/displayFulltext?type=1&fid=748416&jid=PNS&volumeId=51&issueId=01&aid=748408

Share

New blogger!

by Christine on September 22nd, 2010

filed under General Information

If you get a chance, please say hello to Libby from “This one time…in band camp.” She could use some support! She’s getting the gastric band soon, with her surgery date TBD!  Go say hello!

Share

Lessons Learned

by Christine on September 22nd, 2010

filed under Christine's Life Updates

Yesterday I had dinner with an old friend and colleague of mine. It was great to see him.  While I was out, I ordered the salmon (cooked “dry” with no butter), but with some mayo and mustard on the side. I mixed the mayo and mustard (2 parts mustard to 1 part mayo) and used just a little dab on my fork with each bite. It was absolutely delicious! 4 oz of salmon plus the mustard + mayo combination rang in at the most at 240 calories. Not bad at all!  The fish was served with a side of risotto with corn and asparagus in it. It looked delicious, but I didn’t even touch it.

Despite the great food choice, the calories for my day topped 1500! Considering my calorie goal is 800 a day, I actually almost doubled that! Dear heavens!  I was actually right on target with my food throughout the day and with dinner. So where did I go astray?  Apparently 2 beers, 2 glasses of wine (we were at the restaurant chatting for five hours!) followed by two small bites of cookie dough at home adds up to a ridiculous 600 calories!  I know, you’re sitting there thinking, “DUH,” but honestly, this calorie amount really snuck up on me yesterday.  However, I learned a lesson from it:

  1. Count up your calories prior to a dinner out, so the number is fresh in your mind.  Hell, write that number on the back of your hand school-girl style if you need to.
  2. If you’re going to drink, drink water in between each drink.  It hydrates you AND slows you down.
  3. The evening out is about catching up with friends, NOT about the food, NOT about drinking.

This morning my scale was up to 138.0, and there’s little surprise as to why.

Last night I woke up at 3 a.m. with terrible menstrual cramps, really bad dehydration, and painful constipation. I was lucky that I was able to fall back asleep, but ugh, owch.  The remedy is to drink some diluted prune juice throughout the day, lots of water, and an apple. And a bucket full of Aleve.

Tonight after work I have another evening out with friends. I will do a much better job keeping my calories in check.  Unfortunately I won’t have time to go the gym, which is maybe just as well because my cramps would definitely prevent me from running today anyway!

Picture of my colleague friend I met yesterday, John (left) with me at a work event. What a fun “before” picture! I remember that suit I was wearing: it was a size 16.

John and Tom

Recent pictures of me (size 6):

Share

New blogger! Stop and say hello!

by Christine on September 20th, 2010

filed under General Information

My Trek Downward is a brand-new blogger, with three followers! If you have a chance, stop by her blog to say hello!

Share

Finally went to the gym!

by Christine on September 19th, 2010

filed under Christine's Life Updates, Diet, Food, Nutrition

About three weeks ago I caught a cold or something, followed by another week of tiredness. Because of that, I stopped going to the gym. However, last week I felt fine…and I still didn’t go to the gym. I had nothing to blame except for all out laziness!

Well, I finally made it back to the gym today! I did 3 miles (40 mins) with incline raised on the treadmill, followed by situps. Not a really killer day, but that time really showed me how much three weeks off can set back my progress on the treadmill.  I felt relieved after I went to the gym. I don’t like to work out; I don’t like sweating, I don’t like the gym, and my lazy inner nature just doesn’t like the effort. Given my preference, I would much rather “work out” in ways that are fun, such as playing volleyball with friends, riding my bike, rollerblading after work, etc. I prefer outdoorsy, social activities.

That being said, it has become so ingrained in me that a healthy lifestyle simply requires working out. Consequently, I feel guilty when I don’t go.

Afterwards, I spent a solid eight hours cleaning the house! I re-potted half of my houseplants and put them in larger pots, with fresh soil. They look fantastic now! I had a giant aloe plant that I broke up in three huge pots, with a few “babies” I put into four little pots to give away to my co-workers tomorrow at work. Man, that took up a lot of room!

I did five loads of laundry and cleaned the cat’s litter boxes. I flipped our king-sized bed mattress, I cleaned the kitchen, I went for a walk with the neighbors. I’m going to spend the next three hours sitting on my butt on the couch reading my book (Patrick, I’m reading Diana Gabaldon’s Outlander series. I’m on “The Firey Cross” currently) and watching football! Go Steelers! They are 2-0!  Wahoo!

Food today:

Noon: 1 large glass of milk (120 calories) + leftover homemade chili (180 calories)
3 p.m.: 1 diet pepsi
4 p.m.: Some leftover couscous (44) with leftover bean stuff on it (30)
7 p.m.: WW pasta (20) and some tomato sauce/ground beef/veggies on it, approx half a cup (80) (barfed a little up…pasta does NOT sit well with me, and I only attempted to eat it because hubby cooked it, and i didn’t want him to feel bad!), 1 big glass of milk (120)
Total: 594!! Yikes, quite a deficit. I have room for a snack tonight…maybe an apple (or two!)

In other news, the lovely Patrick gave me a blog award! Thank you very much!

Ok, this award’s rules for eligibility are:

1. Answer the question, “If you had one chance to go back and change one thing in your life, would you and what would it be?
I don’t think I would change most of the major decisions in my life. I’m super thrilled with the decisions I made for college. Living in Europe for a year was a major life-changer for me. Moving to New York to go to graduate school set me up for some of the happiest moments of my life. For starters, it allowed me to make all the friends I have today and to meet my husband! And, of course, I would certainly have married him!
There are little things that I would have changed though. I wasn’t a very nice person when I was younger. This wasn’t entirely my fault; coming from an abusive household, I certainly wasn’t given a good example to follow. I’m proud of who I am today, so I suppose I needed those younger years to evolve.  And speaking of abusive households: I would have told my father. For lots of reasons I never told him what happened to me. If I had, I think he would have stopped the abuse, or at the very least minimized him. I was scared to tell him, but I should have.  So there…that’s two regrets.
2. Pass on to six people and inform them of the award.
Six people with fantastic blogs! You bet!

  1. Heather from “Healther’s Banded Journey”
  2. Lesia, who recently got her lifetime membership from Weight Watchers! Congrats!!
  3. Sparkler’s Story
  4. Mary from “Band me I’m ready”
  5. Amanda from “Amanda’s Waning”
  6. Sarah from “Losing weight, gaining tons”

Thank you once again Patrick!

Related Posts with Thumbnails
Share