This month, the American College of Obstetrics and Gynecology (ACOG) – the certifying board for Ob/Gyns – released a paper on pregnancy and obesity. The paper has several different parts to it; some address the problems that obesity causes in pregnancy and one part addresses the specific concerns of pregnancy in patients who have had weight loss surgery. The part about bariatric surgery patients mainly discusses gastric bypass as this is associated with so many vitamin and nutrient deficiencies, but some is applicable to the Lap Band as well.
The risks of pregnancy in overweight women is astounding: “…everything we do in obstetrics is made more difficult and more complex by obesity—from using external monitors to performing surgery.” “According to ACOG, some studies show that obesity is an independent risk factor for miscarriage among women who undergo fertility treatment. Data also links obesity to miscarriage in women who conceived naturally. Obesity has been linked to an increased risk of gestational hypertension, preeclampsia, and gestational diabetes. And the higher the body mass index (BMI) a woman has, the higher the chance she will need a cesarean.”
“Other studies show that obese women have more complications during and after cesarean surgery, including excessive blood loss, operating time greater than two hours, and wound infection. Surgery in obese women also poses anesthetic challenges, among them difficult epidural placement and respiratory problems from difficult intubation.” “Elevated risks to the babies of obese women include stillbirth, prematurity, macrosomia (large for gestational age), neural tube defects, and higher rates of childhood obesity. ” – ACOG press release
Pregnancies following bariatric surgery are often less likely to have serious complications such as diabetes, high blood pressure, very large babies and cesarean sections. They do recommend that patients who have had bariatric surgery wait 1-2 years before getting pregnant as there are certain low levels of some nutrients (such as B12 and Folate) during periods of large weight loss which can effect the health of the baby. However, since fertility is increased by weight loss, it is recommended that women take a multivitamin per day in case of accidental pregnancy. The other reason to wait until you’re close to your goal weight is that the closer you are to your ideal body weight, the fewer complications you are likely to have with pregnancy.
21. June 2009 at 11:26 pm
I had lapband surgery in 2005, I had two children previous to having the band surgery. Since the band surgery I have had two miscarriages in less than a year, i am wondering if the band could in any way be the cause? I have asked OBGYNs I have asked bariatric surgeons, noone will give a straihgt answer, can you help me?
25. June 2009 at 6:19 pm
I think nobody is giving you a “straight” answer because we almost never say never in medicine. But having said that, I have never heard at a national conference nor read an article that suggests that the LapBand causes miscarriages. I could see where a nutritional deficiency or imbalance might increase your risk for miscarriage though, so you might want a thorough work-up before attempting another pregnancy. Every bariatric surgeon I know sees a dramatic increase in fertility and childbearing after weight loss, not pregnancy loss.
2. July 2009 at 10:33 am
I am 29 weeks pregnant and have been banded now for about 1.5 years. My pregnancy has been uncomplicated so far. No preeclampsia, no diabetes, no low iron, no morning sickness, no tightness needing an unfill (I actually got looser after getting pregnant), and no excessive weight gain (have actually only gained 3 lbs but am eating healthy plenty so my OB isn’t concerned).
I would like to have a completely natural childbirth, but I wonder what complications the lap band could reasonably cause during labor.
2. July 2009 at 2:18 pm
We aren’t aware of any of our patients, nor any patients in general, having troubles with labor because of the Lap Band. The Lap Band is around the stomach and as such generally should not affect the uterus or childbirth in any way.
Congratulations!
7. July 2009 at 1:18 pm
Will actual labor and contractions labor push or move the port?
8. July 2009 at 1:12 pm
It shouldn’t as most of the work is done by the uterus and not really the abdominal wall muscles. But even if you were doing powerful sit-ups or contractions of your abdominal wall muscle, this should not push or move the port.