Bariatric surgery improves fertility success rates and PCOS management. Lower rates of miscarriage, gestational diabetes, hypertension, fetal macrosomia, and congenital abnormalities.
Recomend to delay pregnancy until weight is stable (1 year after sleeve or bypass, 2 years gastric band). Optimise weight, nutritional status and diabetes >3 months before pregnancy (including a diabetes screen)
Avoid oral contraceptives (use LARC)
Malnutrition
Fetal growth restriction
Worsening postprandial (“dumping”) syndromes
Postoperative intra-abdominal complications
Vitamin D 1000 units OD
Folic acid (400 mcg OD if not obese, 5 mg OD if obese)
Monitor weight gain & intervene if poor
Check: FBC, folate, ferritin, active B12, U&Es, LFTs, vitamin D, calcium, phospate, PTH, magnesium, PT, INR (vitamin K if abnormal clotting)
Serial thrid trimester growth scans
Test all women for GDM: one week of CBG monitoring (finger prick or continuous) for sleeve gastrectomy or bypass (using >5.3 fasting or 7.8 at one hour), or OGTT for gastric bands
Encourage bresatfeeding