Pre-op, questions concerning preg after VSG and nutrition

[VSG4aHealthierMe 6]

I am pre-op and considering the VSG. Unlike with the lap, which what I was considering originally, there is no ability to "open" the stomach up anymore to allow for an easier way to make sure you get enough nutrients for you and baby with VSG, as you all know. DH and I plan to have one more child once I finish school and we get settled. I have already lost one baby at 20 weeks 5 days due to a condition that should have been prevented by the folic acid supplements I was taking, so nutrition during pregnancy would be a #1 priority, with or without the sleeve. My concern is that with the limited dietary intake that even with the supplements I may not be able to consume enough of vital nutrients to keep baby and myself healthy. How much more of a concern is nutritional intake during pregnancy? Does it present a problem usually? I have heard/read that pregnancy after surgery can actually be safer for baby than pregnancy while obese, so overall I am comfortable with the WLS, although I am still trying to adjust to the idea of actually altering my anatomy irreversibly, but nutrition during preg after WLS is a concern for me. Had I not lost a child already to a deficiency I may not be a bugged out about it now but because I have it is a very present concern for me. One which I must know more about before I can truly feel comfortable with ANY WLS. My doctor has me on 4 mg of folic acid a day and I have since had a healthy, term pregnancy. I do not plan to get a malabsorbtion procedure, so I guess my question is will my dosage of pill be absorbed fully, same as b4 surgery given that part on my stomach would be removed. I am thinking it should, but I can't allow myself to just think it. I need to know 150% for sure. Furthermore, given my dietary intake will change should I talk to my doc about upping my dosage post-op(I have to take the folic acid for the rest of my reproductive life, just in case of an oops)?

What other big changes will there be once I get preg post-op? Will I be considered high-risk because of this surgery or will I just be a mother 2 be who has to REALLY watch what she eats? My weight made my last preg VERY high risk. I had too much Water in the amniotic sac caused by BP issues (caused by fat), mid pregnancy, then for the rest of it I could barely walk and had to take a leave from work, had to see a high risk specialist... the whole 9. It would be nice to just have a nice, mostly normal and uncomplicated preg next time (plus, I will admit... it will be nice to watch my belly grow bit by bit instead of having to watch my fat rolls- yeah, I said it lol- move out further and further until baby is big enough to make me actually LOOK preg lol).

Is there anything you wish you had known pre-op regarding preg post-op? Any other info would be great! Thanks in advance!

[Tiffykins 672]

Honestly, VSG does NOT make you high risk as long as you stay on top of your labs, follow the post-op, and then allow your body to settle into maintenance. I am able to easily eat the recommended 1700-1800 calories with 100gr of Protein and a minimum of 100gr of carbs per day, on top of pushing about 80-100oz of clear fluids.

I would recommend that you wait until your body has settled at a good maintenance weight just like what was recommended for me. I begged my surgeon to release me early for TTC only because we were looking at a possible deployment, my weight was stabilized, and my labs had always been stellar. I was released because of my results, my labs, and we needed to see if we could even get pregnant without medical assistance.

In the 13-14 months that we tried, I had 2 chemical pregnancies. VSG did NOT contribute to the losses, it was just my body. I had one in January 2011, and got pregnant February 2011, and today I am 6 months pregnant with zero issues related to my VSG.

You will absorb all the folic acid you ingest, and I take my Celebrate multi with Iron per my high risk ob. I am high risk for other issues. The stomach doesn't break down folic acid like it does the B12. You'll need to use a sublingual or get injections for B12. The folic acid is absorbed in our intestines.

Let me just tell you about band life with pregnancy. There's a few on OH, and they gained lots of weight, puked, and caused slips, and had emergency band removal due to complications even with wide open bands. Morning sickness puking does NOT bode well for the band. I puked on Water some days with my band so I can't imagine being pregnant with it.

You should use protection, preferably 2 forms of bc during your losing stage. Your hormones are so out of whack early out, not to mention most post-op diets are low carb, and capacity is half of what it is once you hit about 9-12 months out. Low carb causes ketosis which will cause fetal brain damage and increase risks.

Here is a picture that shows where nutrients are absorbed in our intestines, it's used to illustrate malabsorption for RNY, but with the sleeve, this is NOT an issue since there is no re-routing. I just wanted you to see where the folate is actually absorbed.

I already researched so much about pregnancy after weight loss surgery, I was prepared. I'm very happy that I can stay on my Celebrate multi with Iron, and that my labs have remained stellar throughout this entire pregnancy. I've had labs pulled every 4-6 weeks since I was 5.5 weeks pregnant.

Believe me, the band is not safer, nor does it have less complications. There are plenty of us here, and on obesityhelp.com that have HAD to revise. It wasn't just a matter of wanting to, we did it out of necessity. I won't recommend the band to my worse enemy.

Best wishes in your research. If you have any other questions, want some research articles, information, statistical data, or other information about the VSG and the band, please feel free to let me know.

[Tiffykins 672]

I should add that regaining weight, NO matter what anyone says, for the pregnancy is definitely difficult for me mentally. I've shared that on here a couple of times, and yes, I realize it's baby weight, and that I will lose it. BUT, that doesn't change the fact that I've gained weight after working my a&& off to lose it.

So, while I'm overjoyed with pregnancy, beyond elated that she is growing, healthy, thriving, all the good stuff, I can tell you that gaining weight after being in maintenance for 1 year, and being 20 months post-op when I got pregnant, is really a mindtwist. It messes with me mentally. I always said "Oh I won't care about gaining weight" THAT is a complete lie!!! And, I'd rather admit the way I feel about it, and be realistic than deny those feelings and not be able to work on them.

[VSG4aHealthierMe 6]

I should add that regaining weight, NO matter what anyone says, for the pregnancy is definitely difficult for me mentally. I've shared that on here a couple of times, and yes, I realize it's baby weight, and that I will lose it. BUT, that doesn't change the fact that I've gained weight after working my a&& off to lose it.

So, while I'm overjoyed with pregnancy, beyond elated that she is growing, healthy, thriving, all the good stuff, I can tell you that gaining weight after being in maintenance for 1 year, and being 20 months post-op when I got pregnant, is really a mindtwist. It messes with me mentally. I always said "Oh I won't care about gaining weight" THAT is a complete lie!!! And, I'd rather admit the way I feel about it, and be realistic than deny those feelings and not be able to work on them.

Thanks so much! That picture was especially helpful! I know what you mean about the weight loss messing with your head because after my loss I was finally back down closer than I had been in a very long time to my pre-preg weight with my first(my loss was my second preg) then I got preg again and, like you siad I knew that gaining was part of pregnancy but it really upset me, and in my case, for good reason. Since my last preg I have weighed as much as I did at the END of my first pregnancy and I can't lose it to save my life. Long-story-short, I get it.

The B12, I have heard/read ppl mention that as a post-op Vitamin. I am assuming I will be taking it sublingually starting right after surgery, right? Which would mean its not preg specific?

[Tiffykins 672]

Thanks so much! That picture was especially helpful! I know what you mean about the weight loss messing with your head because after my loss I was finally back down closer than I had been in a very long time to my pre-preg weight with my first(my loss was my second preg) then I got preg again and, like you siad I knew that gaining was part of pregnancy but it really upset me, and in my case, for good reason. Since my last preg I have weighed as much as I did at the END of my first pregnancy and I can't lose it to save my life. Long-story-short, I get it.

The B12, I have heard/read ppl mention that as a post-op Vitamin. I am assuming I will be taking it sublingually starting right after surgery, right? Which would mean its not preg specific?

Correct. You'll always need to take it sublingualy. The portion of the stomach that is removed is where the intrinsic factor is and that's what breaks down B12 to be absorbed properly. Your dosage will vary based on your labs. At this point, I pop a 2500mcg 3-4 days a week instead of every day based on my labs. I took one every day for the first 18 months post-VSG, and at my 18 month follow-up, my b12 was super high so my surgeon knocked my dosage down to a few times a week. My labs went back to normal ranges in 3 months with my first prenatal labs that were pulled. It's a Water soluble Vitamin so it didn't take long for my body to get back in normal ranges.

[VSG4aHealthierMe 6]

Correct. You'll always need to take it sublingualy. The portion of the stomach that is removed is where the intrinsic factor is and that's what breaks down B12 to be absorbed properly. Your dosage will vary based on your labs. At this point, I pop a 2500mcg 3-4 days a week instead of every day based on my labs. I took one every day for the first 18 months post-VSG, and at my 18 month follow-up, my b12 was super high so my surgeon knocked my dosage down to a few times a week. My labs went back to normal ranges in 3 months with my first prenatal labs that were pulled. It's a Water soluble Vitamin so it didn't take long for my body to get back in normal ranges.

Thanks. That makes sense.