story by

Meredith Raine

When Abby Erias had gastric bypass surgery, she remembered the physicians telling her that one of the side effects to her rapid weight loss could be increased fertility.

She already had two daughters and wasn’t planning to have more children, so she went on birth control. She didn’t want to take any chances.

“I couldn’t find the right birth control for me, so my plan was to go off birth control for 30 days and then go a different route with something new,” Erias says. “In less than 30 days, I didn’t think I could get pregnant, but I went a different route all right. I had a baby!”

When bariatric surgeons at The University of Texas Medical School at Houston host information sessions about gastric bypass and lap-band procedures, they emphasize that, as the unwanted pounds come off, pregnancy may become a very real possibility. This discussion often produces some chuckles and a few “Yeah, right” comments from women in the audience.

Terry Scarborough, M.D., assistant professor in the medical school’s Department of Surgery, understands why women might find this news laughable. Some are toward the end of their childbearing years. Others have had such a difficult time in the past becoming pregnant that they think there is no way weight-loss surgery could improve their ability to conceive. Some are amused because a risk of pregnancy would imply sexual activity—something in which they haven’t engaged in quite some time because of their weight.

Whatever the case, Scarborough reminds his patients, “If you don’t want to get pregnant, you need to be diligent about birth control.”

Roslyn Spivey has some advice for those women who think it can’t happen to them. “I tell people you better be careful or you can get one of these,” Spivey says with a smile, as she gives a bottle to her infant daughter.

Spivey recalled the discussion about increased fertility before Scarborough did her lap-band procedure, but she “just glossed over it” because she thought she was too old to have more children. One day she was fatigued and wasn’t feeling well. She went to her physician to talk to him about what she thought were symptoms of menopause. She couldn’t believe it when the doctor told her “the change of life” she was experiencing was actually a pregnancy.

Scarborough says obesity often creates high levels of hormones that can hinder fertility. As women begin to lose weight after bariatric surgery, hormone levels begin to stabilize. Plus, patients are often eating healthier and exercising more, which creates a more conducive environment for ovulation and conception.

Nutrition and pregnancy after surgery

Pregnancy after bariatric surgery is considered safe, as long as patients adhere to a few important guidelines.

“It’s absolutely imperative that they not get pregnant for the first year after the surgery, and we prefer that they wait two years,” Scarborough warns. “That’s the time of greatest weight loss and the greatest stress on the body.”

During that time, Pamela Berens, M.D., associate professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the UT Medical School at Houston, recommends birth control pills or a contraceptive vaginal ring. She advises against Depo-Provera, a three-month shot that may promote weight gain.

Once the patient is a healthy weight and a year or two past the surgery, if she chooses to become pregnant, Berens recommends she consult with an obstetrician who has experience with weight-loss surgery patients and begin taking folic acid at least three months before trying to conceive.

The key is to make sure the mother is absorbing enough nutrients to sustain herself and the fetus. For gastric bypass patients who may not be absorbing adequate levels of vitamins and minerals, Berens may suggest B12 injections, which are more easily absorbed than oral vitamins.

Carol Wolin-Riklin, a bionutritionist who works with patients at the UT Medical School at Houston and Memorial Hermann-Texas Medical Center, adds that chewable prenatal vitamins are now available, and these may be easier than regular supplements for gastric bypass patients to swallow.

“There are a lot of nutritional issues that they need to be aware of and manage responsibly so that they can have a healthy baby,” Wolin-Riklin says.

The goal for women who become pregnant after weight-loss surgery should be 1,500 to 1,800 calories per day. “They need five to six meals and snacks a day with no skipping,” she recommends.

Scarborough, who operates at Memorial Hermann-TMC, says that if lap-band patients are having trouble getting enough nutrients, the band could always be adjusted to allow them to eat more. He added that gastric bypass patients must be monitored closely.

“We consider it a high-risk pregnancy, but we think it’s probably safer to have surgery and get down to a normal weight before becoming pregnant than it is to become pregnant while being morbidly obese,” Scarborough says.

Wolin-Riklin adds that losing excess weight reduces a woman’s risk of developing high blood pressure and gestational diabetes during pregnancy.

In addition to the health and safety of both mother and baby, women who become pregnant after weight-loss surgery are often concerned about the baby weight—what they put on during pregnancy. Most bariatric patients will gain 15-20 pounds during their pregnancy, Wolin-Riklin says, “And we can work with them to help them lose that weight.”

Erias, whose daughter Destiny is now more than a year old, says she lost the weight she gained during her pregnancy and then some. “I used to be a size 24,” she says. “Now, I’m a size 6. I’m healthy, and I have a healthy baby.”

UPDATED: 7-25-2007

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