Did you or someone you know have weight loss surgery?
An estimated 84% of weight loss surgeries are performed on women of childbearing age, and weight loss surgery is on the rise, so questions about its implications for breastfeeding are becoming more common.
I asked Lou Lamb, RN, IBCLC, author of an article on weight loss surgery and breastfeeding for Clinical Lactation, to explain what the research says and what mothers should know. Lou is a hospital-based lactation consultant in Virginia with many years of assisting nursing mothers.
Did you know that bariatric or weight-loss surgery (WLS) is one of the fastest growing sub-surgical fields in the U.S. today?
Although participants on the TV show “The Biggest Loser” achieve amazing results, for the average person who is 100 pounds or more overweight, diet, exercise and behavior modification is unsuccessful. WLS is known to be the most effective and long lasting treatment for morbid obesity. Even more astonishing, mounting evidence suggests WLS may be among the most effective treatments for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol, and obstructive sleep apnea.
So, WLS is an exciting treatment option for this complex medical condition for the nearly one in two women of childbearing age in the U.S. who are either overweight or obese.
But could WLS have an effect on a mother’s ability to breastfeed?
First, let’s get familiar with the two most common types of weight- loss surgery (WLS): the Roux-en-Y Gastric Bypass (RYGB) and the Laproscopic Adjustable Gastric Band (LAGB).
The RYGB is a restrictive and malabsorptive procedure. This means that it involves creating a “mini-stomach” the size of your thumb which limits the amount of food you can eat at one time. In addition, 20% of the small intestine is bypassed, which affects the absorption of certain nutrients. Advantages: rapid weight loss (average 76% of excess body weight lost in the first year). Disadvantages: decreased intestinal absorption of food and nutrients resulting in lifelong need for vitamin and mineral supplementation.
The LAGB is a procedure in which a gastric band is placed around the upper stomach to form a pouch, and it too limits the amount of food eaten at one time. Advantages: no negative effect on absorption of nutrients, and a less invasive procedure. Disadvantage: slower weight loss (average 48% of excess body weight lost in the first year).
With regard to breastfeeding, you can see that the LAGB procedure has less impact on the nutritional status of the mother, as there is no issue with absorption of nutrients. However, due to the small stomach size, a breastfeeding mother would need to eat frequent, small, high protein meals/snacks to ensure she receives the recommended 70 grams of protein. As one nutritionist puts it, “Eat healthy meals and nutrient dense snacks—not rabbit food!”
On the other hand, the RYGB has much more serious implications for breastfeeding. A 2010 review of the literature shows that perinatal outcomes after bariatric surgery are generally considered as favorable for both mother and child. However, a few case reports
highlight the possibility of side effects for the fetus and newborn. These researchers reported on five cases of newborns with severe intracranial bleeding, all possibly related to vitamin K deficiency following maternal bariatric surgery. In addition, there have been a
limited number of case reports of babies developing certain forms of Vitamin B12 deficiency anemia who were breastfed by a mother with a history of RYGB. In all of these cases, women were either not taking their prescribed vitamin/mineral supplements or consuming a poor diet.
What are some related issues which might affect breastfeeding among mothers with a history of WLS? Studies show that women with a history of WLS have a higher rate of cesarean section, which can result in delayed onset of lactation. One case study reports on a
woman with significant fat malabsorption post-WLS who had a failure-to-thrive baby. When tested, her breastmilk showed a low mean fat and calorie content. This woman failed to follow nutritional guidelines post WLS.
Hormonal issues (such as Polycystic Ovary Syndrome or diabetes mellitus) can cause overweight, and even after weight loss these same issues may affect a mother’s ability to produce an abundant milk supply. Of further impact on breastfeeding is a history of plastic
surgery as many women, after losing over 100 pounds, have “skin sagging” (particularly breast ptosis) and may have had “body contouring” procedures done. Much more research needs to be done in this growing field of post-WLS and breastfeeding.
So, if you plan to breastfeed and are considering or have had WLS, don’t be discouraged! Breastfeeding is recommended for you. It will help keep your weight down and oxytocin release will contribute to your feeling of well-being.
But, here are some important tips to remember:
1. After WLS, wait 2 years before becoming pregnant. Hopefully you will have lost the majority of your weight.
2. Always take vitamin/mineral supplements as prescribed.
3. During your pregnancy, see a dietician (possibly one who specializes in bariatric surgery) for nutrition counseling. A healthy, growing fetus equals a healthy newborn.
4. After delivery, get help with breastfeeding right away! Try to breastfeed frequently, particularly in the first 24 hours, to help prevent delayed lactogenesis. Do lots of skin-to-skin with your baby and use creative positioning, including the use of blanket rolls and pillows. Try Suzanne Colson’s Biological Nurturing/Laid Back Breastfeeding positions.
5. While breastfeeding, ask your doctor to check your blood to see that you are absorbing enough vitamins (especially Vitamin B12) and protein.
6. Inform your baby’s pediatrician of your WLS, as more frequent well baby checks may be needed to check for appropriate growth and development.
7. Remember: a motivated woman who commits to losing weight has a healthier future for both her and her baby.