It's important to remember that with gastric by-pass
the term is used to cover a broad range of surgery
types.  The amount of calories & nutrients absorbed
are dependent on where the "y" limb is connected, and
how much of the bowel is diverted.  Different surgeons
have different techniques & philosophies concerning
postoperative food intake. Ask if the woman has had
any other prior weight-loss surgeries because if she
has and they failed to produce long-term weight
management, a surgeon may choose to perform a distal
anastomosis which can cause malabsorptive/chronic
malnutrition syndromes.

A general rule of thumb is that women not get pregnant
for one year postoperatively.  It gives a chance for
the weight loss to taper off on its own as calorie
intake matches up with energy output.  It is necessary
for all gastric by-pass patients to be on vitamin
supplementation for the rest of their life & it is
essential that they take in B12 whether sublingually
or injected.  In the early months postoperatively,
patients often only take in 400-800 calories per day.
Past one year, most patients take in adequate calories
despite the smaller "new" stomach & increased transit
time for food to pass through the gastrointestinal
tract.  Problems can arise if patients fall back in to
old eating habits & make poor nutritional choices.  I
am in a support group for gastric bypass patients
(almost 3 years postop) & the majority of us mourn the
fact that after the first year, once again, we must be
vigilant about eating so as not to regain weight.

It is important to get a thorough picture of their
health history and how breastfeeding is going.
Several cases mentioned over the last 2 days have
mentioned PCOS, early return to work, early formula
supplementation & scheduled feeds--all red flags for
poor supply issues & inadequate infant nutrition
rather than a direct link to a side effect of gastric
bypass.

Remember also the number of women in under-developed
countries with caloric intake much less than those of
us who live in the industrialized world end up
successfully breastfeeding in those less than ideal
circumstances and in general breastfeed for a much
longer period of time.  If the woman who has had a
gastric bypass surgery can maintain a healthy
pregnancy, most should be able to feed their infants.



Linda Madsen, CPN, IBCLC




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