>>It is very early in her pregnancy.  She did
> breastfeed her first child 7-8 years ago, although
this was before
she had
> the gastric-by-pass.
> This mom became pregnant two days before her
surgery. Thanks for any
help
> you can provide.<<

Dear Wendy:

First of all, this mother is at risk for maintaining a
healthy pregnancy and fetus, because of when she got
pregnant.  I had the surgery in December of 2000.  My
surgeon cautioned me against conceiving prior to
surgery as well as for the first year postop.  I had a
pregnancy test done the day prior to surgery (as were
all women of child-bearing age in the group) and an
abdominal sono a few days prior to the procedure.

The difficulty comes in because the size of the new
gastric pouch is only about the size the ball of the
thumb.  Caloric intake is only 400 calories a day on
average in the beginning, about 800 calories maximum
in the early months.  Extreme weight loss occurs in
the first 9 months after the procedure, then levelling
off to none over the next 18 months as caloric intake
equals energy expended and the pouch stretches
somewhat.  (We take longer than a newborn to have the
stomach grow due to the titanium staples.)  Stomach
size never returns to preoperative levels.  Intake is
gradually increased so that protein is about 50 grams
per day, then vegetables & fruit make up the other
half of the meal with limited intake of processed
carbohydrates under the eating plan my doctor
recommends.  Each surgeon offers different plans &
postop nutritional intake--alot depends on how
knowledgeable the surgeon is to begin with about
nutrition.  There are some programs where people were
started off with mashed potatoes & told to eat
whatever they want.  They have lower weight losses &
more problems with malnourishment.

This mother will need close supervision by a dietician
as well as a perinatologist & her obstetrician during
her pregnancy as well as adding the IBCLC.  She may
(although right now this is not as high on the list of
concerns) not have an optimal outcome from the bypass
as well since she will miss the high weight loss
period.  In the early weeks following bypass, most
recipients have an absence of appetite & a change in
taste.  Eating becomes rote and it is an opportunity
to work on building new, healthier appetites.  After 9
months to a year, weight control issues return to
pre-surgery.  The body has adjusted & if new habits
are not established, weight can be regained.  After
the first year postoperatively, pregnancy &
breastfeeding can proceed normally.  I do have
personal experience with a mother who conceived 6
months after surgery & did quite well, but it did take
her some extra dietary supplementation to maintain
good fetal growth.  The child is normal.  I don't know
of outcomes of other mothers who conceived earlier.
The mother I know of was the earliest to have
conceived in the group I attended.  I would think some
of the problems would be similar to mothers with
bulimia/anorexia who conceive.

I'll be keeping this family in my prayers.

Linda Madsen, RN, IBCLC
Plano, TX

__________________________________
Do you Yahoo!?
Free Pop-Up Blocker - Get it now
http://companion.yahoo.com/

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html