>>Mom's history is gastric by-pass a year and a half
ago.  Got
pregnant less than 3 months post-op (much to horror of
her docs, who
advised waiting a year), had normal pregnancy, but
rough delivery<<


At 18 months post-op, she is still at the tail end of
extreme weight loss for most gastric by-pass patients.
 Besides following up on the suggestion from a
previous poster on the mother's vitamin
supplementation intake (including the very necessary
B-12 supplement), I would suggest asking the mom about
her general intake.  Pregnant mothers who have had
gastric by-pass in the past in the practice where I
had mine done were counselled to increase their intake
even when they were beyond the 1 year - 18 month
postop delay recommended for pregnancy.  Food intake
is generally just beginning to be liberalized at this
point.

Reglan & domperidome are not recommended for gastric
by-pass patients because they increase the transit of
food through the GI tract.  The surgery in & of itself
increases food transit through the tract increasing
the likelihood the patient will not have adequate
absorption of nutrients.  Depending on where the
mother's intestine was reanastamosed from the new
small stomach pouch to the remainder of the small
intestine also plays into how much is absorbed--some
surgeons have a preference for attaching the "Y" lower
down on the small intestine turning the operation into
a malabsorptive one.  It's done more frequently on
patients who had traditional "stomach-stapling"
procedures in the past & regained their weight, but
some doctors do perform the operation in that manner
regardless of a patient's weight-loss/gain history.

Sincerely,
Linda A. Madsen, RN, IBCLC & gastric by-pass recipient

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