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Pregnancy after Bariatric Surgery
Blog Series on nutrition in pregnancy after bariatric surgery
Part Three: Vitamins and minerals for pregnancy after bariatric surgery
Welcome back! If you’re traveling along with me in this blog series, I’m glad to see you again. And to those that are just hopping in for this article – hope you enjoy and check out the other articles for further information about this subject.
We are diving into vitamins and minerals on this one. It’s yet another chance to nerd out together (can you tell how I truly love to be a nerd?) This section is possibly the one that I could get most detailed with. I will advise that if any of this is confusing, make sure to get some guidance from your bariatric team, OBGYN or specialized dietitian. I’ll also put some contact details at the end of this post.
Let’s Jump In…
What are micronutrients?
Your micronutrients, better known as vitamin and minerals, may have some different needs during pregnancy. Keep in mind that it is always easier to keep your micronutrient levels within normal range rather than treat a deficiency.
It’s best to have your levels within normal range prior to getting pregnant. If, for some reason, you’ve stopped taking your vitamins or haven’t had your labs checked in over a year – I’d suggest to start there.
How to know if a multi-vitamin is “complete”
Once you are pregnant, many people will stop taking vitamins completely, however, those getting pregnant after bariatric surgery will need to take these micronutrients to fill in the blanks from surgery or support additional needs that are not available otherwise.
Let’s start with the multivitamin first. Look for one that is complete and includes minerals. My “quick check” for completeness is if it includes iron, selenium and zinc, those are the usual ones that will be missing. This is different from a pre-natal vitamin. Those of you that have gone through bariatric surgery, especially one that bypasses or re-routes parts of the intestine, will need a complete multivitamin. There are also bariatric formulated vitamins that may be your best bet for this.
Vitamins of note during pregnancy:
Thiamine / B1: It’s used for brain development for the growing fetus. This vitamin can easily be depleted with vomiting and the body only has storage for about 2 weeks. If you experience frequent vomiting during your pregnancy course, make sure you are getting additional Thiamine. The recommendation is 14mg daily during pregnancy after bariatric surgery.
Vitamin B12: B12 works to develop the baby’s neural tube, as well as brain and spine formation. Along with folate, it also produces red blood cells and assists with DNA synthesis. You’ll need 350-500mcg daily.
Folic Acid / Folate: Prevents neural tube defects and is essential for DNA and RNA synthesis. Women who have had bariatric surgery and are planning a pregnancy are recommended to take 1.0 mg of folic acid supplementation daily. Even if you are planning on getting pregnant, you may want to start taking this in advance.
Vitamin A / Beta-Carotene: This vitamin makes people a little nervous, as both too much or too little can cause adverse effects. Vitamin A is used for eye formation and effects the developing skeleton and organs. Beta-Carotene is what is considered a “pre-curser” to vitamin A, which means the body can control how much carotene it converts into usable vitamin A. Some people may prefer to use beta-carotene (or a combo of vitamin A / beta carotene) during their pregnancy if additional is needed. The maximum vitamin A is 5,000 units per day.
Vitamin D / Calcium: Vitamin D is primarily used for bone growth and formation. While calcium plays a role in the formation of bone, teeth, heart, nerves and muscles. Vitamin D needs are increased toward the latter part of the pregnancy. Daily Vitamin D recommendation is 3000 units (75mcg) daily, while Calcium ranges between 1200 – 2000 mg and should be taken in divided doses throughout the day.
Iron: Takes part in blood formation and is helpful in the prevention of low birth weight and pre- term birth. Part of the reason why iron is a struggle during pregnancy is that iron requirements increase nearly 10-fold during pregnancy. It is recommended to have 45mg of elemental iron daily during pregnancy after bariatric surgery. For those of you that may be envisioning adverse effects from increased iron… just know that supplementation has come a long way and there are other types of iron available that are much gentler on your stomach and digestive tract.
Choline: this micronutrient is used for development of brain cognition. The American Medical Association advises 450mg of choline per day and notes that many multivitamins and prenatal formulations do not include that amount. Foods that contain choline are egg yolks, fish, poultry, legumes, nuts and cruciferous vegetables. But, you may also need to add an additional choline supplement.
DHA / EPA: Both of these fatty acids are part of the Omega-3 family. DHA and EPA assist with numerous aspects of development. In selecting a supplement, the amount of DHA is should be higher than the amount of EPA included. Look for one that has 300mg of DHA included.
Vitamins can definitely be the most confusing part of pregnancy after bariatric surgery and this is just a brief overview. I would HIGHLY recommend connecting with a Bariatric Dietitian that is experienced with pregnancy and weight loss surgery. If you need help finding someone, reach out to Steph at Steph@bariatricfoodcoach.com and she can help get you connected.
Up next in the final blog of this series, I’ll take a look at breastfeeding and beyond for pregnancy after bariatric surgery.