Calorie recommendations for the pregnant bariatric patient include approximately 300 kcal/day above maintenance guidelines for bariatric surgery. As with protein, calorie recommendations may vary between institutions. Typically, 1 year after surgery, individuals consume approximately 1,200 kcal/day, so this would result in a caloric recommendation of 1,500 kcal/day for pregnant bariatric patients. These are general guidelines, and each patient should be monitored for appropriate weight gain during pregnancy to ensure she is getting adequate caloric intake.
Weight gain during pregnancy after bariatric surgery is variable, as with any pregnancy. There are no published guidelines for pregnancy weight gain in bariatric patients. Therefore, the guidelines set forth by the Institute of Medicine should be used (Table 6.2) . The postoperative BMI should be used to determine the appropriate weight category.
Even when weight gain is normal and expected during pregnancy, some patients may have an emotional response to this gain since they worked so hard to lose weight. It should be reinforced to patients that pregnancy is not a time to lose weight. Inadequate weight gain can result in intrauterine growth retardation and fetal abnormalities . Patients may also be nervous about losing their pregnancy weight after the birth of their infants. It may be helpful to refer the patient to a psychologist to help sort out these issues.
Recommendations for Weight Gain during Pregnancy
Recommended weight gain (lb)
Underweight: BMI < 19.8 Normal weight: BMI = 19.8-25 Overweight: BMI = 26-29 Obese: BMI > 29
28-40 25-35 15-25 15
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