Standard supplement recommendations

Dietary supplementation before and during pregnancy should be based on laboratory findings as well as the type of bariatric surgery. General practice includes adding a prenatal vitamin to the current supplement regimen for the bariatric surgery, not giving it in lieu of the standard postoperative regimen.

The standard prenatal vitamin contains 1 mg of folic acid, which is sufficient to reduce the risk of neural tube defect in the fetus (1 mg of folic acid per day should be taken prior to pregnancy for maximum benefit). For RYGB and BPD-DS, it is important that the calcium source be citrate because citrate does not require an acidic environment in order to be broken down. It is best that vitamin B12 be taken sublingually in crystalline form for better absorption [18]. When prescribing iron, ferrous fumarate is best tolerated [25]. For all patients who take iron and calcium, to maximize absorption the two should not be taken at the same time. If BPD-DS patients are compliant with taking fat-soluble vitamins but remain deficient in vitamin A, then additional vitamin A should be given as beta-carotene, since vitamin A may have teratogenic potential [27]. While general recommendations are given below, each patient should be treated as an individual and may require a slightly different regimen (Table 6.1).

Table 6.1

Standard Prenatal Supplementation for Women who have Undergone Bariatric Surgery

Table 6.1

Standard Prenatal Supplementation for Women who have Undergone Bariatric Surgery

Procedure

Supplement and dose

Laparoscopic adjustable gastric

Prenatal vitamin with iron

banding or sleeve gastrectomy

Calcium citrate 1200 mg/day plus vitamin D 800 IU/day

Roux-en-Y gastric bypass

Prenatal vitamin with iron

Calcium citrate 1200 mg/day plus vitamin D 800 IU/day

Vitamin B12: 500 mcg/day

Elemental iron: 300 mg/day (ferrous and

polysaccharides complex)

Biliopancreatic diversion with

Prenatal vitamin with iron

duodenal switch

Calcium citrate 2000 mg/day plus vitamin D 800 IU/day

Vitamin B12: 500 mcg/day

Elemental iron: 300 mg/day (ferrous and

polysaccharides complex)

ADEK: three times per day

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