I'm pregnant.... Seeking other post-DS mamas!

 Hi all. I'll be 3 yrs post-DS come August. Doing great. Getting on the lower end of what I'M comfortable with iron-wise and vitamin D is a struggle to keep within acceptable levels, but other than that, my #'s look good and I'm feeling great. At goal, no digestive side-effects anymore (had gas from HELL for the first yr post-op, which has completely subsided, thank God!)
In short, I LOVE my DS!!!!! 

I am 6 wks pregnant with my 3rd child. It's my first post-op pregnancy though, so I'm a little nervous and have lots of questions. I hesitate to ask my WLsurgeon's office b/c they are so RNY-centric, I fear I wouldn't get correct info.  So I'm reaching out here to anyone who has had a post-DS pregnancy (I remember someone having twins on here, but can't recall the username....) or anyone who is knowledgable about post-DS pregnancy. I would love it if someone would be willing to help guide me...

I'm wondering what (if anything) I need to add to my vitamin routine (already taking 2 prenatals and folic acid each day, in addition to my regular stuff)... also, should I continue taking vit A? I heard it can be toxic to a fetus. And lastly, I want to make sure I'm getting a good dose of Omega-3s during the pregnancy... what is the most absorbable for of it for us Dsers?   Thank you so much!   

Not a post-op pregnant DSer...but congrats.

A few of my impressions:
The pregnancy is going to likely destroy your iron.  Happens even in normal women.  I don't know what your comfort level with iron is, but if it is truly low, I'm assuming you could still get an iron infusion during pregnancy if you get too low.  Pregnancy totally increases your need for iron.

I do think you should still take vit A.  It IS still an essential vitamin.  Of course, you just don't want to be getting too much.  I have seen lots of post-DS mamas getting their labs done all.the.freaking.time.

The omega-3 thing is sort of controversial...lol.  There are some "more absorbable" forms that people seem to take...Coromega, Vectomega.  I'm not sure there is a fabulous product for us, really.  I have tried taking coromega with digestive enzymes...*****ally knows if it works.  There is an essential fatty acid blood panel you can have run.

Hopefully newyork***** will chime in.  She seems to be a great post-DS pregnancy authority.  If she doesn't, I would try PMing her...she probably just didn't see the thread. 

I would also recommend a high-risk OB.  Good luck!!

Get labs every 6 weeks.  Insist.
Schedule iron infusions NOW before your levels tank -which they will.
Double your calcium and D intake (what forms are you taking)?
Continue with your A - you are NOT going to absorb enough to harm the fetus - in fact the opposite
Take more folic acid than a regular pregnant patient is advised to
Your WLS surgeon's office is worthless for your pregnancy issues
You must INSIST on frequent growth scans during your last trimester.  And BPPs toward the end.  If your regular OB isn't on board with that NOW,  go see a perinatologist (high risk OB) NOW and insist that they understand your risk for IUGR (just have to be cautious) and what that means.

DO NOT WAIT UNTIL YOU HAVE A PROBLEM.

Eat a lot of protein.  Avoid simple carbs.  Drink a TON of fluid.  Get some exercise.  Sleep adequately.

You should be taking a prescription prenatal vitamin that contains omega-3's, DHA, etc

Thank you for this.  How would you suggest getting buy-in on iron infusions at the earliest point?  Most of the time they want to see it really tank before they'll approve of that route, so I was wondering if you had specific techniques of persuasion.  Also, in terms of the perinatologist, would you suggest keeping the regular OB on board or seeing them exclusively. 

In my case this is VERY premature, but I just wanted to take advantage of the OPs question.

I'm searching now but do you have any specific articles to reference on bariatric patients and IUGR?  Just wondering how you armed yourself for these initial discussions with you health care professionals.

I don't have to get "buy-in" on anything.  I am a very aggressive,  very smart and informed patient.  Doctors don't say no to me.  I don't mean to sound arrogant , it's just true.  I have a long time hematologist,  I get iron infusions regularly and I simply said I wanted to increase the frequency - no argument from him,  he just agreed and thought it was smart.  I saw a high risk OB from the very start - my regular ob/gyn thought it was a good idea too and that was that.    I did not "arm" myself with anything - I have/had very smart informed doctors who were willing and interested to understand all of my issues.  I'm lucky,  I live in NYC,  I have access to the best and brightest, I have excellent health insurance and there are loads of bariatric patients in NYC so lots of docs have encountered the issues.  My high risk OB is such a practice. 

If you need to "persuade" a doctor to do what is smart and appropriate - spend your medical dollars elsewhere.  You are the consumer.    You don't "ask,"  you inform  your doctor of what you need and why and you insist.  Be aggressive. 

 NY*****
Thanks so much for the info!
I don't think labs every 6 weeks will be an issue, my surgeon's office will do labs whenever I ask. Did you do your labs through your WLS or your high-risk OB during your pregnancy?  
I will call my hemotologist and get infused ASAP.
I'm taking calcium citrate and Dry D .... is it OK to double the magnesium too? I take 500 mgs with every dose of calcium or I will never **** again.  
Are there any other advantages to a RX prenatal, other than the DHA/omegas being included in the same pill?
Also, currently I am taking 1600 mcgs of folate in the 2 prenatals, and an additional 400 mcgs of folic acid separately... do I need more than that? 
I'm curious why WLS patients are more prone to IUGR....I hadn't heard that before.
thanks again,

-V 

I have not seen my WLS surgeon in over 10 years - no need or use for him for any reason.  I did my labs through my OB and my hematologist (depending on where I was).  They both ran the whole list whenever I asked.  

IUGR is higher risk because of poor nutrition - and WLS patients are at higher risk for poor nutrition due to malabsorption.  But if  you stay way on top of your vites,  supps, protein, labs etc starting prior to being pregnant and all during,  you should be fine.  I was very very on top of everything and my pregnancy was pretty uneventful.  I delivered early but that was just because my water broke early and that just happens sometimes.

 Thanks so much for the info! I think I will probably follow a similar path and have my OB run the labs.
I can understand why you stopped dealing with your WLSurgeon---  My surgeon, like many, is a skilled "cutter", but far far less knowledgable about DS aftercare and DS-specific nutrition/supplementation... (His nutritionists, knowing I had DS and NOT RNY, have still repeatedly referred to my 'pouch'... Also, his office tried to prescribe me oil-based vitamin D, apparently not grasping that I will **** out like 80% of it.) 
Still wondering if the amount of magnesium I'm taking is OK for the fetus. Taking 1500 mgs of mag oxide divided into 3 doses daily. I hope this amount is ok, because without it, I get "backed up" just about instantly.  I'm having trouble finding good data on this. 
Nice to see someone doing so well relatively far out from their DS.... it seems like the most successful DSers health-wise are very self-assured, educated and assertive people! 

Thanks again, -V

Check out the post-op pregnancy forum!!!!  This is where I was at, and WHY i actually joined OH back in 2005.  Usually a GREAT bunch of ladies!!!!!


http://www.obesityhelp.com/forums/postop_pregnancy/





Hope this helps, I know it HELPED me tremendously!!!!
-Jamie

Congratulations.
healthy happy dust coming your way.

Kimberly