What to expect when you're expecting (22 page)

You’ll need to keep up with your recommended vitamin supplementation while you’re expecting (this is not the time to be at a nutritional disadvantage). A prenatal vitamin is a good start, but you may need more iron, calcium, folic acid, vitamin B
12
, and vitamin A because of certain mal-absorption issues. Be sure to speak to both your prenatal practitioner and your surgeon about your particular supplement needs.

Watch your weight closely (with your practitioner, of course). You’re used to watching it go down, but now it will have to start going up. If you don’t gain enough weight during pregnancy, your baby may not be able to grow to its potential. Make sure you know what your target weight gain is (it may be different than for the average expectant mom), and make sure you have an eating plan in place that will help you reach your weight gain goal.

Watch what you eat, too. As a gastric bypass patient, the quantity of food you can eat is limited, so you’ll need to focus on quality (not a bad concept when you’re expecting, anyway). Try not to waste calories, and instead try to choose foods that efficiently pack the most nutrients into the smallest volume.

If at any time you experience abdominal pain and excessive bloating, call your doctor right away.

As for your part, good self-care will make a big difference. Eliminating all pregnancy risks that are within your control—such as drinking and smoking—will be particularly important for you. Keeping your weight gain on target will be, too—and it’s likely that your target will be smaller than the average expectant mom’s and monitored by your doctor more closely. ACOG recommends that overweight women gain 15 to 20 pounds and obese women gain no more than 15 pounds, though your practitioner’s recommendations may differ.

Even with a scaled-down bottom line to stick to, your daily diet will have to contain adequate calories and be packed with foods that are concentrated sources
of vitamins, minerals, and protein (see the Pregnancy Diet in
Chapter 5
). Focusing on quality over quantity and making every bite matter will help you make those calories count—and will help your baby get the most nutritional bang for the calories you consume. Taking your prenatal vitamin faithfully will provide extra insurance. (But keep over-the-counter appetite suppressants that you might have been taking prepregnancy off the menu; they can be dangerous during pregnancy. The same goes for beverages that claim to suppress your appetite.) Getting regular exercise, within the guidelines recommended by your doctor, will allow you to eat more of the healthy foods you and your baby need—without packing on too many pounds.

For your next pregnancy, if you are planning on one, try to get as close as possible to your ideal weight before you conceive. It will make everything about pregnancy a lot easier—and less complicated.

“I’ve always been skinny. How will my pregnancy be affected by my being underweight?”

Pregnancy’s definitely a time for eating well and gaining weight—for both the skinny and the not-so-skinny. But if you’ve come into pregnancy on the super-skinny side (with a BMI of 18.5 or less; see
page 166
for how to calculate yours), you’ll have to be filling up your plate even more. That’s because there are some potential risks (such as having a small-for-date baby. associated with being pregnant and extremely underweight, particularly if you’re also undernourished. But any added risk can be virtually eliminated with a good diet (one that includes not only extra calories but also fresh fruit and vegetables, which provide the vitamins and minerals thin people are sometimes short on); prenatal vitamins; and adequate weight gain. Depending on where you started out on the scale, your practitioner may advise you to gain a little extra—possibly 28 to 40 pounds, instead of the 25 to 35 pounds recommended for the average-weight woman. If you’ve been blessed with a speedy metabolism that makes putting on pounds tricky, see
page 181
for some tips. As long as your weight gain stays on track, though, your pregnancy shouldn’t encounter any other bumps (besides that belly bump).

“I’ve been fighting bulimia for the last 10 years. I thought I’d be able to stop the bingeing-purging cycle now that I’m pregnant, but I can’t seem to. Will it hurt my baby?”

Not if you get the right kind of help right away. The fact that you’ve been bulimic (or anorexic) for a number of years means your nutritional reserves are probably low, putting your baby and your body at a disadvantage right off the bat. Fortunately, early in pregnancy the need for nourishment is less than it will be later on, so you have the chance to make up for your body’s nutritional shortfall before it can hurt your baby.

Very little research has been done in the area of eating disorders and pregnancy, partly because these disorders cause disrupted menstrual cycles, reducing the number of women who suffer with these problems from becoming pregnant in the first place. But the studies that have been done suggest the following:

If you get your eating disorder under control, you’re just as likely to have a healthy baby as anyone else, all other things being equal.

It’s critical that the practitioner who is caring for your pregnancy know about your eating disorder (so speak up, even if your condition is in the past).

Counseling from a professional who is experienced in treating eating disorders is advisable for anyone who suffers from such a problem, but it is essential when you’re pregnant. You may also find support groups helpful (check online, or ask your practitioner or therapist for a recommendation).

Continuing to take laxatives, diuretics, and other drugs favored by bulimics and anorexics can harm your developing baby. They draw off nutrients and fluids from your body before they can be utilized to nourish your baby (and later to produce milk), and they may lead to fetal abnormality if used regularly. These medications, like all others, should not be used by any pregnant woman unless prescribed by a physician who is aware of the pregnancy.

Bingeing and purging during pregnancy (in other words, active bulimia) seems to increase the risk of miscarriage, premature birth, and postpartum depression. Putting those unhealthy habits behind you now will allow you to nourish your baby and yourself well. If you’re having trouble doing so, make sure you get the help you need.