I'm a big pro-nursing advocate, and lately I've been wondering if nursing after gastric bypass will be just as hard easy as it was last time. I nursed my last child exclusively, from birth to age 3 (coincidentally she weaned abruptly with my stay in the hospital for the actual weight loss surgery, but she was by then only comfort nursing and we were more than ready to end it). Even though we had a rough beginning, and it took a long time for me to establish a good milk supply, it worked out in the end, and she was by far my most normal-weight baby. I formula fed the first two children after very short failed attempts at nursing, and they were both overweight as infants also.
I've been wondering, will I be able to establish a normal milk supply? Will I be able to provide enough vitamins, namely B-12 with the supplementation I'm recieving through B-12 injections? Will my state of anemia cause problems - or will it gradually improve once the baby is born, and not cause problems? Will I be able to safely lose the baby weight I've gained while nursing and ingest enough calories to maintain my milk supply?
These are things that any pregnant post weight-loss surgery patient needs to be aware of. There are potential problems, but it seems most if any can be avoided or treated with monitoring up front.
A question from- http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm
"A lactation consultant referred a 3 week old infant not back to discharge weight. Mom had a gastric by-pass 3 years ago. The pediatrician wants to supplement with formula about 4 times per day and is also supportive of herbal supplements (e.g., fenugreek, mother's milk tea, brewer's yeast) for Mom or prescribing Reglan. With lactation consultant support they got a good pump, also a starter SNS, and 2 different feeding cups, and nipple shield. Still weight gain was marginal. Could the mother's gastric by-pass be a contributing factor in this problem?" This situation of a breastfeeding woman who has had a gastric bypass is probably rare.
(Guess I'm a rarity.)
The answer from: http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm
However, there have been a few cases of significant nutrition problems in infants with mothers who had gastric bypass. Two case studies were of infants who were diagnosed with vitamin B12deficiency and megaloblastic anemia (1,2). This was secondary to decreased vitamin B12 in the breast milk; the mothers had subclinical vit B12 deficiencies. In another case, the 4 month oldinfant was diagnosed with failure to thrive (3). Creamatocrit analysis of the breast milk indicated only 39% of the normal fat content of breast milk, and thus the energy level of the milk was reduced. In the case described here, there may be infant factors contributing to the lactation problems, but they seem to be addressed appropriately by the lactation consultant. There may also be stress or emotional feelings in the mother that is contributing. In any case, frequent monitoring, including signs of vitamin B12 deficiency in the mother and infant, is indicated. A creamatocrit may also be useful at some point.
According to Kellymom.com:
Who needs vitamin B12 supplements?
By Kelly Bonyata, IBCLC
Infants of well-nourished mothers with adequate vitamin B12 intake do not need vitamin B12 supplements.
It is recommended that mothers who do not eat animal proteins or who are otherwise at risk for vitamin B12 deficiency get adequate amounts of vitamin B12 during pregnancy and lactation via supplements or fortified foods.
Since vitamin B12 (cobalamin) is widely present in foods from animal sources, dietary deficiency is rare except in those eating a strict vegan diet (no fish, meat, poultry, eggs or dairy products). Most infants, children and adults in the United States get the recommended amounts of vitamin B12. If a breastfeeding mother has an adequate B12 status, her baby will receive sufficient amounts of vitamin B12 via her milk. A simple blood test can diagnose current vitamin B12 deficiency.
In the US, the DRI for vitamin B12 for adults is 2.4 µg per day, 2.6 µg during pregnancy, 2.8 µg during lactation; the DRI is proportionally less for children. The DRI has a significant margin of safety built in. Unlike other B vitamins, small amounts of vitamin B12 are stored in the liver so daily consumption is not necessary.
Who is at risk for vitamin B12 deficiency?
- Anyone who is on a strict vegetarian or vegan diet (no fish, meat, poultry, eggs or dairy products) and is not getting adequate amounts of vitamin B12 through supplements or fortified foods.
- Anyone who has had gastric bypass surgery, has pernicious anemia or has certain gastrointestinal disorders and is not getting adequate amounts of vitamin B12 through supplements or fortified foods. Some medications may also decrease absorption of vitamin B12.
- An infant born to a mother who has been a strict vegetarian or vegan for at least 3 years and who is vitamin B12 deficient herself.
- An infant born to a mother who is vitamin B12 deficient due to any other dietary or medical reason.
- An exclusively breastfed baby of a woman who is vitamin B12 deficient.
According to Nutrition During Lactation (Hamosh 1991, p. 157-58), a full-term infant of a well-nourished mother will be born with a store of vitamin B12 sufficient to meet his needs for about 8 months. If the mother is not vitamin B12 deficient herself, then her milk is an excellent source of vitamin B12 and is more than sufficient for baby’s needs through the first year.
There is evidence that babies born to vitamin B12 deficient mothers have low stores of vitamin B12 at birth. Studies have shown that mothers who are vitamin B12 deficient have low levels of vitamin B12 in their milk.
Breastfed infants may develop clinical signs of vitamin B12 deficiency before their mothers do. Vitamin B12 deficiency may develop in the breastfed infant by 2 – 6 months of age, but may not be clinically apparent until 6 – 12 months. Signs and symptoms of vitamin B12 deficiency in infants include vomiting, lethargy, anemia, failure to thrive, hypotonia (low muscle tone), and developmental delay/regression.
There have been anecdotal reports of low milk supply in vitamin B12 deficient mothers, which improved when the B12 deficiency was corrected. Mothers with pernicious anemia are also at higher risk for thyroid problems, which can affect milk supply.
For mothers who are vitamin B12 deficient, increasing vitamin B12 intake increases the amount of the vitamin in her milk."
What are the caloric demands for a nursing mom? Some moms worry that they won't be able to physically eat enough calories to maintain a solid milk supply after gastric bypass.
From: http://newton.nap.edu/books/0309043913/html/213.html
Nutrient needs during lactation depend primarily on the volume and composition of milk produced and on the mother's initial nutrient needs and nutritional status. Among women exclusively breastfeeding their infants, the energy demands of lactation exceed prepregnancy demands by approximately 640 kcal/day during the first 6 months post partum compared with 300 kcal/day during the last two trimesters of pregnancy (NRC, 1989). In contrast, the demand for some nutrients, such as iron, is considerably less during lactation than during pregnancy.
hardeasy as it was last time. I nursed my last child exclusively, from birth to age 3 (coincidentally she weaned abruptly with my stay in the hospital for the actual weight loss surgery, but she was by then only comfort nursing and we were more than ready to end it). Even though we had a rough beginning, and it took a long time for me to establish a good milk supply, it worked out in the end, and she was by far my most normal-weight baby. I formula fed the first two children after very short failed attempts at nursing, and they were both overweight as infants also.I've been wondering, will I be able to establish a normal milk supply? Will I be able to provide enough vitamins, namely B-12 with the supplementation I'm recieving through B-12 injections? Will my state of anemia cause problems - or will it gradually improve once the baby is born, and not cause problems? Will I be able to safely lose the baby weight I've gained while nursing and ingest enough calories to maintain my milk supply?
These are things that any pregnant post weight-loss surgery patient needs to be aware of. There are potential problems, but it seems most if any can be avoided or treated with monitoring up front.
A question from- http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm
"A lactation consultant referred a 3 week old infant not back to discharge weight. Mom had a gastric by-pass 3 years ago. The pediatrician wants to supplement with formula about 4 times per day and is also supportive of herbal supplements (e.g., fenugreek, mother's milk tea, brewer's yeast) for Mom or prescribing Reglan. With lactation consultant support they got a good pump, also a starter SNS, and 2 different feeding cups, and nipple shield. Still weight gain was marginal. Could the mother's gastric by-pass be a contributing factor in this problem?" This situation of a breastfeeding woman who has had a gastric bypass is probably rare.
(Guess I'm a rarity.)
The answer from: http://depts.washington.edu/nutrpeds/faq/pregnancy/bypass.htm
However, there have been a few cases of significant nutrition problems in infants with mothers who had gastric bypass. Two case studies were of infants who were diagnosed with vitamin B12deficiency and megaloblastic anemia (1,2). This was secondary to decreased vitamin B12 in the breast milk; the mothers had subclinical vit B12 deficiencies. In another case, the 4 month oldinfant was diagnosed with failure to thrive (3). Creamatocrit analysis of the breast milk indicated only 39% of the normal fat content of breast milk, and thus the energy level of the milk was reduced. In the case described here, there may be infant factors contributing to the lactation problems, but they seem to be addressed appropriately by the lactation consultant. There may also be stress or emotional feelings in the mother that is contributing. In any case, frequent monitoring, including signs of vitamin B12 deficiency in the mother and infant, is indicated. A creamatocrit may also be useful at some point.
According to Kellymom.com:
Who needs vitamin B12 supplements?
By Kelly Bonyata, IBCLC
Infants of well-nourished mothers with adequate vitamin B12 intake do not need vitamin B12 supplements.
It is recommended that mothers who do not eat animal proteins or who are otherwise at risk for vitamin B12 deficiency get adequate amounts of vitamin B12 during pregnancy and lactation via supplements or fortified foods.
Since vitamin B12 (cobalamin) is widely present in foods from animal sources, dietary deficiency is rare except in those eating a strict vegan diet (no fish, meat, poultry, eggs or dairy products). Most infants, children and adults in the United States get the recommended amounts of vitamin B12. If a breastfeeding mother has an adequate B12 status, her baby will receive sufficient amounts of vitamin B12 via her milk. A simple blood test can diagnose current vitamin B12 deficiency.
In the US, the DRI for vitamin B12 for adults is 2.4 µg per day, 2.6 µg during pregnancy, 2.8 µg during lactation; the DRI is proportionally less for children. The DRI has a significant margin of safety built in. Unlike other B vitamins, small amounts of vitamin B12 are stored in the liver so daily consumption is not necessary.
Who is at risk for vitamin B12 deficiency?
According to Nutrition During Lactation (Hamosh 1991, p. 157-58), a full-term infant of a well-nourished mother will be born with a store of vitamin B12 sufficient to meet his needs for about 8 months. If the mother is not vitamin B12 deficient herself, then her milk is an excellent source of vitamin B12 and is more than sufficient for baby’s needs through the first year.
There is evidence that babies born to vitamin B12 deficient mothers have low stores of vitamin B12 at birth. Studies have shown that mothers who are vitamin B12 deficient have low levels of vitamin B12 in their milk.
Breastfed infants may develop clinical signs of vitamin B12 deficiency before their mothers do. Vitamin B12 deficiency may develop in the breastfed infant by 2 – 6 months of age, but may not be clinically apparent until 6 – 12 months. Signs and symptoms of vitamin B12 deficiency in infants include vomiting, lethargy, anemia, failure to thrive, hypotonia (low muscle tone), and developmental delay/regression.
There have been anecdotal reports of low milk supply in vitamin B12 deficient mothers, which improved when the B12 deficiency was corrected. Mothers with pernicious anemia are also at higher risk for thyroid problems, which can affect milk supply.
For mothers who are vitamin B12 deficient, increasing vitamin B12 intake increases the amount of the vitamin in her milk."
What are the caloric demands for a nursing mom? Some moms worry that they won't be able to physically eat enough calories to maintain a solid milk supply after gastric bypass.
From: http://newton.nap.edu/books/0309043913/html/213.html
Nutrient needs during lactation depend primarily on the volume and composition of milk produced and on the mother's initial nutrient needs and nutritional status. Among women exclusively breastfeeding their infants, the energy demands of lactation exceed prepregnancy demands by approximately 640 kcal/day during the first 6 months post partum compared with 300 kcal/day during the last two trimesters of pregnancy (NRC, 1989). In contrast, the demand for some nutrients, such as iron, is considerably less during lactation than during pregnancy.