Breast feeding has multiple health benefits in

• reducing the risk of developing diabetes and breast cancer in the mother
• reduce the rates of obesity and metabolic disease in the child

But obesity is associated with premature breastfeeding cessation and reduction in prolactin in response to suckling

Bariatric surgery hopes to restore the hormone balance, corrects the hypothalamic pituitary ovarian axis, improve ovulation, improved conception rates and hopefully increase breast feeding rates

There are special emphasis on adequate fluid, protein and micronutrient intake for women in their reproductive age group after bariatric metabolic surgery (especially after the gastric bypass)

• During pregnancy extra monitoring to ensure adequate macro and micronutrients are necessary
• Similarly breast feeding mothers after bariatric surgery require adequate nutrients and supplements

Fortunately so far evidence suggest that the composition and volume of human milk is no different between patients who had bariatric surgery compared to those who didn’t

• The caloric and fat composition of human milk was comparable between the two groups
• Some studies even found that post bariatric patients had better carbohydrate and milk protein concentration compared to normal weight or obese patients who didn’t have bariatric surgery

Lactation requires more caloric intake, fluid and micronutrients *During the lactation period mother’s milk composition often will increase in calorie, total fat and carbohydrate   For non bariatric population, the guidelines recommend: *An additional 330 calories/day to initiate breast feeding then 400 calories/day after the first 6 months *Additional 25g protein/day *Fluid intake between 2.5 to 3 litres/day

After bariatric metabolic surgery the ability to increase the fluid and protein intake may be severely restricted

Multivitamin and mineral supplements are important throughout the gestation period

Mothers are encouraged to take:

• Dietary docosahexaenoic acid (omega 3 fatty acids) for fetal brain growth during pregnancy and lactation
• The fat soluble vitamins
• Iron, B12, folate, calcium
• Others which include vitamin A, B1, B6, C, D, K, selenium, phosphorous

Special caution with vitamin A supplements

• Retinol in the first trimester can result in central nervous system defects, cardio-vascular abnormalities and spontaneous abortion
• The obstetrician recommends that pregnant women consume less than 10 000 IU of vitamin A (Beta carotene is preferred over retinol)