Suggested Pregnancy Labs

On June 8, 2010, in Pregnancy after WLS, Tests, by Andrea

So you’ve peed on a stick and you’re pregnant post WLS.

Now what?

Well.  That’s quite the question, isn’t it?  And the answer is multi-faceted depending on which surgery you’ve had, how far out you are, etc.

But for now let’s tackle blood tests.

I’ve had two kids post RNY Gastric Bypass.  And I’ve learned a few universal truths from those two pregnancies:

  1. most doctors have no clue what to do with pregnant WLSers (including the surgeons that DID this to us!)
  2. ask three medical professionals what to do and you’ll get three completely contradictory answers
  3. not enough attention was paid to my nutrition, despite seeing a nutritionist associated with my OB as evidenced by extremely low ferritin, serum iron, b12, and vitamin D levels

With this in mind, knowing what I know now, I’ve put together a list of suggested labs for the post-WLS patient.  These are not to be construed as medical advice, but simply if I were to end up pregnant tomorrow (and that had better not happen or Mirena and I will be having a long discussion requiring lawyers and a check with many $0′s…), this is what I would tell my doc that I wanted drawn and why.  (And yes, I really do walk into a doc’s office with lists of labs to draw.  If they don’t like it, I go somewhere else.)

Regardless of how far out you are, or which surgery you’ve had, as soon as you get a positive pregnancy test and get an appointment with an OB, you need blood tests to determine your nutritional status at the beginning.  For your very first blood draw, it should be an exhaustive draw  to get a baseline.  I suggest this list:

  • 85025  CBC w/ diff
  • 800053  Comprehensive Metabolic Profile
  • 84134  Pre-albumin
  • 83735  Magnesium
  • 7444  Thyroid panel
  • 85025  Hemogram with platlets
  • 7573  Iron (Includes TIBC and Sat %)
  • 83550  Ferritin
  • 84630  Zinc
  • 84446  Vitamin A
  • 82306  Vitamin D (25-hydroxy)
  • 84052  Vitamin B-1 (Thiamin)
  • 84207  Vitamin B-6 (Pyridoxine)
  • 7065  Vitamin B-12 & Folate
  • 83970  Serum intact PTH
  • 84597  Vitamin K
  • 85610  PT
  • 85730  PTT
  • 83921 MMA
  • 84255  Selenium
  • 84590  Vitamin E
  • 82525  Copper
  • 496  Hemoglobin A1C

This gives you (and your doc) a good baseline as to your nutritional status going into the pregnancy and any problem areas that you need to address with additional supplementation.

It should be noted that high-dose vitamins generally are not passed on to baby if mama is deficient.  So if your D is a 20?  You need to take the high-dose D to get your levels up.  It’s not going to endanger your baby and will help you keep your bones.  But ideally, you won’t be getting pregnant with a D level of 20… right…?  RIGHT?

So after the initial blood draw, then you should get draws every 8 weeks of the following items, plus any additional problem things identified by the first lab:

I really consider this above list a “bare bones” list.  It covers your iron (the “live” numbers such as hemoglobin, hematocrit, serum iron, as well as the back up numbers), your neurological vitamins (thiamin, b12, folate, and MMA), and bone health (vitamin D and PTH).  Additionally, a CBC and CMP are important for protein values, blood cell values, and liver function.

The things that tend to drop fastest in all pregnant women are iron, B12, and vitamin D.  They tend to plummet in post-WLS women who have difficulty getting a high volume of food ingested and absorbed.  Even those who have simply a restrictive surgery (AGB or VSG) should take these warnings to heart as there is an issue with lack of food intake.  I cannot stress how important frequent labs and supplements are during pregnancy.

Babies are thieves — they learn this while inside the womb by stealing your nutrients.  Heed my warning:  be prepared by having enough to share.

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4 Responses to “Suggested Pregnancy Labs”

  1. Dawn says:

    Cannot possibly explain to you how valuable I’ve found your blog to be while being pregnant post WLS! Thanks so much for all of the information and work you put into this!!!

  2. Cathie says:

    Glad i’ve found this! I’ll def. take this list with me to my first OB appt. end of the month.

  3. Heather Kozak-Lundquist' says:

    Thank you for this! I want to get pregnant again a couple more times and it’s good to know this for after I have the surgery in the future.

  4. I always recommend this list to my girls in the pregnancy group I run on Facebook.

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