Breastfeeding after wls?

[Dutchie]

Obviously not for me...
But this was a question, that came up on the Dutch forum: is it safe to breastfeed you baby after wls?
Not nutrition wise for the mother, but more in terms of what susbstances and old residues that were stored in bodyfat will find their way into the milk?
I have not been able to found a solid answer.
Are there any experiences here?
Articles and/or url's are greatly appreciated!

[Ann2]

Surely, the answer to this depends on how long after WLS surgery the mother has given birth and is breast-feeding and whether and how fast the mother is still losing weight.

[Dutchie]

Her son is already born and she is waiting for the procedure to take place.
She reckons her baby will be around 6/7 months, by the time she has her wls.
We all loose like a madman those first few months after the surgery, so hence the question.
To what extend will there be "junk" in the milk?
She is willing to give up the nursing, but she would rather not.

[Ann2]

Here's my immediate (INCREDIBLY UNINFORMED) response to this situation:

There's no way in the world a woman who is breastfeeding at the time of surgery will be able to get NEARLY enough sustenance and nutrition into her body to produce milk that would be worth breastfeeding any child.

Please note that I am not a medical doctor of any kind, and certainly not an obstetrician, nor a midwife, nor even a woman who has given birth.

But it still seems just nuts to me that someone would expect to be able to produce breat milk and to breastfeed right after having had WLS surgery!

[Ann2]

P.S. Here's a link about breastfeeding after WLS. But you'll note that the article presumes that a woman is at least 12-18 months post-op before getting pregnant -- it is NOT an article about how to breasteed before and immediately after WLS.

This article also makes somewhat of a big deal out of breastfeeding mothers' increased caloric needs and nutritional needs while breastfeeding -- neither of which are physically possible for the first few months post-WLS.

http://www.nursingnurture.com/gastri...breastfeeding/

[Dutchie]

Thanks Ann!
My thoughts exactly.
But I promised I would look it up for her.
Apperently there are no studies about the quality of the milk after wls.
I, personally, would never take the risk, but as I said, this is not about me.
Thanks again and have a nice weekend!

[Stacey03]

Hi Dutchie, I'm a midwife... more studies needed as there haven't been a lot on this, but I just did a search on my uni library for you and came up with these......
Impact of Weight-Loss Surgery on Pregnancy 2008 ( a bit old but not a lot of new studies)
and Lactation
Of the 103,000 surgeries performed in 2003, 84% were on women of childbearing age (Moore et al., 2004). It is likely that in the future, lactation consultants will encounter increased numbers of mothers with a history of WLS.
While WLS patients are cautioned to avoid pregnancy for 12 to 24 months during the period of rapid weight loss following surgery, many become pregnant soon after surgery. It is well known that as obesity decreases, fertility increases. The strongest evidence of increased fertility is in women with polycystic ovarian syndrome, as biochemical studies have shown a normalization of hormones after WLS (Maggard et al., 2008a). In addition, WLS with a significant malabsorption component can increase the risk of oral contraception failure (ACOG, 2009). Pregnancy during the period of rapid weight loss is of significant concern as we know that prenatal nutritional status and maternal weight gain are two of the most important variables that determine fetal outcome (Viswanathan et al., 2008).
Until 2005, there were very few studies about WLS and perinatal outcomes for mothers and infants. These included a handful of case studies, such as “Small Bowel Ischemia after Roux-en-Y Gastric Bypass Complicated by Pregnancy” (Charles et al., 2005) and “Maternal and Fetal Deaths after Gastric Bypass Surgery for Morbid Obesity” (Moore, 2004), each presenting serious adverse outcomes. Sheiner was the first to review a large number of women (N=298) who had a pregnancy post-WLS and found no adverse maternal or
18 Clinical Lactation 2011, Vol. 2-3 Electronic version of this issue is available at www.ClinicalLactation.org

perinatal outcomes; however, the study did find an increased incidence of C-section, fetal macrosomia, PROM, and labor induction (Sheiner et al., 2004). Now many more studies have examined perinatal outcomes for women with a history of WLS, including a 2008 review, which concluded that bariatric surgery is a safe and effective method of weight loss for morbidly obese women of childbearing age, with favorable outcomes for pregnancies after surgery (Grundy et al., 2008).
What IBCLCs Need to Know
The explosive use of malabsorptive types of WLS, such as RYGB with documented risks (up to 30% to 90% of patients can develop a post-surgery nutritional deficiency), is increasing the frequency of working with nutritionally challenged mothers (Stefanski, 2006). Post WLS mothers may have vitamin and mineral deficiencies including vitamin B12, vitamin D, folate and iron, and, less common, a condition called protein energy malnutrition. RYGB patients are eating with a stomach pouch that is now basically the size of a shot glass and may have difficulty tolerating meat, which has a higher proportion of protein than other foods. In addition, with the stomach and duodenum bypassed, the decreased intrinsic factor production limits the release of vitamin B12 from food sources. Decreased gastric acid secretion reduces conversion of iron into a more absorbable form. As you can readily see, patient compliance with bariatric supplementation is critical.
Assisting a Mother Succeed in Breastfeeding after WLS
Case Report
A mother on postpartum day 1 with a history of RYGB two years ago, self-reports losing 120 pounds and being severely anemic and “slightly” vitamin B12 deficient during her pregnancy. She has delivered a full-term baby weighing 5 lb 3 oz. The baby did not grow and develop well in utero (IUGR). In addition, the mother was vitamin B12 deficient during her pregnancy and gave birth to a B12 deficient baby who is now being breastfed with B12 deficient breast milk. A thorough evaluation of her nutritional status is in order with her history of bariatric surgery and nutritional deficiencies. Forming a multi-disciplinary team with her obstetrician, pediatrician, a registered dietitian and lactation consultant is a great way to optimize care. At a minimum, all maternal-child healthcare professionals caring for this mother must be aware of her WLS and nutritional status. See box for other questions you might want to ask her.
Questions for a Post-WLS Breastfeeding Mother
• What vitamin and mineral supplements did you take regularly during pregnancy?
• Were vitamin B12 injections prescribed? Did you get them?
• Have you had lab work to rule out vitamin B12, vitamin D, or folate deficiency?
• Has your doctor told you are anemic?
• Did you experience breast growth during this
pregnancy?
• Any history of reconstructive plastic surgery? Adapted from Biancuzzo (2004).
Pregnancy Post-WLS
• Type and date of surgery
• Status of co-morbid condition
• Weight check each prenatal visit or more frequently
• Monthly growth ultrasounds after 24 week
• Lab checks for protein, iron, Vitamins B12 and D, folate, and urinary ketones
• Referral for nutrition counseling to a dietician specializing in bariatric surgery
• Conditions, such as hyperemesis gravidum, require hospitalization and parenteral nutrition
For lactation purposes, the prenatal nutritional status of mother and baby is inextricably linked to breastfeeding outcomes. Recommendations for pregnancy after RYGB include frequent lab work to spot any micronutrient deficiencies (ACOG, 2009). Bariatric vitamin and mineral supplements should continue, avoiding high doses due to possible teratogenic affect. Also, prenatal women (with a history of RYGB) should avoid a fasting blood sugar (FBS) with Glucola due to the possibility of dumping syndrome (Gabel, 2007). An FBS and 1 hour postprandial may be substituted. For the woman with a history of LAGB, band adjustment may be necessary for poor weight gain during pregnancy or severe reflux (Carelli et al., 2010).
Clinical practice considerations for this mother would first include lots of skin-to-skin time as we know from a recent study, which demonstrated a dose-response relationship between early skin-to-skin contact and exclusive breastfeeding (Bramson et al., 2010). In addition, frequent, effective breastfeeds, particularly in the first 24 hours postpartum have been shown to help ameliorate delayed lactogenesis, a risk for overweight/obese women (Nommsen-Rivers et al., 2010). There may be challenges to positioning as many women who lose a large amount of weight have breast ptosis (sagging from the reduction of volume/adipose tissue in the breast). In fact, many women have plastic surgery to correct this, usually a mastopexy (breast lift), often combined with augmentation. Be sure to take a thorough history as these plastic surgery procedures potentially impact breastfeeding.
Creative positioning, including the use of blanket rolls and pillows, while trying Suzanne Colson’s Biological NurturingTM position (also known as “laid-back nursing”), is an option
© 2011 United States Lactation Consultant Association 19

Critical Thinking
• The human body adapts to the changing demands of lactation by:
− Increasing nutrient intake
− Improving absorption
− Decreasing excretion
− Using tissue stores
• For the woman who has undergone WLS, can her body overcome the physiological changes the surgery has created to adapt for lactation?
Stefanski J, Today’s Dietitian, 2005, Used with permission.
(Colson, 2010). With the loss of adipose tissue, the breasts feel “pillowy” and the glandular tissue seems “hard to find,” making it difficult for baby to “milk” the ducts. With Biological Nurturing TM, the mother is semi-reclined and baby is in a full frontal feeding position, not fighting gravity, but using it, to settle in and latch deeply onto the breast. Alternately, these mothers may also be at risk for fluid overload (with their increased incidence of labor induction and C-section) and so reverse pressure softening is a good tool for areolar edema (Cotterman, 2004; Sheiner et al., 2004). Also, mothers with a history of overweight/obesity may have certain body image issues which call for more attention to positioning and latch and increased sensitivity for privacy (Sarwer et al., 2010).
Breast ptosis
Photo courtesy of Wikimedia Commons
We already know that obese women have a higher incidence of delayed lactogenesis, but what about the woman who has had WLS and lost weight? Does she have the same risk? Further research is needed. But, any way that you can help a motivated mother optimize her milk production is time well spent. An excellent resource to give to mothers is ILCA’s Inside Track, Breastfeeding after Weight Loss Surgery. This handout (which gives permission to photocopy and distribute freely) answers many of the questions mothers with a history of WLS might have, such as “will I make enough milk for my baby and will it be good?” and “how will I know if my baby is growing well?” (Kombol, 2008).
Impact of Growth and Development of the Breastfed Baby Born to a Mother with a History of WLS
Celiker’s 2009 case study presents an exclusively breastfed infant, born to a mother with a history of RYGB six years prior. At 4 months of age, baby showed physical and neurological developmental delays (i.e., failure to thrive, lethargy) and pancytopenia (a shortage in the amount of different kinds of blood cells). Serum studies showed low vitamin B12 and iron. Treatment of both mother and baby with parenteral B12 resolved the baby’s pancytopenia, improved the neurological status and resulted in steady weight gain. Re-testing at 16 months found normal growth and labs, but gross motor and speech significantly delayed. The authors state “this case illustrates that maternal B12 deficiency following gastric bypass surgery may lead to severe B12 deficiency with long- term neurological sequelae in their infants. Screening and prompt treatment of these deficiencies both during pregnancy and lactation are important” (Celiker et al., 2009, p. 640). In addition, while there is no documented evidence that WLS results in changes in breast milk fat content, there is anecdotal evidence. Hendrix describes a mother with a history of RYGB and vitamin B12 deficient as the inspiration for her recent phenomenological study (unpublished). This mother’s baby experienced faltering weight around 3 months of age. Furthermore, this mother described her pumped milk as having no “fat” separation with an appearance of “watered down skim milk” (P. Hendrix, personal communication, Jan 18, 2011). Once again, further studies are needed. This underscores the importance of the pediatrician being aware of a mother with a history of WLS. Frequent checks for appropriate growth and development (particularly between 4 to 6 months of age when growth can falter) and labs (vitamin B12, vitamin D, folate, calcium, and iron) must be considered.

and this one... still old...
Breastfeeding after Weight Loss Surgery
Phyllis Kombol
Journal of Human Lactation. 24.3 (Aug. 2008): p341+.
DOI: http://dx.doi.org.ezp01.library.qut....44080240031801
Copyright: COPYRIGHT 2008 Sage Publications, Inc.
http://jhl.sagepub.com.ezp01.library.qut.edu.au/
Listen
Full Text:
Byline: Phyllis Kombol, RNC, MSN, IBCLC

341 Breastfeeding after Weight Loss Surgery SAGE Publications, Inc.2008DOI: 10.1177/08903344080240031801 PhyllisKombol RNC, MSN, IBCLC You might wonder how weight loss surgery (like gastric bypass) can affect you and your baby while you are pregnant and while you breastfeed. Here are some things to think about: Getting Pregnant It may be easier to get pregnant after you have lost about 50 pounds.

If you can, wait until your weight loss is mostly done before getting pregnant.This will be about 18 months after your surgery. Your weight loss might slow down or even stop while you are pregnant.This is okay because you will need to focus on eating all that your baby needs to grow and be healthy. Follow the advice of your doctor and dietician about what to eat and what extra nutrients you might need. Plan to have blood tests to check your nutrient and vitamin levels. Get Help With Breastfeeding Most women can breastfeed after this surgery, and their babies grow well! When your baby is born, ask to see a lactation consultant (LC) in the hospital. LCs can help you know when your baby is feeding well. You'll learn to tell if your baby is getting enough milk. Schedule a follow-up visit with the LC and baby doctor within 2 weeks of the birth.

They will weigh your baby and watch your baby feed. They will give you helpful ideas and make sure your baby is feeding well. If you're having problems, they will help you fix them. Will I Make Enough Milk for My Baby? Weight loss surgery itself does not always change how much milk you can make. If you needed the surgery because hormone problems made you gain weight, the same hormone problems could affect your pregnancy and ~ breastfeeding. If your IBCLC = International baby seems to need Board Certified Lactation more milk than you Consultant, sometimes are making, talk to called "LC" your doctor about ~ your hormone levels, because fixing them might help you make plenty of milk. Will My Milk Be Good? Yes, your milk will be great for your baby! Your milk has many special nutrients and things that are not in any formula. You may need extra vitamin B 1 2, especially if you had a bypass type of surgery. Will I Have to Eat Differently? The surgery reduced the amount you can eat at one time, so choose to eat very healthy foods to 342 stay strong and well. Keep taking your extra vitamins and minerals, like vitamin D, vitamin B12, folic acid, iron, and calcium. Be sure you eat enough protein, too. Ask your doctor to check your blood to be sure you are absorbing enough of the vitamins, minerals, and protein. How Will I Know My Baby Is Growing Well? Keep track of how often and how well your baby breastfeeds. Count how many times your baby wets and stools each day. Your LC can help you tell if your baby is feeding well and growing well. Take your baby to the doctor for normal check-ups. The doctor will help you watch your baby for signs of good growth, weight gain, and development.

Remember . . . # Breastfeed your baby often to help your body make lots of milk. # Eat healthy foods to keep you and your baby strong and well. # Take your supplements: vitamins, calcium, protein, and iron. # Have blood tests to check that your body is keeping enough of the most important nutrients. # Watch your baby's health and growth by getting regular check-ups. Most important of all, your milk is the best gift you can give your baby!

And this 2015 so a bit better.....

Breast Milk Macronutrient Composition After Bariatric Surgery Goele Jans & Christophe Matthys & Matthias Lannoo &
Bart Van der Schueren & Roland Devlieger
Published online: 18 February 2015
# Springer Science+Business Media New York 2015
Abstract Breast milk samples from 12 lactating women with bariatric surgery were investigated by comparing the macronu- trient and energy content with samples from 36 non-surgical controls. Samples were analyzed with the Human Milk Ana- lyzer and the maternal diet 24 h prior to sampling with a food record. A higher fat, energy, and a slightly higher carbohydrate milk content was found in the surgical group compared to the
G. Jans : R. Devlieger
Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
G. Jans
e-mail: goele.jans@med.kuleuven.be
C. Matthys : M. Lannoo : B. Van der Schueren
Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
C. Matthys
e-mail: christophe.matthys@uzleuven.be
M. Lannoo
e-mail: matthias.lannoo@uzleuven.be
B. Van der Schueren
e-mail: bart.vanderschueren@uzleuven.be
C. Matthys : B. Van der Schueren
Department of Endocrinology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
M. Lannoo
Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
R. Devlieger (*)
Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
e-mail: roland.devlieger@uzleuven.be
R. Devlieger
Department of Obstetrics, Gynecology and Reproduction, St-Augustinus Hospital, Oosterveldlaan 24, 2610 Wilrijk, Belgium
non-surgical group (3.0 ± 0.7 versus 2.2 ± 0.9 g/100 ml, P = 0.008; 61.0 ± 7.2 versus 51.7 ± 9 kcal/100 ml, P = 0.002; and 6.6 ± 0.6 versus 6.3 ± 0.4 g/100 ml, P = 0.045, respectively). No correlations and no strong explanatory variance were found between milk macronutrient composition and corresponding maternal dietary intake. The nutritional value of breast milk after bariatric surgery appears to be at least as high as in non- surgical controls.
Keywords Lactation . Macronutrients . Body mass index . Bariatric surgery . Maternal diet
Introduction
Breastfeeding is generally regarded as the number one option to provide newborns with all nutrients required for a healthy growth and development. However, concerns rise whether caution is needed in lactating women with bariatric surgery.
This type of abdominal surgery aims to generate significant long-term weight loss by restricting the macronutrient intake as a result of malabsorption. This malabsorption potentially results in nutrient deficiencies which are reflected in lower serum concen- trations [1]. The lower serum concentrations potentially result in lower energy and macronutrient content in the breast milk.
Some authors have reported negative outcomes in exclusively breastfed children of mothers with bariatric surgery. For vitamin B12, low levels in the mother and breast milk have been docu- mented resulting in symptomatically depleted children [2, 3].
No systematic analysis of human milk macronutrients has been published in this specific population. The aim of the study was to compare the macronutrient and energy content of breast milk from lactating women with bariatric surgery with obese, overweight, and normal weight controls.

OBES SURG (2015) 25:938–941
939
Y Gastric Bypass) and in 36 controls (12 obese, 12 over- weight, and 12 normal weight women). Women in the over- weight group were significantly older than women in the other groups (P = 0.003). No other differences in baseline characteristics and pregnancy outcomes were found (Table 2).
The surgery group showed a significantly higher fat (P = 0.008) and energy (P = 0.002) content compared to women without surgery. The milk carbohydrate content after bariatric surgery was slightly higher compared to non-surgical controls (P = 0.045). Sub-analyses showed a higher fat content in the surgery and the obese group compared to the normal weight and overweight group. The surgery group also showed higher energy levels compared to the normal weight and overweight group (Table 2).
Significantly lower carbohydrate (P=0.032) and pro- tein (P < 0.001) values for the total study population were seen when comparing to the reference values for colos- trum from the UK Food Composition Table. The breast milk protein and energy content were, respectively, lower (P < 0.001) and higher (P = 0.035) in women with bariatric surgery compared to the reference values. In the non- surgical controls, also the protein level, as well as the carbohydrate content, were significantly lower compared to these references (P < 0.001 and P = 0.011, respectively) (Table 1).
The milk macronutrient composition and maternal diet showed no correlation. A maximum of 1.2 % of the macronu- trient composition could be explained by the corresponding maternal dietary intake (R2 = 0.012), while almost 5 % of the macronutrient composition can be explained by the maternal pre-pregnancy BMI (R2 = 0.050).
A negative correlation was seen between maternal age and fat content (r = −0.81, P = 0.029). No correlation was found between the interval period surgery-conception and macronutrient (fat P=0.521, protein P=0.840, carbohy- drate P = 0.055) and energy (P = 0.477) content. No other correlations or associations were observed between mac- ronutrient composition and baseline and pregnancy outcomes.
Materials and Methods
The study was conducted at the University Hospital Leuven, Belgium. Ethical approval has been obtained from the local ethical committee (S54464). Lactating women, who delivered a term (≥37 weeks of gestation), did not smoke, were normoglycemic, and who were not on predefined medication, were invited.
The milk sample was gathered in a standardized manner 4 days after delivery. Two trained researchers assisted with sam- ple collection. They instructed participants to contact them before starting to breastfeed. Infants were fed for 3 min before collection of 5 ml occurred manually or by use of an electric pump. Sam- ples were immediately frozen at −80 °C and afterwards analyzed with the Human Milk Analyzer (MIRIS®, HMA) [4]. Values were compared with the reference values for colostrum as pre- sented in the UK Food Composition Table (Table 1).
The maternal diet 24 h prior to sampling was questioned by using an estimated dietary record method, and analyzed with a self-developed software program based on the Belgian Food Composition Database (NUBEL). Baseline characteristics (maternal age, parity, pre-pregnancy body mass index (BMI), and relevant pregnancy outcomes) were retrieved from the electronic patient file.
Statistical analyses were performed using the SPSS soft- ware (IBM SPSS Statistics Version 19). The normality of con- tinuous variables was tested using the Shapiro–Wilk-test. The Student’s t test or non-parametrical Mann–Whitney U test examined differences in continuous variables between two groups. A one-way ANOVA or non-parametrical Kruskal– Wallis test examined differences in continuous variables be- tween more than two groups. Pearson and Spearman correla- tion coefficients examined correlations between two continu- ous variables. Regression analyses evaluated causal relations. A P value <0.05 was considered significant.
Results
Analyses were performed in 12 lactating women with pre- vious bariatric surgery (1 Sleeve Gastrectomy, 11 Roux-en-
Table 1 Comparison of breast milk macronutrient composition with references from the UK Food Composition Table
Fat (g/100 ml)
Protein (g/100 ml) Carbohydrate (g/100 ml) Energy (kcal/100 ml)
UK Food Composition Table
2.6 2.0 6.6
Total study group N=48
2.4 1.3 6.4
P value 0.541
<0.001 0.032 0.479
Surgical study group n=12
3.0 1.5 6.6
61.0
Non-surgical control group n=36
P value
0.071 2.3
<0.001 1.2 0.860 6.3 0.035 52.8
P value 0.184
<0.001 0.011 0.100
56.0
Variables are presented as mean and compared by the one sample t test
54.1

940 OBES SURG (2015) 25:938–941 Table 2 Milk macronutrient composition and corresponding maternal dietary intake in lactating women with previous bariatric surgery and obese,
overweight and normal weight controls
Total population
Group
Normal weight
n=12 30.3 ± 2.3
21.4 ± 1.9 5 (23.8) 14.6 ± 4.5 3320±459
2.0±0.6 1.2±0.3 6.2±0.3 49.8 ± 5.0
123.1 ± 99.7 121.6 ± 43.0 315.5 ± 8.0 2602.3 ± 353.3
Correlation breast milk composition/maternal dietary intake
r = −0.020 P = 0.898 r = −0.175 P = 0.261 r = 0.050 P = 0.752 r = 0.155 P = 0.320
Maternal age (years) Pre-pregnancy BMI (kg/m2) Nullipara
Gestational weight gain (kg) Birth weight (g) Composition of breast milk
Fat (g/100 ml)
Protein (g/100 ml) Carbohydrates (g/100 ml) Energy (kcal/100 ml)
Maternal dietary intake
Fat (g/100 ml)
Protein (g/100 ml) Carbohydrates (g/100 ml) Energy (kcal/100 ml)
30.8±4.3 27.5±5.2 21 (43.7) 12.8±5.4 3370±450
2.4±0.9 1.3±0.3 6.4±0.5 54.1±9.5
107.2±59.0 108.6±36.2 306.9±68.3 2576.4±515.1
Overweight n=12
34.5±3.6 27.5±1.7 3 (14.3) 12.7±5.1 6252±391
1.9 ± 0.9 1.4 ± 0.2 6.3 ± 0.5 49.6±9.1
108.1 ± 43.8 114.5±41.2 301.1 ± 80.2 2657.8 ± 756.1
Obese n = 12 29.7 ± 4.7
33.6 ± 3.9 5 (23.8) 10.1 ± 5.3 3426±538
2.7±0.9 1.3±0.3 6.4±0.5 55.5 ± 11.3
96.4 ± 26.9 101.9 ± 26.2 314.9 ± 72.5 2567.5 ± 443.4
Bariatric surgery n=12
28.7 ± 4.4 27.6 ± 3.6 8 (38.1) 13.5 ± 6.5 5236±398
3.0±0.7 1.5±0.2 6.6±0.6 61.0 ± 7.2
97.8 ± 26.1 93.5 ± 26.8 294.9 ± 57.6 2464.6 ± 480.4
P value 0.003
0.001 0.229 0.266 0.727
0.006 0.224 0.221 0.005
0.995 0.119 0.902 0.752
Variables are presented as mean±SD or n (%). Milk composition was compared between groups by the one-way ANOVA test. The relation between the milk macronutrient composition and maternal dietary was calculated by the Kruskal–Wallis test
Discussion
Unexpectedly, we globally found an unchanged or slightly more caloric breast milk composition in postsurgical patients. This cannot be explained by the maternal diet assessed from the 24 h food record, as we found no correlations and no strong explanatory variance for the maternal macronutrient intake and levels in breast milk. In non-surgical patients, milk production and gross composition (lactose, fat, and protein) were found to be largely independent of the maternal diet [5], although some studies have documented small fluctuations related to maternal intake, especially in the human milk fat fractions [5, 6]. The current findings are somehow unexpected as we and others have demonstrated that the dietary pattern of pregnant obese women and women with bariatric surgery is far from optimal [7]; therefore, a more detailed analysis of the different macro- and micronutrients would be necessary.
Careful consideration of the obtained results is necessary. First, the human milk macronutrient content in the total study population slightly differs from the reference values of the UK Food Composition Table. Possible explanations might be the influence of the timing of sample collection, the freezing pro- cedure [8], or small differences in analysis when comparing the HMA with other standard laboratory assays for the deter- mination of human milk macronutrient content [4]. Second, our sample was relatively small, as well were the explanatory variances of breast milk macronutrient composition by the
maternal dietary intake and pre-pregnancy BMI. Besides, the maternal pre-pregnancy BMI appears to play a larger influen- tial role than the maternal dietary intake. The 24 h food record provided insight in the actual intake of nutrients and therefore did not necessarily reflect the long-term food intake. This might be important as it has been suggested that the milk composition tends to be buffered against fluctuations in ma- ternal dietary intake and status (at least for the macronutrients) [9]. Hormone levels (e.g., estrogens), which might be de- ranged after bariatric surgery, should be taken into account as some can influence milk volume and composition.
A larger longitudinal cohort is currently being conducted in which we are using a food frequency questionnaire (FFQ) and are collecting samples on a weekly basis from day 4 of the postpartum period until the routine postnatal visit 6 weeks after delivery to take into account the rapid subtle changes in breast milk content [10].
Conclusion
These preliminary results suggest that the nutritional value of breast milk in women with previous bariatric surgery approx- imates these of women without bariatric surgery. Despite these encouraging findings, further studies on specific micronutrients are required before breastfeeding can safely be advised in postsurgical lactating women.

The jury is out a bit, I think personally there needs to be more studies but I do think she can breastfeed with very close supervision on the baby thriving, regular weighs etc but she may well have to supplement with milk from a milk bank or formula. I hope that helped a bit!

[Stacey03]

Sorry I couldn't put in the actual links but I cant do that from the uni library site!

[AnnieG]

Thanks Ann!
My thoughts exactly.
But I promised I would look it up for her.
Apperently there are no studies about the quality of the milk after wls.
I, personally, would never take the risk, but as I said, this is not about me.
Thanks again and have a nice weekend!

Stacey03, fabulous information. Here in the states we have La Leche League, which may be of some help if its available, since that's their focus.
I am a lifetime member.

While the nutrition might be do-able, you have to really push your liquids to keep your milk production up. That's at the best of times. So I think it might be a very frustrating challenge for the mom and certainly for the baby.

I do believe breast feeding, when possible, is best. But health and a mother in your life are equally important. Nurture has a lot of meanings.
Good luck to your friend.

And 6 months is pretty good in terms of immunity passed on from mom. There are milk banks as well.

[Christie13]

Is waiting until her child is a little older not an option? I would think that she should postpone surgery until she stops nursing. I definitely would not risk it. I also think that the shock of surgery would also cause her milk supply to be minimal.

[Dutchie]

Edie: thank you, thank you, thank you!Interesting reaading material.
Annie and Christie: thanks for your input!

Like I said: her baby has already been born and by the time she gets her operation he will be around 5 or 6 months old.

But: the question remains: will there be residues of old hormones and medications, that were stored in fatty tissues that find their way into the milk?
Certainly, the things we eat, can be traced in the milk.
There haven't been any studies (that I can find), which can answer this question, so it all comes down to common sense I guess.
If it was me, I would not do it.
But that is me.

[Stacey03]

Edie: thank you, thank you, thank you!Interesting reaading material.
Annie and Christie: thanks for your input!

Like I said: her baby has already been born and by the time she gets her operation he will be around 5 or 6 months old.

But: the question remains: will there be residues of old hormones and medications, that were stored in fatty tissues that find their way into the milk?
Certainly, the things we eat, can be traced in the milk.
There haven't been any studies (that I can find), which can answer this question, so it all comes down to common sense I guess.
If it was me, I would not do it.
But that is me.

I don't think that residue of stuff would be a problem from what I have read. Just more that the trauma of the surgery and minimal amount of food could knock her supply on the head. in fact her body might just make up its mind for her. But she may well be able to carry on feeding for a while with tops ups and weaning foods. I think the answer will become obvious for her. As Annie said getting support fro la leche league or similar will be invaluable. And weigh that babe weekly ;-)

[Dutchie]

And the B12 deficiency, as I read it.
I have given her your reading material, which was greatly appreciated!
She'll have to make up her own mind.
Like you said: her body will probably solve the issue for her, but she will find that out soon enough.
Thanks again!