Management of Pregnant Women after Bariatric Surgery

Table 4

D-A-CH recommendations for supplementation of nutrients in pregnancies [68], tolerable upper intake levels according to EFSA [26] in pregnancy, and further nutritional recommendations in pregnancies after bariatric surgery according to Schultes et al. [25], Kaska et al. [75], Gonzalez et al. [28], Quyang et al. [7], Kushner et al. [62], ACOG [19], and Busetto et al. [5].

Nutrient	Recommended daily dietary intake during pregnancy (D-A-CH) [68]	UL (per day)	Pregnancy after bariatric surgery (per day)
Iron	30 mg	45 mg	100–200 mg [25], 40–65 mg [75], 65 mg [7], and 200 mg^8 [5]
Calcium	1000 mg^6	2500 mg	1500 mg [25], 1000–2000 mg [75], 1200–1500 mg [28], 1200 mg [7], and 1000–1200 mg [5]
Vitamin D	20 µg = 800 IU^4	100 µg = 4000 IU^4 [82]	400 IU [7], 1200–2000 IU [25], 2000–6000 IU [75], 1000 IU [5]
Vitamin A	1100 µg equivalent^1 from the 4th month	3000 µg = 10000 IU	No more than 5000 IU^1 [7, 75], 770 µg [28]
Vitamin E	13 mg equivalent^2,3	300 mg, 1000 mg	—
Vitamin K	60 µg	—	120 µg [7]
Vitamin B12	3.5 µg	—	1000 µg every 3 months i.m. [5, 25], 350 µg orally/day or 1000 µg every month [75], 1000 µg/week i.m. or 350–500  µg/day p.o. [7]
Folic acid	550 µg	1 mg	600–800 µg [19], 400 µg [28], 800 µg [7], 4 mg [75], 400 µg or 5 mg^7 [5]
Iodine	230 µg	600 µg, 1100 µg	250 µg [75], 200 µg [28]
Zinc	10 mg	25 mg, 40 mg	11 mg [7], 20–30 mg [25], 15 mg [75]
Magnesium	310 mg	250 mg^5, 350 mg^5	200–1000 mg [75]

UL = upper limit; IU = international unit. In general, most of vitamins and trace elements mentioned are contained in typically available supplements used in pregnancy (e.g., Femibion, Pregnavit). ¹1 mg retinol equivalent = 6 mg all-trans-β-carotene = 12 mg other provitamin A carotenoids = 1 mg retinol = 1.15 mg all-trans-retinyl acetate = 1.83 mg all-trans-retinyl palmitate; 1 IU = 0.3 µg retinol. ²1 mg RRR-α-tocopherol equivalent = 1 mg RRR-α-tocopherol = 1.49 IU; 1 IE = 0.67 mg RRR-α-tocopherol = 1 mg all-rac-α-tocopheryl acetate. ³1 mg RRR-α-tocopherol (D-α-tocopherol) equivalent = 1.1 mg RRR-α-tocopheryl acetate (D-α-tocopheryl acetate) = 2 mg RRR-β-tocopherol (D-β-tocopherol) = 4 mg RRR-γ-tocopherol (D-γ-tocopherol) = 100 mg RRR-δ-tocopherol (D-δ-tocopherol) = 3.3 mg RRR-α-tocotrienol (D-α-tocotrienol) = 1.49 mg all-rac-α-tocopheryl acetate (D, L-α-tocopheryl acetate). ⁴1 µg vitamin D = 40 IU. ⁵This UL does not include nutritional intake of magnesium from food or fluids and accounts for supplements only. ⁶1200 mg calcium in women <19 years of age. ⁷5 mg in patients with T2DM or BMI > 30 kg/m² until 12 weeks of gestation. ⁸2–3 times daily. All NIH recommendations for women >18 years of age; i.m., intramuscular; p.o., per os.