Management of Pregnant Women after Bariatric Surgery

Table 5

D-A-CH recommendations of nutritional intake during lactation [68] and tolerable upper intake level (UL) according to EFSA Guidelines [102] or the NIH [103] for healthy nonbariatric women as well as recommendations for intake after bariatric surgery for women (when available, data specific for lactation are reported).

Nutrient	Recommended daily dietary intake during lactation (D-A-CH reference)	UL per day	Recommended daily intake after bariatric surgery
Iron	20 mg	45 mg	45–60 mg [6, 62] up to 300 mg [104]
Calcium	1000 mg^6	2500 mg	1200–1500 mg [6, 62], 1500–2000 mg RYGB [104], BPS/DS 1800–2400 mg [62, 104]
Vitamin D	20 µg = 800 IU^4	100 µg = 4000 IU^4 [82]	At least 3000 IU [6] up to 6000 IU [62]
Vitamin A	1500 µg equivalent^1	3000 µg = 10000 IU	5000–10000 IU^9 [62, 104]
Vitamin E	17 mg equivalent^2,3,7	300 mg, 1000 mg [62]	Lactation 19 mg, else 15 mg [62]
Vitamin K	60 µg	No recommendation	90–120 µg, BPS 300 µg [62]
Vitamin B12	4.0 µg^8	No recommendation	1000 mg/month i.m. or s.c. [6, 62]. 350–500 µg p.o. [62, 104]
Folic acid	450 µg	1 mg	400 µg [6, 104], 400–800 µg, 800–1000 µg^10 [62]
Iodine	260 µg	600 µg, 1100 µg	—
Zinc	11 mg	25 mg, 40 mg	BPS 16–22 mg RYGB 8–22, mg, SG, LABG 8–11 mg [62]
Magnesium	390 mg	250 mg^5, 350 mg^5	—

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 IU = 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. ⁵The UL does not include magnesium from nutritional sources or fluid and accounts for supplements only. ⁶1200 mg calcium in women <19 years of age. ⁷Around 260 µg RRR-α-tocopherol equivalent extra per 100 g secreted milk. ⁸Around 0.13 µg vitamin B12 extra per 100 g secreted milk. ⁹Depending on procedure, LABG 5000 IU, RYGB or SG 5000–10000 IU, BPS 10000 IU per day, β-carotene form does not contribute to vitamin A toxicity. ¹⁰To women of childbearing age. All NIH recommendations for women >18 years of age; i.m., intramuscular; p.o., per os; BPS = biliopancreatic diversion; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; LAGB = laparoscopic gastric banding; DS = duodenal switch surgery.