need help

i'm also posting this on the pregnancy after wls board, but i need help!  i'm pg with #4.  all my kids i've had post-bypass.  i'm almost 7 years out.  my last baby was filled with complications at the end (after 2 perfect pregnancies).  pathology on the placenta revealed that it was filled with blood clots and later blood testing revealed that my blood (in laymen terms from doc) 'is a very favorable environment for clotting'.  i'm scared that the clotting will happen with this pg again as i almost lost my daughter.  i've been put on baby aspirin and yesterday, they called in a prescription for folgard.  the nurse didn't know exactly what that was for so i did some research on the internet and it is a B6, B12, & folic acid suppliment.  i've always been under the impression that we could not aborb much (if any) B12 in pill form which is why we do sublinguals or shots.  can someone clarify?  am i correct in my thinking?  and does anyone know anything about this folgard?  my docs office is being vague as i've only talked with nurses about this, not the doc personally.  after mentioning the gastric bypass (again!) to them, she said he would have to call me back after research but injections would probably be next.  ok, but injections for what?  the b12 or blood thinner?  i hate not knowing!  thanks for your help!!

christie

You're correct that B12 is not well absorbed in pill form.  B12 requires the hormone called Intrinsic Factor which is produced in the lower part of the stomach -- which is obviously now bypassed.  The body is able to passively absorb about 2% of B12 taken in pill form if we are taking a mega dose... but to ensure you're really getting what you need you should be doing injections or sublinguals. 

B1 and B6 are both common deficiencies after RNY.  Especially if you have morning sickness, the B1 is important.  (Vomiting is one of the risk factors for B1 deficiency).  And while you're growing a baby, it'll suck all the B6 and folic acid it can get... so supplementing with extra of these is a good idea.

Baby asprin... just make sure that your doc understands that it's an NSAID and that your pouch is at a higher risk of ulcers when taking these types of medications.  It sounds like the risks of ulcers outweigh the benefit of lower clotting possibilities... so he may already have weighed these issues. 

As for research.  Start him out with a few files of your own. 

ASMBS Bariatric Nutrition Guidelines
Medication Absorption Considerations after Gastric Bypass

 Yup, you're right in your thinking that you will have a hard time absorbing in pill form.  I would STRONGLY recommend you go back and insist on talking with the doctor, not the nurse and ask for shot of B12 - not pill.  As for the B1, B6 & folate -- that you will be able to absorb via pill form - and a mega dose is best (folgard is fine).  B vitamins are not toxic to your body so it's very difficult to take too much.  Recently we have seen some B1 deficiencies in post -RNY people, so asking for B1 via injection is not unrealistic.  These shots can be given monthly or even every other month - no need for daily or weekly shots.  

As for the aspirin ... keep taking it as per doctor's orders.  You can call and clarify this with your surgeon, if you're worried, but aspirin should help keep your blood from clotting.  

Good luck with baby #4!  How far along are you?  

One last thing ... be sure to get enough protein while pregnant!  Minimum of 80 grams!!