Table 5. Suggested micronutrient monitoring and supplementation in women before, during and after pregnancy following bariatric surgery (15,38-41).

Stage of pregnancy	Timing of screening	Monitoring of micronutrients	Supplementation
Preconception	Six monthly	Full micronutrient screen to include: vitamin B12; iron; folate; vitamin D; vitamin A*; vitamin E*; vitamin K*; thiamin; zinc; copper	Complete multivitamin (avoiding retinol and retinyl esters) and additional vitamin B12, calcium, iron, vitamin D supplements as needed
During pregnancy	Every trimester; additional screening required if low levels identified	Vitamin A*, D, B12, folate, K* and iron; recommend full micronutrient screen as above at first maternity appointment if not done before conception	Complete multivitamin (avoiding retinol or retinyl esters) and additional vitamin B12, calcium, iron, vitamin D supplements as needed
Postpartum	Within first 3 months post-partum in all women, of particular importance if breastfeeding; additional screening required if low levels identified; annual follow-up as per standard post bariatric monitoring	Vitamin A*, D, B12, folate, K* and iron; recommend full micronutrient screen as described for pre-conception if not done during pregnancy	Complete multivitamin (avoiding retinol or retinyl esters) and additional vitamin B12, calcium, iron, vitamin D supplements as needed

*, additional screening if BPD-DS or if steatorrhea. Table adapted from Benhalima et al. (40) and used with permission.