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Contraception and bariatric surgery

Many fail to follow contraception guidelines after bariatric surgery

Factor associated with early conception were: age per 10 years, p=0.03), being married or living as married (p<.001) and rating future pregnancy as important (p<.001)

Many women do not follow the guidelines to prevent pregnancy for an 18-month period following bariatric surgery, according to researchers examining post-surgery contraceptive practices and conception rates from the University of Pittsburgh. The American Society for Metabolic & Bariatric Surgery recommends that women avoid conception for the first year-and-a-half following weight-loss surgery to optimise the likelihood of maternal weight stability during fatal growth.

Despite the recommendation, four percent of study participants were actively trying to get pregnant and an additional 42 percent reported having unprotected intercourse during this at-risk post-surgical timeframe.

"This is concerning given recent research suggests that bariatric surgery increases the risk for small-for-gestational-age newborns, preterm deliveries and neonatal intensive care unit admissions in the first 18 months after surgery," said lead author, Dr Marie Menke, assistant professor of obstetrics, gynecology and reproductive sciences at Pitt's School of Medicine and Magee-Womens Hospital of UPMC. "Our findings highlight a public health issue that merits additional scrutiny regarding contraceptive counselling before and after surgery, and provision of contraceptive services for all reproductive-aged women undergoing bariatric surgery."

The study, ‘Contraception and Conception After Bariatric Surgery’, published was published online in the American College of Obstetricians and Gynecologists Obstetrics & Gynecology journal, examined data from the Longitudinal Assessment of Bariatric Surgery-2 study - a multi-centre, prospective cohort sof adults undergoing first-time bariatric surgery as part of routine clinical care at 10 US hospitals.

This study was restricted to women 18–44 years old with no history of menopause, hysterectomy or oestrogen and progesterone therapy. The primary outcomes were self-reported contraceptive practices, overall conception rate and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year, and conception rates were determined from self-reported pregnancies.

From 740 eligible women, 710 (95.9%) completed follow-up assessment(s) and in the first postsurgical year, 12.7% of women had no intercourse, 40.5%  had protected intercourse only, 41.5% had unprotected intercourse while not trying to conceive and 4.3% tried to conceive.

The prevalence of the first three groups did not significantly differ across the seven years of follow-up (all p>0.05); however, more women tried to conceive in the second year (13.1%, p<.001). The conception rate was 53.8 per 1,000 woman-years across follow-up; 42.3 per 1,000 woman-years in the 18 months after surgery.

Anita Courcoulas

Factors associated with early conception were: age per 10 years, p=0.03), being married or living as married (p<.001) and rating future pregnancy as important (p<.001).

"Contraceptive counselling both before and after bariatric surgery are critical pieces of the multidisciplinary needs of the bariatric patient. This study clearly shows that early conception rates and contraceptive practices after bariatric surgery are not ideal," said study co-author, Dr Anita Courcoulas, director, minimally invasive bariatric and general surgery at Magee-Womens Hospital of UPMC. "The findings highlight the need for more frequent referral to counselling for contraception guidance throughout the bariatric surgery process."

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