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Bariatric surgery and counselling

Women more likely to use post-op contraception after counselling

They reported that approximately 24% of women were not using any method of contraception post-operatively with 89% of those in a relationship
Regarding counselling, approximately 63% of women had counselling about contraception and 83% received information on delaying pregnancy in the bariatric care programme

A study from the Netherlands examining contraceptive use pre- and post-operatively in women who underwent bariatric surgery has reported that 60% of women are using safe contraception post-operatively. However, only 62.6% of patients recall receiving contraceptive counselling but, the investigators noted, they were more likely to use safe contraception after surgery. Therefore, the authors recommended more counselling and monitoring in the post-operative and outpatient setting.

American and European guidelines recommend avoiding pregnancy for 12–24 months after bariatric surgery because the weight loss in the early months after bariatric surgery increases the risk of adverse effects and complications. Approximately 50% of women undergoing bariatric surgery are of reproductive age.

In the paper, ‘Assessment of Contraceptive Counseling and Contraceptive Use in Women After Bariatric Surgery’, published in Obesity Surgery, researchers from Almelo, Groningen, Rotterdam and Leeuwarden in The Netherlands sought to assess contraceptive use pre- and post-operatively in women who underwent bariatric surgery in two obesity clinics in The Netherlands. The researchers also investigated contraceptive and pregnancy counselling.

From October 2017 until August 2018, a web-based questionnaire focused on contraceptive and pregnancy counselling and contraceptive use pre- and postoperatively in women of reproductive age (18–45 years) was sent to all women who underwent a bariatric procedure within the last five months, in the obesity clinics of Ziekenhuisgroep Twente (ZGT) and Medical Center Leeuwarden (MCL), in The Netherlands.

Outcomes

In total, the answers from 230 women were eligible for final analysis and the researchers report that 60% of women used a safe method of contraception post-operatively and 43.7% of users with unsafe contraception pre-operatively switched to a safe method of contraception post-operatively (p<0.0001). Interestingly, the use of short-acting unsafe contraceptives such as combined oral contraceptives (COCs) or progesterone-only pills (POPs) decreased from 30.8% pre-operatively to 16.1% postoperatively (p<0.0001), whilst the use of long-acting safe contraceptives increased from 44.7 to 60.0% (p<0.0001).

Figure 1: Contraceptive methods used pre- and post-operatively (n=230). (b) Of women using no contraception postoperatively, 89% responded to have a partner

They reported that approximately 24% of women were not using any method of contraception post-operatively with 89% of those in a relationship. Four women using unsafe contraception pre-operatively switched to using no contraception post-operatively.

Regarding counselling, approximately 63% of women had counselling about contraception and 83% received information on delaying pregnancy in the bariatric care programme. About 71% of women received information in writing regarding contraception and 72% regarding pregnancy in the information pre-operative meeting.

The odds ratio of receiving contraceptive counselling for using safe contraceptive methods compared with no counselling was 2.20 (p=0.005), the women who received contraceptive counselling were more likely to use safe contraceptives.

Counselling was predominantly given preoperatively and by the obesity nurse and nurse specialist in the bariatric care programme. The authors stated that it may be worthwhile including general practitioners and pharmacists in the outpatient setting in monitoring whether women who underwent bariatric surgery are using safe contraception as they usually prescribe and dispense this contraception. Therefore, they recommend that bariatric surgery should be registered as a condition in the electronic medical record of women when contraindicated drugs, like oral contraception, are prescribed or dispensed.

“We suggest implementing more counselling and monitoring in the postoperative and in the outpatient setting,” they concluded. “Adequate signalling in the electronic medical information systems for contraindicated drugs like oral contraception after bariatric surgery could be helpful for better monitoring and guidance.”

To access this paper, please click here

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