Early postsurgical conception rate worryingly high among bariatric surgery patients
Current postsurgical contraceptive practices and conception rates may not be in line with recommendations for up to an 18-month delay in conception after weight-loss surgery, according to 7-year data from reproductive-aged women in the Longitudinal Assessment of Bariatric Surgery-2 study.
By clinical practice guidelines, women are strongly advised to avoid getting pregnant for at least 12 to 18 months following bariatric surgery to optimize the likelihood of maternal weight stability during foetal growth and improve the chance of success for a healthy maternal and neonatal outcome. [Obesity (Silver Spring) 2013;21(suppl 1):S1–27]
On the contrary, the conception rate in the study cohort of 710 women (median preoperative age 34 years) who underwent first-time weight-loss surgery as part of routine clinical care appeared to be particularly high at 42.3 per 1,000 woman-years in the 18 months after the procedure. The rate was 53.8 per 1,000 woman-years over a median follow-up of 6.5 years. [Obstet Gynecol 2017;doi:10.1097/AOG.0000000000002323]
Early conception was associated with age (adjusted relative risk [RR], 0.41 per 10 years; p=0.03), being married or living as married (adjusted RR, 4.76; p<0.001), and regarding future pregnancy as important preoperatively (adjusted RR, 8.50; p<0.001).
Data on contraceptive practices in the first year following bariatric surgery showed that 12.7 percent had no intercourse, 40.5 percent had protected intercourse only, 41.5 percent had unprotected intercourse while not trying to conceive, and 4.3 percent tried to conceive.
There was no significant difference in the prevalence of the first three contraceptive practices across the 7 years of follow-up (p>0.05). However, the number of women who tried to conceive increased in the second year (13.1 vs 4.3 percent; p<0.001).
“The early conception rate reported in our study of 42.3 per 1,000 woman-years in the 18-month postsurgical window is especially concerning given recent findings that bariatric surgery increases the risk of small-for-gestational-age neonates, preterm deliveries and neonatal intensive care unit admissions in the first 2 years after surgery,” researchers said. [JAMA Surg 2017;152:1–8; N Engl J Med 2015;372:814–24]
The present data point to a public health concern that warrants increased contraceptive counselling and service provision for all reproductive-aged women undergoing bariatric surgery, they added.
Optimal education should be encouraged in these women so that they can make well-informed decisions about planning pregnancy after weight-loss surgery. Additionally, more research is required to shed light on the extent to which surgery and subsequent weight loss improve fertility and pregnancy outcomes. [The Obstetrician & Gynaecologist 2013;15:37–43]
“Guidelines recommending inclusion of referral for counselling for postoperative contraceptive use as part of the preoperative evaluation would be prudent,” researchers said.