Family planning, reproductive health and pregnancy after bariatric surgery: a survey of bariatric healthcare professionals in Switzerland.

Abstract

Aims: A wide range of reproductive health issues, including fertility, pregnancy outcomes and contraceptive practices can be affected by morbid obesity and weight loss subsequent to bariatric surgery. This study aimed to explore the attitudes and practices of bariatric healthcare professionals in Switzerland regarding reproductive health counselling in the context of bariatric surgery.

Methods: We conducted a national, cross-sectional, 36-question online survey among bariatric professionals in Switzerland. Survey topics included demographic factors, baseline characteristics of bariatric patients, perioperative reproductive health practices, attitudes and knowledge about contraception and recommendations regarding pregnancy. The survey was open from 1 October 2022 to 30 April 2023.

Results: A total of 75 healthcare professionals participated in the survey. The majority of participants responded that female patients of reproductive age constitute more than half of the referred bariatric patients. Forty participants (57%) recommended contraception for a duration of 18-24 months following a bariatric operation. Only twenty-three respondents (31%) stated that they always refer their female bariatric patients of reproductive age to a gynaecologist prior to bariatric surgery. Fifty-six participants (75%) replied that they always discuss family planning prior to surgery. There was high variation regarding the recommended methods of contraception after surgery.Only thirty-nine participants (52%) reported that they always inform their patients about the occurrence of possible surgery-related complications during future pregnancies. More than half of the participants reported inadequate knowledge regarding absorption and safety of contraceptive pills after bariatric surgery. Although most professionals routinely follow up and provide counselling on maternal and foetal risks in pregnant women with previous bariatric surgery, forty-nine participants (65%) have no standardised protocol for such patients who present with acute abdominal pain in their practice.

Conclusion: Despite acknowledging the importance of reproductive health counselling, bariatric professionals address perioperative and contraception issues inconsistently and mostly reported a lack of adequate knowledge in the latter. Therefore, a stronger collaboration between bariatric professionals and women's healthcare providers is needed to improve care of female bariatric patients of reproductive age.