A systematic review on clinical practice guidelines for managing pregnancy following metabolic-bariatric surgery

Objective

The ongoing pandemic of obesity is associated with an increase of weight loss surgeries in women of reproductive age. This study was conducted to review clinical practice guidelines (CPGs) for managing pregnancy following metabolic-bariatric surgery.

Methods

We conducted a comprehensive literature search of all CPGs that covered the management of pregnancy following metabolic-bariatric surgery, 2010 through 2022, and that were published in English. Two authors independently scored the quality and usefulness of CPGs using the Appraisal of Guidelines for Research and Evaluation II tool (AGREE II).

Results

From a total of 20 CPGs, consistent recommendations included the following: 1) contraception with long-acting reversible contraceptives before surgery until the optimal time of pregnancy; 2) nutritional care by a dietitian; 3) considering gastrointestinal discomforts during pregnancy as a potential surgical complication; and 4) modified screening for gestational diabetes instead of glucose tolerance tests preventing post-bariatric hypoglycemia. There was a lack of uniformity concerning surgery-to-conception interval and dose of supplements, as well as research gaps regarding the surgical type, mental health, delivery type, breastfeeding, neonatal care, and weight retention.

Conclusions

All recommendations for managing pregnancy after metabolic-bariatric surgery were deemed clinically useful. Although consistent recommendations should be implemented, inconsistencies should be the focus of research.