Family planning knowledge, attitudes and practices among bariatric healthcare providers.

This survey aimed to identify the family planning knowledge, attitudes and practices of bariatric providers in the perioperative period. We developed a quantitative survey based on semistructured interviews with six bariatric providers. We mailed the survey to the American Society of Metabolic and Bariatric Surgery members with plans to use data from the first 275 responders to assess knowledge, attitudes and practices regarding family planning. Over 70% of 272 respondents recommended that women avoid pregnancy for 12-24months after bariatric procedures. Most (73.0%) considered female reproductive health discussions very important, and most feel comfortable (70.4%) with these discussions. The majority considered the most effective contraceptive methods to be safe for women after gastric bypass; only a minority (35.3%) provided contraceptive services or referrals, and few (4.9%) have accurate knowledge of contraceptive effectiveness. Respondents most frequently preferred the patient's own gynecologist (80.9%) or bariatric surgeon (71.0%) discuss contraception. Discussing contraception was associated with provider age 40-49years, training region in southeast or midwest and degrees of physician assistant or nurse practitioner with adjusted odds ratios exceeding 2.0. Bariatric providers consider reproductive health very important, and while most are comfortable having these conversations, few have accurate knowledge of contraceptive safety and effectiveness. Most would prefer patients see their gynecologists to discuss contraception. These findings suggest an opportunity for gynecologists to educate themselves and bariatric colleagues about contraception recommendations after bariatric surgery and collaborate with bariatric centers in their area to meet the needs of these patients. Gynecologists must become educated and involved in the care of female bariatric patients to discuss reproductive health concerns and to counsel effectively regarding contraception after bariatric surgery.

Jatlaoui TC ，Cordes S ，Goedken P ，Jamieson DJ ，Cwiak C ... -  《-》

Reproductive health counseling, attitudes, and practices: a cross-sectional survey among bariatric surgeons.

Women of childbearing age constitute a substantial proportion of patients who undergo weight loss procedures. However, little is known regarding family planning knowledge, attitudes, and practices among bariatric surgeons. We explored the reproductive health and contraceptive practices among bariatric surgeons. A national society of bariatric surgeons. A cross-sectional study. Anonymous surveys were sent to all members of the Israeli Society for Metabolic and Bariatric Surgery. The Israeli Society for Metabolic and Bariatric Surgery survey elicited a response rate of 96% (n = 48). Most (89.6%, n = 43) considered female reproductive health perioperative counseling very important, and the majority of respondents (66.7%, n = 32) felt comfortable discussing these issues. Nevertheless, only 54.2% (n = 25) reported routinely having family planning and pregnancy conversations with their patients. There was a general awareness that women should delay conception after surgery; however, only a minority of bariatric surgeons consistently either recommended the use of contraception after surgery (39.6%, n = 19) or referred patients for contraceptive advice (25.0%, n = 12). Most (81.3%, n = 39) practitioners reported not having accurate knowledge of contraception and felt that collaboration with other bariatric healthcare providers would provide patients with optimal reproductive-health counseling. Bariatric surgeons acknowledged the importance of reproductive healthcare and the need to delay conception among women undergoing bariatric surgery. However, they inconsistently addressed family planning and contraceptive issues and reported lack of accurate knowledge in this regard. This highlights the need for multidisciplinary collaboration between bariatric healthcare providers to improve reproductive and contraceptive care in these patients.

Ben Porat T ，Yuval JB ，Elchalal U ，Shushan A ，Sakran N ，Elazary R ，Rottenstreich A ... -  《-》

A Survey of Bariatric Surgical and Reproductive Health Professionals' Knowledge and Provision of Contraception to Reproductive-Aged Bariatric Surgical Patients.

Graham YN ，Mansour D ，Small PK ，Hinshaw K ，Gatiss S ，Mahawar KK ，McGarry K ，Wilkes S ... -  《-》

Reproductive health counseling and practices: a cross-sectional survey of bariatric surgeons.

Nearly 50% of bariatric surgery patients are women of reproductive age. Both obstetric and gynecology and surgery professional guidelines recommend a delay of fertility 1-2 years postbariatric surgery. We sought to assess bariatric surgeons' perioperative reproductive counseling and contraceptive provision for women of reproductive age. We conducted a cross-sectional, national 32-question mail survey of bariatric surgeons. Survey topics included demographic factors, contraceptive counseling and provision, and method preference. Descriptive statistics were reported and Χ2 tests compared results among respondent demographic characteristics. A total of 574 of 1,935 physicians returned surveys (30%). After excluding 41 surveys due to missing data, we analyzed 533 (27%) surveys. Mean respondent age was 48.1 years. Most respondents were male (89%), white (78%), and completed residency training ≥10 years ago (72%). The majority of respondents' bariatric surgery patients were female (77%), 63% of which were of reproductive age. Most respondents recommended that their female patients delay pregnancy 12-24 months (87%). Whereas 70% of respondents did not require preoperative contraception, 52% always required postoperative contraceptive use. Although the majority of respondents (64%) referred patients to an obstetrician-gynecologist or primary care physician to obtain contraception, 35% did not know how their female patients obtained contraception. Female respondents were more likely than male respondents to always require a medicine consultation and preoperative contraception, P<.05. Despite consistently recommending a delay in pregnancy, bariatric surgeons inconsistently address perioperative contraceptive needs of women of reproductive age. These findings highlight the need for greater collaboration between bariatric surgeons and women's healthcare providers to address the reproductive health needs of women having bariatric surgery.

Chor J ，Chico P ，Ayloo S ，Roston A ，Kominiarek MA ... -  《-》

Perioperative pregnancy interval, contraceptive counseling experiences, and contraceptive use in women undergoing bariatric surgery.

Reproductive-aged women represent about half of those undergoing bariatric surgery in the United States. Obstetric and bariatric professional societies recommend that women avoid pregnancy for 12-18 months postoperatively due to concern for increased pregnancy risks, and that providers should counsel women about these recommendations and their contraceptive options. However, knowledge about women's experience with perioperative counseling and postoperative contraceptive use is limited. We sought to: (1) determine prevalence of perioperative contraceptive and pregnancy interval discussions among women who have recently undergone bariatric surgery; and (2) describe postoperative contraceptive use within the first year of surgery in this population. We performed a cross-sectional study of US women, aged 18-45 years and recruited through Facebook, who underwent bariatric surgery within the last 24 months. We enrolled 363 geographically diverse women. Three-quarters recalled perioperative pregnancy or contraceptive discussions, the majority with a bariatric provider. Half felt it was "very important" to discuss these issues perioperatively, and 41% of those who reported discussions wished they had had more. Of the 66% of women who reported using contraception in the first 12 months postoperatively, 27% used oral contraceptives and 26% used an intrauterine device. One third of contraceptive users who had undergone Roux-en-Y gastric bypass, a combined restrictive-malabsorptive procedure, were using oral contraceptives. Perioperative contraceptive or pregnancy discussions were independently associated with increased postoperative contraceptive use (odds ratios, 2.5; 95% confidence interval, 1.5-4.3, P < .001). A substantial proportion of women who had undergone bariatric surgery reported having had no perioperative pregnancy or contraception counseling, and many women who had felt the discussions were insufficient. Those who had had perioperative discussions were more likely to use contraception postoperatively. Reproductive-aged women should be routinely counseled perioperatively about pregnancy and contraception in the context of their reproductive desires, so they can make informed decisions about perioperative pregnancy prevention and contraceptive method use.

Mengesha BM ，Carter JT ，Dehlendorf CE ，Rodriguez AJ ，Steinauer JE ... -  《-》