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Contraception and Conception After Bariatric Surgery

Menke, Marie, N., MD, MPH; King, Wendy, C., PhD; White, Gretchen, E., MPH; Gosman, Gabriella, G., MD; Courcoulas, Anita, P., MD, MPH; Dakin, Gregory, F., MD; Flum, David, R., MD, MPH; Orcutt, Molly, J., DO; Pomp, Alfons, MD; Pories, Walter, J., MD; Purnell, Jonathan, Q., MD; Steffen, Kristine, J., PhD, PharmD; Wolfe, Bruce, M., MD; Yanovski, Susan, Z., MD

doi: 10.1097/AOG.0000000000002323
Contents: Obesity: Original Research

OBJECTIVE: To examine contraceptive practices and conception rates after bariatric surgery.

METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18–44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies.

RESULTS: Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30–39) years. In the first postsurgical year, 12.7% (95% CI 9.4–16.0) of women had no intercourse, 40.5% (95% CI 35.6–45.4) had protected intercourse only, 41.5% (95% CI 36.4–46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4–6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3–17.0; P<.001). The conception rate was 53.8 (95% CI 40.0–71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9–7.0] years); 42.3 (95% CI 30.2–57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19–0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02–11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92–24.75], P<.001) were associated with early conception.

CONCLUSIONS: Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery.


University of Pittsburgh School of Medicine, the University of Pittsburgh Graduate School of Public Health, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Weill Cornell University Medical Center, New York, New York; the University of Washington, Seattle, Washington; the Neuropsychiatric Research Institute, Fargo, North Dakota; Brody School of Medicine, East Carolina University, Greenville, North Carolina; Oregon Health & Science University, Portland, Oregon; North Dakota State University, Fargo, North Dakota; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

Corresponding author: Marie N. Menke, MD, MPH, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Hospital, 300 Halket Street, Suite 5150, Pittsburgh, PA 15213; email:

The Longitudinal Assessment of Bariatric Surgery-2 was funded by a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases. Grant numbers: Data Coordinating Center—U01 DK066557; Columbia-Presbyterian—U01-DK66667 (in collaboration with Cornell University Medical Center CTSC, Grant UL1-RR024996); University of Washington—U01-DK66568 (in collaboration with CTRC, Grant M01RR-00037); Neuropsychiatric Research Institute—U01-DK66471; East Carolina University—U01-DK66526; University of Pittsburgh Medical Center—U01-DK66585 (in collaboration with CTRC, Grant UL1-RR024153); Oregon Health & Science University—U01-DK66555. M. Menke was funded under National Institutes of Health K12 HD 063087.

Financial Disclosure Dr. Courcoulas has received research grants from Covidien, Ethicon, Nutrisystem, and PCORI and consultant fees from Apollo Endosurgery. Dr. Flum has had an advisor role with Pacira Pharmaceuticals, has provided expert testimony for Surgical Consulting LLC, and has received travel expenses from the Patient Centered Outcomes Research Institute. Dr. Pomp is a consultant and speaker for Medtronic, Ethicon, and WL Gore and Associates. Dr. Pories has received research grants from J & J and Janssen Pharmaceuticals. Dr. Wolfe has received consultant fees from Enteromedics. The other authors did not report any potential conflicts of interest.

Presented at the 33rd Annual Meeting of the American Society for Metabolic and Bariatric Surgery at Obesity Week, October 31-November 4, 2016, New Orleans, Louisiana.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.