A qualitative assessment of pregnancy intention, experiences and preferences for perioperative contraceptive and pregnancy interval counseling among women undergoing bariatric surgery
Awarded 2017
Complex Family Planning Fellowship Research
Biftu Mengesha, MD
University of California, San Francisco

Obesity is a major public health problem in the United States, and the number of bariatric procedures has exponentially increased in the last decade concordant with this epidemic. Bariatric surgery affords several important long-term benefits, but for women of reproductive age there may be complications that are of particular importance to pregnancies conceived in the immediate postoperative period including nutritional and metabolic deficiencies with subsequent maternal and fetal morbidity. Consequently, both the American Congress of Obstetricians and Gynecologists and the American Society of Metabolic and Bariatric Surgery recommend abstaining from pregnancy for 12 to 18 months after bariatric surgery and use of effective and reliable contraception in this time period. Obese women may be less likely than women with a normal body mass index to use contraception, and not all bariatric centers have protocols in place to standardize preoperative pregnancy and contraceptive counseling. Additionally, oral contraceptive methods have been designated category 3 for malabsorptive procedure in the United States Medical Eligibility Criteria because of absorption and efficacy concerns, and the potential for inappropriate contraceptive method use exists. Previous studies have focused on quantitative assessments of contraceptive use among women undergoing bariatric surgery as well as counseling and referral patterns of bariatric providers regarding this issue, however no studies have assessed patients’ conceptualizations of contraception and pregnancy intention among patients or have evaluated potential interventions to improve and standardize preoperative counseling. This information is vital to be able to effectively counsel women undergoing bariatric surgery using a patient-centered framework while being conscientious of their desires, preferences and motivations.
There are no studies evaluating patient perspectives regarding contraceptive and pregnancy interval counseling in the perioperative period in a qualitative manner or evaluating the efficacy, acceptability and feasibility of specific counseling interventions. My primary study quantitatively assessed baseline contraceptive use prevalence, pregnancy intention and perioperative reproductive counseling experiences from a national sample of women undergoing bariatric surgery using Facebook. However, a nuanced understanding of how these women perceive the importance of this counseling perioperatively as well as how they think this counseling can best be done is a crucial first step in moving towards designing interventions to improve counseling for these women. This current secondary project aimed to assess the needs and preferences for perioperative contraceptive counseling among women undergoing bariatric surgery and to help identify best possible modalities for this perioperative counseling based on their desires.
We recruited women from a pool of participants in my primary fellowship study who indicated willingness to participate in future research. These women were between the ages of 18 and 45 years who underwent surgery in the last twelve months or are currently undergoing the preoperative process will be eligible for inclusion into the study. Women who did not speak English, had a hysterectomy or tubal ligation or were exclusively sexually active with women were excluded from the study. Emails were sent to potential participants, and participants were enrolled in the study upon their response. This group represented a geographically diverse sample, and consisted of women who were both preoperative and postoperative. All subjects completed a short demographic survey and then underwent a semi-structured interview of approximately 30-60 minutes in length addressing our research aims, which was audio recorded and then transcribed. Subjects were given a $25 gift card at completion of the interview.
During the interview phase, we evaluated for themes represented in the audio recordings and stopped recruitment once we had reached thematic sufficiency, which was at 18 interviews, when no new patterns relevant to the study’s aims emerged in our data. The audio transcriptions have been imported into Dedoose, a qualitative coding software, and data analysis is currently underway with expected completion by the end of February 2018 with publishable results in Spring 2018.