Lazaridis Ioannis I, Lukovnikova Sofya, Peros Georgios, Andreou Andreas, Mattiello Diana, Köstler Thomas, Schizas Dimitrios, Zingg Urs, Cavelti-Weder Claudia, Delko Tarik
Obesity and Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, Zurich- Schlieren, Switzerland.
Medical Faculty, University of Basel, Basel, Switzerland.
Swiss Med Wkly. 2024 Dec 4;154:3841. doi: 10.57187/s.3841.
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.
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.
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.
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.
包括生育力、妊娠结局和避孕措施在内的一系列生殖健康问题可能会受到病态肥胖以及减肥手术后体重减轻的影响。本研究旨在探讨瑞士减肥医疗保健专业人员在减肥手术背景下对生殖健康咨询的态度和做法。
我们在瑞士的减肥专业人员中开展了一项全国性的横断面在线调查，共36个问题。调查主题包括人口统计学因素、减肥患者的基线特征、围手术期生殖健康做法、对避孕的态度和知识以及关于妊娠的建议。调查于2022年10月1日至2023年4月30日开放。
共有75名医疗保健专业人员参与了调查。大多数参与者回答说，育龄女性患者占转诊减肥患者的一半以上。40名参与者（57%）建议在减肥手术后避孕18至24个月。只有23名受访者（31%）表示，他们总是在减肥手术前将育龄期女性减肥患者转诊给妇科医生。56名参与者（75%）回答说，他们总是在手术前讨论计划生育。术后推荐的避孕方法差异很大。只有39名参与者（52%）报告说，他们总是告知患者未来怀孕时可能出现的与手术相关的并发症。超过一半的参与者报告说，他们对减肥手术后避孕药的吸收和安全性了解不足。尽管大多数专业人员会对有过减肥手术的孕妇的母婴风险进行常规随访并提供咨询，但49名参与者（65%）在其执业中对于此类出现急性腹痛的患者没有标准化的方案。
尽管认识到生殖健康咨询的重要性，但减肥专业人员在处理围手术期和避孕问题上并不一致，并且大多报告在后者方面缺乏足够的知识。因此，需要减肥专业人员与女性医疗保健提供者加强合作，以改善对育龄期女性减肥患者的护理。
