Pregnancy After Bariatric Surgery: A Comparison of Antenatal Care Practices With the 2019 International Consensus Recommendations in Queensland, Australia.

Abstract

Background: Clinical practice guidelines recommend additional monitoring in pregnancy for women post-bariatric surgery, to reduce the risk of maternal and infant complications.

Aim: To examine if pregnancy care post-bariatric surgery at an Australian quaternary public hospital is consistent with guidelines and to report on perinatal outcomes.

Materials and methods: A retrospective audit of medical records and perinatal outcomes from post-bariatric surgery pregnancies from June 2016 to February 2021 was completed. Micronutrient monitoring and supplementation practices, gestational diabetes mellitus (GDM) screening, gestational weight gain (GWG) and fetal growth (FG) monitoring were compared with guidelines. Perinatal outcomes were compared with Queensland and Australian population data.

Results: Eighty-three women meeting the inclusion criteria delivered 86 infants. Twenty percent (n = 16) had recommended GDM screening, 86% (n = 71) recommended FG monitoring at 12-weeks and 98% (n = 81) at 20-weeks, but only 24% (n = 20) had monthly monitoring from viability. GWG monitoring was 95% (n = 79) in the second trimester and 94% (n = 78) in the third trimester. Monitoring rates were highest for iron, and lowest for copper and selenium. Adverse infant outcomes for length of stay, neonatal intensive and special care admissions and caesarean section were significantly higher than the Queensland and Australian populations (all p < 0.05).

Conclusion: Adherence with consensus recommendations aligning to standard antenatal monitoring for the general population was high, but additional monitoring for post-bariatric surgery specific care was lower. The evidence suggesting increased rates of adverse perinatal outcomes highlights the importance of consistency and adherence with post-bariatric surgery specific care for this group during pregnancy.