OBJECTIVES: Bariatric surgery has become more common in the US. It is recommended to avoid becoming pregnant for 12 to 24 months after surgery due to potential risk of complications to both the patient and the fetus. Use of nonoral contraceptives is encouraged and should be part of post-operative care planning. The objective of this study was to analyze the contraceptive use patterns among reproductive-aged women after bariatric surgery.

METHODS: We identified 18-45 years-old female patients who were enrolled in a commercial insurance plan and had undergone bariatric surgery between January 2017 and September 2021 from Merative MarketScan Research Databases. Patients without a minimum of 1 year of both pre- and post-surgery follow-up and who were identified as infecund or sterilized were excluded. We used CPT, HCPCS, ICD-10, and NDC codes to identify bariatric surgeries and prescriptions. We assessed the median time to the new first contraceptive prescription after surgery (continuation of previously prescribed contraception was excluded). McNemar Test was used to assess differences before and after the surgery.

RESULTS: Among 13,263 patients identified, the two most commonly prescribed contraceptive types were oral contraceptives (18% before and 17% after surgery; p=0.049) and long-acting reversible contraceptives (LARC) (12% before and 15% after surgery; p<0.001). Most patients did not receive any prescription contraceptives before or after surgery (70% and 68%; p<0.001). We did not have data on use of non-prescription forms of birth control. Among those who had new prescriptions for contraception after surgery, the median time to first prescription was 154 days (interquartile range [IQR]: 74-243 days) post-surgery for LARCs and 132 days (IQR: 56-231 days) post-surgery for oral contraceptives.

CONCLUSIONS: Contraceptive care for reproductive-aged female bariatric surgery patients may be inadequate, posing potential risks for complications to themselves and their fetuses for any pregnancies within the 12-month postoperative period.