Background

Current guidelines recommend patients undergoing bariatric surgery should wait at least 12 months before conceiving so the fetus is not affected by rapid maternal weight loss. The objective of this study was to describe contraceptive use among reproductive-aged Medicaid patients who underwent bariatric surgery.

Methods

We identified female Medicaid patients 18-45 years old who underwent bariatric surgery between January 2017 and September 2021 from a large insurance claims database (Merative MarketScan). We analyzed patients who had a minimum of 1 year of both pre- and post-surgery follow-up and were not known to be infecund or sterilized. We used CPT, HCPCS, ICD-10, and NDC codes to identify claims for surgeries and pharmacy benefits for prescription contraceptives.

Results

Among 7,047 patients identified, most patients did not receive any prescription contraceptives in the year before or after surgery (71% and 68%, respectively; p<0.01). Long-acting reversible contraceptives (LARC) were the most commonly used contraceptive options (14% before and 17% after surgery; p<0.01); followed by oral contraceptives (14% before and 13% after surgery; p<0.01). After surgery, 77% and 41% of patients aged 35-45 and 18-24, respectively (p<0.01), did not have evidence of prescription contraceptive use, 11% and 32% of patients aged 35-45 and 18-24 (p<0.01) used LARC after surgery.

Conclusions

Significant underutilization of effective contraception, including LARC, was observed in reproductive-aged female Medicaid patients after bariatric surgery, potentially posing high pregnancy-related risks to the patients and their fetus. The underutilization was even more severe in late-reproductive age groups, reaching 77% in patients aged 35-45.