OBGYN Involvement and Reproductive Outcomes in Reproductive-Aged Women Undergoing Bariatric Surgery

Introduction Bariatric surgery is an increasingly common intervention for obesity in reproductive-aged women. However, the rapid improvement in fertility following surgery, along with hormonal and metabolic shifts, presents significant reproductive health risks if not appropriately managed. Although ACOG recommends contraception and pregnancy delay for 12 to 24 months postoperatively, the role of routine OBGYN involvement in this population is underexplored. This study aims to evaluate how OBGYN care impacts reproductive planning, contraceptive use, and metabolic outcomes in women undergoing bariatric surgery. Methods This IRB-approved retrospective chart review included 454 women aged 18 to 45 who underwent primary sleeve gastrectomy at a large academic institution from January 2021 to December 2023. Data collected included BMI, comorbidities, polyendocrine metabolic ovarian syndrome (PMOS) symptoms, hemoglobin A1c, number of hypertension medications, contraceptive use, OBGYN follow-up, and pregnancy outcomes. Comparative statistics evaluated associations between OBGYN involvement and clinical outcomes. Results Of 547 reproductive-aged women undergoing bariatric surgery, 454 met inclusion criteria. Sleeve gastrectomy was the predominant procedure, with procedural volume declining over the study period. At 1 year postoperatively, patients demonstrated significant metabolic improvement, including reductions in mean HbA1c (5.77% to 5.27%), diabetes medication use, and hypertension prevalence. Among patients with polyendocrine metabolic ovarian syndrome, 73.7% demonstrated improvement in at least one symptom domain following surgery. Patients with OBGYN follow-up post-operatively had higher rates of contraceptive use compared to those without follow-up (40.8% vs. 29.3%; p=0.02), including increased uptake of long-acting reversible contraception. Pregnancy occurred in 17.4% of the cohort. Weight-loss outcomes did not differ by OBGYN follow-up status. Conclusion/Implications Bariatric surgery is associated with significant improvements in metabolic health and polyendocrine metabolic ovarian syndrome-related outcomes. However, low overall contraceptive use highlights a critical gap in perioperative reproductive counseling. Higher contraceptive uptake among patients with OBGYN follow-up suggests that structured involvement of OBGYN clinicians improves care delivery and patient outcomes. These findings support the integration of OBGYN clinicians into multidisciplinary bariatric care pathways to enhance inpatient and peri-discharge counseling, improve perioperative contraceptive counseling, optimize pregnancy timing, and strengthen reproductive care transitions in women undergoing bariatric surgery. As surgical volumes decline with increasing use of GLP-1 therapies, standardized, team-based approaches will be essential to maintain quality reproductive and metabolic care for this population.