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

Obesity is increasingly prevalent in Australia, where ~2 out of 3 people are classified as overweight or obese, and the use of bariatric surgery has also increased. Pregnancy after this procedure is associated with a higher risk of adverse perinatal outcomes, including preterm birth, small for gestational age (SGA), and NICU admission. Bariatric surgery results in anatomically and physiologically altered digestive tracts, which, when combined with the increased nutritional demands of pregnancy, can lead to nutritional deficiencies and complicate accurate gestational diabetes diagnosis. Guidelines were developed for antenatal management of this population, including micronutrient monitoring, fetal growth assessment, and gestational diabetes screening, though these are largely based on limited evidence. This study evaluated adherence to these guidelines and associated maternal and neonatal outcomes in pregnancies following bariatric surgery. This retrospective audit analyzed antenatal care in pregnancies following bariatric surgery at a quaternary public hospital in Queensland, Australia, between 2016 and 2021. Eligible patients were women with a history of bariatric surgery, and only their first pregnancy during the study period was included. Data on maternal characteristics, pregnancy outcomes, and antenatal care practices were obtained from medical records and institutional databases. Care practices were compared against the 2019 international consensus guidelines, including gestational diabetes screening, fetal growth monitoring, gestational weight gain, and micronutrient monitoring and supplementation. Adherence to these guideline-recommended practices was assessed, and perinatal outcomes were compared with those of the general Queensland and Australian population. A total of 83 women (86 infants) were included. Adherence to guideline-recommended antenatal care was low across several domains. Only 38% of patients completed gestational diabetes screening between 24 and 28 weeks, with 20% receiving both the recommended timing and method. Fetal growth monitoring was performed in 86% and 98% of pregnancies at 12 and 20 weeks, respectively, but only 24% received the additional recommended growth scans. Micronutrient monitoring varied, with ≥65% adherence for ferritin but as low as 4% for copper and selenium. Among patients with inadequate gestational weight gain, 45% were referred to dietetics and 65% underwent third-trimester growth monitoring. Rates of adverse outcomes were higher than population averages, including increased rates of preterm birth, small for gestational age infants, NICU or special care nursery admissions, and cesarean delivery. The findings suggest that adherence to guideline-recommended antenatal care after bariatric surgery is variable and support previous research indicating this patient population is especially vulnerable to adverse pregnancy outcomes. While compliance was high for early routine ultrasound and weight monitoring, recommendations specific to this population were often overlooked, including gestational diabetes screening and micronutrient monitoring. Additional fetal growth monitoring was also limited despite the increased risk of small for gestational age infants. Strengths include the use of real-world clinical data and direct comparison to established guidelines. Limitations include the retrospective single-center design and an inability to determine the patient or provider factors influencing adherence. Overall, these results demonstrate gaps in the uptake of consensus-based care for pregnancies following bariatric surgery and highlight the need for greater education and implementation efforts. (Summarized from Willims R, Sullivan H, Ross L, et al. Pregnancy after bariatric surgery: a comparison of antenatal care practices with the 2019 international consensus recommendations in Queensland, Australia. Aust N Z J Obstet Gynaecol . 2025;65:838–847. doi:10.1111/ajo.70041).