To determine the incidence and clinical characteristics of surgical complications during pregnancy in women with a history of bariatric surgery.

A nationwide, prospective, population-based cohort study.

High-risk obstetric care in Belgium: 67.6% of maternity units participated, covering 65% of all births in the study period.

Pregnant women with a history of bariatric surgery presenting with a surgical complication (internal hernia, intussusception, volvulus or adhesions; anastomotic ulcer or abscess; gastric band slippage or incisional hernia) between January 2021 and December 2022.

33 women experienced 35 surgical complications. Internal herniation was most common (n=25), predominantly following Roux-en-Y gastric bypass. Mean gestational age at diagnosis was 27+6 weeks. All women underwent surgical exploration within 24 hours; bowel resection was required in two cases. Caesarean section occurred in 48.5%, with 13 preterm births and one neonatal death. One woman required intensive care. No maternal death occurred.

Surgical complications following bariatric surgery in pregnancy are uncommon but carry significant obstetric risks. In this cohort, all reported complications occurred after procedures involving intestinal rerouting, predominantly Roux-en-Y gastric bypass. Prompt surgical management was associated with low maternal morbidity and no mortality, but frequently resulted in preterm birth and emergency caesarean section. These findings highlight the need for a low threshold for surgical evaluation of abdominal pain in pregnant women with previous bariatric surgery and support balanced counselling regarding the potential benefits and risks of different bariatric procedures in women of reproductive age.

To validate the cross-national psychometric properties of the Mental Health Quality of Life questionnaire (MHQoL) and to develop an open-source toolbox for its scoring, transformation and presentation.

Secondary analysis of data from a multicentre international randomised controlled trial (EMPOWER).

Workplace settings in small-sized and medium-sized enterprises (SMEs) and public sector organisations in Finland, Spain and the UK.

The sample included 564 employees: 122 from Finland, 114 from Spain and 328 from the UK. Most were white-collar workers in SMEs or public organisations, mainly in public administration, manufacturing, health/life sciences or higher education. Women were the majority (56%–91% across countries), and mean age ranged from 43 to 48 years.

No intervention was delivered for this analysis; data were drawn from baseline assessments.

Primary outcomes were internal consistency and construct validity of the MHQoL, evaluated using Cronbach’s alpha, measurement invariance testing and multilevel analyses of associations between MHQoL dimensions and its visual analogue scale (VAS). Secondary outcomes were convergent validity, assessed through correlations between MHQoL scores and other mental health and quality of life measures (EuroQol 5-Dimension 5- level questionnaire (EQ-5D-5L), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, Perceived Stress Scale-4 (PSS-4), Psychosocial Risk Scale, and World Health Organization Five Well-Being Index (WHO-5)).

The MHQoL showed good internal consistency across countries, with Cronbach’s alpha ranging from 0.741 in Finland to 0.806 in Spain (overall α=0.787). Measurement invariance across Finland, Spain and the UK supported construct validity. Multilevel regression analyses showed associations between MHQoL dimensions and the MHQoL-VAS, with strongest contributions from Self-Image, Daily Activities, Mood and Future. Convergent validity was supported by moderate to strong correlations between MHQoL, EQ-5D-5L and related mental health measures. An open-source R package and Shiny web application (‘MHQoL Toolbox’) were developed for scoring, transformation and visualisation

The MHQoL is a reliable and valid measure of mental health-related quality of life across countries. The MHQoL toolbox supports consistent, transparent implementation, facilitating use in research, clinical practice and economic evaluations.

NCT04907604.