Sheiner Eyal, Menes Tehillah S, Silverberg Daniel, Abramowicz Jacques S, Levy Isaac, Katz Miriam, Mazor Moshe, Levy Amalia
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel.
Am J Obstet Gynecol. 2006 Feb;194(2):431-5. doi: 10.1016/j.ajog.2005.08.056.
The objective of the study was to investigate pregnancy outcome of patients with gestational diabetes mellitus following bariatric surgery.
All births to patients with gestational diabetes mellitus delivered between the years 1988 and 2002 were included in the study. A comparison between patients with and without a history of bariatric surgery was performed. Stratified analyses, using the Mantel-Haenszel technique and a multiple logistic regression model were performed to control for confounders.
During the study period, there were 8014 deliveries of women with gestational diabetes mellitus. Twenty-eight were in patients following bariatric surgery. Most patients underwent restrictive (n = 26) and not malabsorptive procedures (n = 2), mainly gastric banding (n = 16). Mean levels of hemoglobin A1c and fasting glucose were comparable between the groups. No significant differences in obstetric characteristics or pregnancy outcomes were noted between the patients following bariatric surgery as compared with the comparison group, except for higher rates of fertility treatments (21.4% versus 5.5%; P < .001). While controlling for nulliparity and maternal age, using a multivariable analysis, a significant association was noted between bariatric surgery and fertility treatments (odds ratios 4.7; 95% confidence interval 1.9 to 11.7; P = .001). Perinatal outcome was comparable between the groups, and no significant differences were noted with regard to complications such as perinatal mortality, congenital malformations, and low Apgar scores at 1 and 5 minutes.
Previous bariatric surgery in patients with gestational diabetes mellitus is not associated with adverse perinatal outcome.
本研究的目的是调查接受减肥手术后妊娠糖尿病患者的妊娠结局。
本研究纳入了1988年至2002年间分娩的所有妊娠糖尿病患者。对有和没有减肥手术史的患者进行了比较。采用Mantel-Haenszel技术和多元逻辑回归模型进行分层分析，以控制混杂因素。
在研究期间，有8014名妊娠糖尿病女性分娩。其中28名是接受减肥手术后的患者。大多数患者接受的是限制性手术（n = 26）而非吸收不良性手术（n = 2），主要是胃束带术（n = 16）。两组之间糖化血红蛋白和空腹血糖的平均水平相当。与对照组相比，接受减肥手术后的患者在产科特征或妊娠结局方面没有显著差异，但生育治疗率较高（21.4%对5.5%；P <.001）。在控制初产和产妇年龄后，通过多变量分析发现减肥手术与生育治疗之间存在显著关联（比值比4.7；95%置信区间1.9至11.7；P =.001）。两组围产期结局相当，在围产期死亡率、先天性畸形以及1分钟和5分钟时低阿氏评分等并发症方面没有显著差异。
妊娠糖尿病患者既往接受减肥手术与不良围产期结局无关。
