Guelinckx Isabelle, Devlieger Roland, Vansant Greet
Department of Nutrition-Preventive Medicine, Leuven Food Science and Nutrition Research Centre, University Hospital Gasthuisberg, Catholic University Leuven, Belgium.
Hum Reprod Update. 2009 Mar-Apr;15(2):189-201. doi: 10.1093/humupd/dmn057. Epub 2009 Jan 8.
After many cycles of weight loss and weight gain, more and more morbidly obese patients undergo bariatric surgery, like gastric banding or gastric bypass, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future pregnancy.
English-language articles were identified in a PUBMED search from 1982 to January 2008 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding.
The few reported case-control and cohort studies clearly show improved fertility and a reduced risk in obstetrical complications, including gestational diabetes, macrosomia and hypertensive disorders of pregnancy, in women after operatively induced weight loss when compared with morbidly obesity women. The incidence of intrauterine growth restriction (IUGR) appears to be increased, however. No conclusions can be drawn concerning the risk for preterm labour and miscarriage, although these risks are probably increased compared with controls matched for body mass index. Operative complications are not uncommon with bariatric surgery and several cases have pointed to the increased risk for intestinal hernias and nutritional deficiencies in subsequent pregnancy. Deficiencies in iron, vitamin A, vitamin B(12), vitamin K, folate and calcium can result in both maternal complications, such as severe anaemia, and fetal complications, such as congenital abnormalities, IUGR and failure to thrive.
Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient's individual requirements can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population.
在经历多次体重减轻和增加的循环后，越来越多的病态肥胖患者接受减肥手术，如胃束带术或胃旁路手术，作为其肥胖问题的最终治疗方法。由于育龄女性是减肥手术的候选对象，因此人们对其对未来妊娠的潜在影响产生了担忧。
在1982年至2008年1月期间，通过在PUBMED数据库中检索，使用妊娠与减肥手术或胃旁路手术或胃束带术的关键词，筛选出英文文献。
少数已报道的病例对照研究和队列研究清楚地表明，与病态肥胖女性相比，手术诱导体重减轻后的女性生育能力提高，产科并发症风险降低，包括妊娠期糖尿病、巨大儿和妊娠高血压疾病。然而，宫内生长受限（IUGR）的发生率似乎有所增加。尽管与体重指数匹配的对照组相比，早产和流产的风险可能增加，但目前尚无关于这些风险的结论。减肥手术的手术并发症并不少见，一些病例指出，后续妊娠中肠疝和营养缺乏的风险增加。铁、维生素A、维生素B12、维生素K、叶酸和钙的缺乏可导致母体并发症，如严重贫血，以及胎儿并发症，如先天性异常、IUGR和发育不良。
在减肥手术后的妊娠前、妊娠中和妊娠后进行密切监测，并根据患者的个体需求进行营养补充，有助于预防与营养相关的并发症，改善这一高危产科人群的母婴健康。
