Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Contraception. 2010 Jul;82(1):86-94. doi: 10.1016/j.contraception.2010.02.008. Epub 2010 Mar 29.
Weight loss after bariatric surgery often improves fertility but can pose substantial risks to maternal and fetal outcomes. Women who have undergone a bariatric surgical procedure are currently advised to delay conception for up to 2 years.
We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women with a history of bariatric surgery.
From 29 articles, five met review inclusion criteria. One prospective, noncomparative study reported 2 pregnancies among 9 (22%) oral contraceptive (OC) users following biliopancreatic diversion, and one descriptive study reported no pregnancies among an unidentified number of women taking OCs following laparoscopic adjustable gastric banding. Of two pharmacokinetic studies, one found lower plasma levels of norethisterone and levonorgestrel among women having had a jejunoileal bypass, as compared to nonoperated, normal-weight controls. The other study found no difference in plasma levels of D-norgestrel between women having a jejunoileal bypass of either 1:3 or 3:1 ratio between the length of jejunum and ileum left in continuity, but women with a 1:3 ratio had significantly higher plasma levels of D-norgestrel than extremely obese controls not operated upon.
Evidence regarding OC effectiveness following a bariatric surgical procedure is quite limited, although no substantial decrease in effectiveness was identified from available studies. Evidence on failure rates for other contraceptive methods and evidence on safety for all contraceptive methods was not identified.
减重手术后的体重减轻通常会提高生育能力，但会对母婴结局造成重大风险。目前建议接受过减重手术的女性推迟受孕时间，最长可达 2 年。
我们对文献进行了系统回顾，从数据库（PubMed）建立到 2009 年 2 月，以评估有减重手术史的女性使用避孕措施的安全性和有效性的证据。
从 29 篇文章中，有 5 篇符合综述纳入标准。一项前瞻性、非对照研究报告称，在接受胆胰分流术后，9 名（22%）口服避孕药（OC）使用者中有 2 例妊娠，另一项描述性研究报告称，在接受腹腔镜可调胃束带术的未知数量的女性中，没有妊娠。在两项药代动力学研究中，一项发现，与非手术、正常体重对照组相比，接受空肠回肠旁路术的女性体内的去甲孕烯和左炔诺孕酮血浆水平较低。另一项研究发现，在空肠回肠旁路术的女性中，无论是 1:3 还是 3:1 的空肠与回肠长度比，D-去甲孕烯的血浆水平没有差异，但长度比为 1:3 的女性的 D-去甲孕烯的血浆水平显著高于未手术的极度肥胖对照组。
关于减重手术后 OC 有效性的证据非常有限，尽管从现有研究中没有发现有效性明显降低。没有发现其他避孕方法的失败率证据，也没有发现所有避孕方法的安全性证据。
