Mead Nancy C, Sakkatos Panagiotis, Sakellaropoulos George C, Adonakis George L, Alexandrides Theodore K, Kalfarentzos Fotis
Nutrition Support and Morbid Obesity Unit, Department of Surgery, School of Medicine, University of Patras, Greece; Nutrition Department, University Hospital of Patras, Greece.
Nutrition Department, University Hospital of Patras, Greece.
Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1166-73. doi: 10.1016/j.soard.2014.02.011. Epub 2014 Feb 24.
Nutritional status during pregnancy and the effects of nutritional deficiencies on pregnancy outcomes after bariatric surgery is an important issue that warrants further study. The objective of this study was to investigate pregnancy outcomes and nutritional indices after restrictive and malabsorptive procedures.
We investigated pregnancy outcomes of 113 women who gave birth to 150 children after biliopancreatic diversion (BPD), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) between June 1994 and December 2011. Biochemical indices and pregnancy outcomes were compared among the different types of surgery and to overall 20-year hospital data, as well as to 56 presurgery pregnancies in 36 women of the same group.
Anemia was observed in 24.2% and 15.6% of pregnancies after BPD and RYGB, respectively. Vitamin B12 levels decreased postoperatively in all groups, with no further decrease during pregnancy; however, low levels were observed not only after BPD (11.7%) and RYGB (15.6%), but also after SG (13.3%). Folic acid levels increased. Serum albumin levels decreased in all groups during pregnancy, but hypoproteinemia was seen only after BPD. Neonates after BPD had significantly lower average birth weight without a higher frequency of low birth weight defined as<2500 g. A comparison of neonatal data between babies born before surgery and siblings born after surgery (AS) showed that AS newborns had lower average birth weight with no significant differences in body length or head circumference and no cases of macrosomia.
Our study showed reasonably good pregnancy outcomes in this sample population after all types of bariatric surgery provided nutritional supplement guidelines are followed. Closer monitoring is required in pregnancies after malabsorptive procedures especially regarding protein nutrition.
孕期营养状况以及减肥手术后营养缺乏对妊娠结局的影响是一个值得进一步研究的重要问题。本研究的目的是调查限制性和吸收不良性手术术后的妊娠结局和营养指标。
我们调查了1994年6月至2011年12月期间113名接受胆胰分流术（BPD）、Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）后分娩150名儿童的妇女的妊娠结局。比较了不同类型手术之间的生化指标和妊娠结局，并与20年的医院总体数据进行比较，同时也与同一组中36名妇女的56次术前妊娠情况进行了比较。
BPD和RYGB术后妊娠分别有24.2%和15.6%出现贫血。所有组术后维生素B12水平均下降，孕期未进一步降低；然而，不仅BPD（11.7%）和RYGB（15.6%）术后出现低水平，SG术后（13.3%）也出现低水平。叶酸水平升高。所有组孕期血清白蛋白水平均下降，但只有BPD术后出现低蛋白血症。BPD术后新生儿平均出生体重显著较低，而出生体重<2500 g的低出生体重发生率并未更高。对术前出生的婴儿和术后出生的同胞兄弟姐妹（AS）的新生儿数据进行比较，结果显示AS新生儿平均出生体重较低，身长或头围无显著差异，也无巨大儿病例。
我们的研究表明，在遵循营养补充指南的情况下，该样本人群在接受所有类型的减肥手术后妊娠结局相当良好。吸收不良性手术后的妊娠需要更密切的监测，尤其是蛋白质营养方面。
