Narayanan Ram Prakash, Syed Akheel A
Department of Obesity Medicine and Endocrinology, Salford Royal NHS Foundation Trust and University Teaching Hospital, Salford, UK.
Faculty of Medical and Human Sciences, The University of Manchester, Manchester, UK.
Obes Surg. 2016 Oct;26(10):2523-9. doi: 10.1007/s11695-016-2294-x.
Bariatric surgery is most commonly carried out in women of childbearing age. Whilst fertility rates are improved, pregnancy following bariatric surgery poses several challenges. Whilst rates of many adverse maternal and foetal outcomes in obese women are reduced after bariatric surgery, pregnancy is best avoided for 12-24 months to reduce the potential risk of intrauterine growth retardation. Dumping syndromes are common after bariatric surgery and can present diagnostic and therapeutic challenges in pregnancy. Early dumping occurs due to osmotic fluid shifts resulting from rapid gastrointestinal food transit, whilst late dumping is characterized by a hyperinsulinemic response to rapid absorption of simple carbohydrates. Dietary measures are the mainstay of management of dumping syndromes but pharmacotherapy may sometimes become necessary. Acarbose is the least hazardous pharmacological option for the management of postprandial hypoglycemia in pregnancy. Nutrient deficiencies may vary depending on the type of surgery; it is important to optimize the nutritional status of women prior to and during pregnancy. Dietary management should include adequate protein and calorie intake and supplementation of vitamins and micronutrients. A high clinical index of suspicion is required for early diagnosis of surgical complications of prior weight loss procedures during pregnancy, including small bowel obstruction, internal hernias, gastric band erosion or migration and cholelithiasis.
减肥手术最常在育龄女性中进行。虽然减肥手术后生育率有所提高，但减肥手术后怀孕会带来一些挑战。虽然肥胖女性在减肥手术后许多不良母婴结局的发生率会降低，但最好在12至24个月内避免怀孕，以降低宫内生长受限的潜在风险。倾倒综合征在减肥手术后很常见，并且在怀孕期间可能会带来诊断和治疗方面的挑战。早期倾倒综合征是由于胃肠道食物快速通过导致的渗透性液体转移引起的，而晚期倾倒综合征的特征是对简单碳水化合物快速吸收的高胰岛素反应。饮食措施是倾倒综合征管理的主要手段，但有时可能需要药物治疗。阿卡波糖是孕期治疗餐后低血糖危害最小的药物选择。营养缺乏可能因手术类型而异；在怀孕前和怀孕期间优化女性的营养状况很重要。饮食管理应包括充足的蛋白质和热量摄入以及维生素和微量营养素的补充。对于怀孕期间早期诊断先前减肥手术的手术并发症，包括小肠梗阻、内疝、胃束带侵蚀或移位以及胆结石，需要较高的临床怀疑指数。
