Menke Marie N, King Wendy C, White Gretchen E, Gosman Gabriella G, Courcoulas Anita P, Dakin Gregory F, Flum David R, Orcutt Molly J, Pomp Alfons, Pories Walter J, Purnell Jonathan Q, Steffen Kristine J, Wolfe Bruce M, Yanovski Susan Z
University of Pittsburgh School of Medicine, the University of Pittsburgh Graduate School of Public Health, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Weill Cornell University Medical Center, New York, New York; the University of Washington, Seattle, Washington; the Neuropsychiatric Research Institute, Fargo, North Dakota; Brody School of Medicine, East Carolina University, Greenville, North Carolina; Oregon Health & Science University, Portland, Oregon; North Dakota State University, Fargo, North Dakota; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
Obstet Gynecol. 2017 Nov;130(5):979-987. doi: 10.1097/AOG.0000000000002323.
To examine contraceptive practices and conception rates after bariatric surgery.
The Longitudinal Assessment of Bariatric Surgery-2 is a multicenter, prospective cohort study of adults undergoing first-time bariatric surgery as part of routine clinical care at 10 U.S. hospitals. Recruitment occurred between 2005 and 2009. Participants completed preoperative and annual postsurgical assessments for up to 7 years until January 2015. This report was restricted to women 18-44 years old with no history of menopause, hysterectomy, or estrogen and progesterone therapy. Primary outcomes were self-reported contraceptive practices, overall conception rate, and early (less than 18 months) postsurgical conception. Contraceptive practice (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive) was classified based on the preceding year. Conception rates were determined from self-reported pregnancies.
Of 740 eligible women, 710 (95.9%) completed follow-up assessment(s). Median (interquartile range) preoperative age was 34 (30-39) years. In the first postsurgical year, 12.7% (95% CI 9.4-16.0) of women had no intercourse, 40.5% (95% CI 35.6-45.4) had protected intercourse only, 41.5% (95% CI 36.4-46.6) had unprotected intercourse while not trying to conceive, and 4.3% (95% CI 2.4-6.3) tried to conceive. The prevalence of the first three groups did not significantly differ across the 7 years of follow-up (P for all >.05); however, more women tried to conceive in the second year (13.1%, 95% CI 9.3-17.0; P<.001). The conception rate was 53.8 (95% CI 40.0-71.1) per 1,000 woman-years across follow-up (median [interquartile range] 6.5 [5.9-7.0] years); 42.3 (95% CI 30.2-57.6) per 1,000 woman-years in the 18 months after surgery. Age (adjusted relative risk 0.41 [95% CI 0.19-0.89] per 10 years, P=.03), being married or living as married (adjusted relative risk 4.76 [95% CI 2.02-11.21], P<.001), and rating future pregnancy as important preoperatively (adjusted relative risk 8.50 [95% CI 2.92-24.75], P<.001) were associated with early conception.
Postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery.
ClinicalTrials.gov, NCT00465829.
研究减肥手术后的避孕措施及受孕率。
减肥手术纵向评估-2是一项多中心前瞻性队列研究，研究对象为美国10家医院接受首次减肥手术的成年患者，作为常规临床护理的一部分。招募工作于2005年至2009年期间进行。参与者完成术前及术后每年一次的评估，最长持续7年，直至2015年1月。本报告仅限于18至44岁、无绝经、子宫切除或雌激素及孕激素治疗史的女性。主要结局指标为自我报告的避孕措施、总体受孕率及术后早期（少于18个月）受孕情况。避孕措施（无性交、采取保护措施的性交、无保护措施的性交或尝试受孕）根据上一年情况进行分类。受孕率根据自我报告的怀孕情况确定。
740名符合条件的女性中，710名（95.9%）完成了随访评估。术前年龄中位数（四分位间距）为34（30 - 39）岁。在术后第一年，1 . 2 . 7%（95%置信区间9.4 - 16.0）的女性无性交，40.5%（95%置信区间35.6 - 45.4）仅采取保护措施的性交，41.5%（95%置信区间36.4 - 46.6）在未尝试受孕时有无保护措施的性交，4.3%（95%置信区间2.4 - 6.3）尝试受孕。在7年随访期间，前三组的患病率无显著差异（所有P值>.05）；然而，第二年有更多女性尝试受孕（13.1%，95%置信区间9.3 - 17.0；P<.001）。整个随访期间受孕率为每1000妇女年53.8（95%置信区间40.0 - 71.1）；术后18个月内为每1000妇女年42.3（95%置信区间30.2 - 57.6）。年龄（每10岁调整相对风险0.41 [95%置信区间0.19 - 0.89]，P =.03）、已婚或同居（调整相对风险4.76 [95%置信区间2.02 - 11.21]，P<.001）以及术前将未来怀孕视为重要事项（调整相对风险8.50 [95%置信区间2.92 - 24.75]，P<.001）与早期受孕相关。
减肥手术后的避孕措施使用及受孕率未反映减肥手术后推迟18个月受孕的建议。
ClinicalTrials.gov，NCT00465829。
