Department of Woman and Child Health, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
Obes Surg. 2018 Oct;28(10):3284-3292. doi: 10.1007/s11695-018-3350-5.
Pregnancy after bariatric surgery (BS) has an increased risk for small-for-gestational-age infants (SGA), shorter length of gestation, and probably perinatal mortality. The aim of this study was to investigate if biliopancreatic diversion could impair pregnancy outcomes in comparison to other bariatric surgery procedures.
We conducted a cohort retrospective single-center study in 65 women before and after BS. Thirty-one pregnancies occurred before BS, while 109 after BS, amongst which n = 51 after biliopancreatic diversion (BPD) and n = 58 after non-malabsorptive procedures.
The pregnancy outcomes after BS in comparison with those before BS resulted less affected by diabetes, hypertensive disorders, macrosomia, and large-for-gestational-age (LGA), but more complicated by preterm births (14.5 versus 4.0%) and low birth weight (LBW) infants (28.9 versus 0%). Moreover, mean birth weight resulted lower after BS than before BS (p < 0.001). In pregnancies after BPD in comparison to those before BS, the LBW rate (42.5%) resulted a drastic increase (p < 0.001), and mean birth weight (p < 0.001) and mean birth weight centile (p < 0.001) were lower after BPD. When pregnancy outcomes after BPD were compared with those after non-malabsorptive procedures, the rate of congenital anomalies, preterm births, LBW, and SGA resulted an increase (p = 0.002, 0.008, 0.032, and < 0.001, respectively).
BPD drastically reduced diabetes, hypertensive disorders, macrosomia, and LGA; however, it was associated with the poorest pregnancy outcomes in comparison to those observed after other BS procedures. On the basis of the present study, we recommend a cautious multidisciplinary selection of severely obese patients for BPD during the fertile age.
肥胖症手术（BS）后的妊娠会增加胎儿小于胎龄儿（SGA）、妊娠时间缩短和围产儿死亡率的风险。本研究的目的是调查胆胰分流术与其他减肥手术相比是否会影响妊娠结局。
我们对 65 名接受 BS 前后的女性进行了队列回顾性单中心研究。BS 前有 31 例妊娠，BS 后有 109 例，其中 n=51 例接受胆胰分流术（BPD），n=58 例接受非吸收性手术。
BS 后的妊娠结局与 BS 前相比，糖尿病、高血压疾病、巨大儿和巨大儿（LGA）的发生率较低，但早产（14.5%比 4.0%）和低出生体重（LBW）婴儿（28.9%比 0%）的发生率较高。此外，BS 后出生体重均值低于 BS 前（p<0.001）。与 BS 前相比，BPD 后 LBW 发生率（42.5%）显著增加（p<0.001），BPD 后出生体重均值（p<0.001）和出生体重百分位数均值（p<0.001）较低。当 BPD 后的妊娠结局与非吸收性手术相比时，先天性畸形、早产、LBW 和 SGA 的发生率均有所增加（p=0.002、0.008、0.032 和<0.001）。
BPD 显著降低了糖尿病、高血压疾病、巨大儿和 LGA 的发生率；然而，与其他 BS 术后观察到的结果相比，BPD 与最差的妊娠结局相关。基于本研究，我们建议在生育期对严重肥胖患者进行谨慎的多学科选择，以避免接受 BPD。
