Centro Hospitalar de Entre o Douro e Vouga, Rua Dr. Cândido de Pinho, 4520-211, Santa Maria da Feira, Portugal.
Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
Obes Surg. 2018 Nov;28(11):3559-3566. doi: 10.1007/s11695-018-3395-5.
Pregnancy in women submitted to bariatric surgery is increasing. Recommendations for surveillance of these pregnancies have been suggested, but an adequate time interval from surgery to conception, to avoid perinatal negative outcomes, is still controversial.
Medical records of pregnancies in women with previous bariatric surgery were retrieved and outcomes were assessed according to three different time thresholds (12, 18 and 24 months). The association between time from surgery to conception and the presence of adverse outcomes was analysed.
Eighty-six pregnancies were assessed. Weight gain was higher (p = 0.014) and more adequate (p = 0.041) when pregnancy occurred more than 12 months after surgery. Foetal growth percentile was lower when pregnancy was achieved before 24 months following surgery (p = 0.021). No differences among groups were found in other assessed outcomes (BMI, gestational age at delivery, type of delivery, gestational diabetes, pregnancy hypertensive disease, anaemia, preterm delivery, foetal weight, foetal growth restriction, Apgar score, admission to neonatal intensive unit) in all considered thresholds. No association between time from surgery to conception and the presence of adverse outcomes was found.
Despite differences found in maternal weight gain and foetal growth percentile, our study does not support the recommendation to delay pregnancy based on a fixed deadline. Other factors, including a more individualised approach, need to be considered.
接受减重手术的女性妊娠率正在增加。已经提出了针对这些妊娠的监测建议，但避免围产期不良结局的手术与受孕之间的适当时间间隔仍存在争议。
回顾了既往接受过减重手术的女性的妊娠病历，并根据三个不同的时间阈值（12、18 和 24 个月）评估了结局。分析了手术与受孕之间的时间间隔与不良结局之间的关系。
评估了 86 例妊娠。与手术后 12 个月后妊娠相比，体重增加更多（p=0.014）且更适当（p=0.041）。当手术后 24 个月内妊娠时，胎儿生长百分位数较低（p=0.021）。在所有考虑的阈值下，各组之间在其他评估结局（BMI、分娩时的孕龄、分娩方式、妊娠期糖尿病、妊娠高血压疾病、贫血、早产、胎儿体重、胎儿生长受限、阿普加评分、新生儿重症监护病房入院）方面均无差异。未发现手术与受孕之间的时间间隔与不良结局之间存在关联。
尽管在母体体重增加和胎儿生长百分位数方面存在差异，但我们的研究不支持基于固定期限延迟妊娠的建议。需要考虑其他因素，包括更个体化的方法。
