Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
PLoS Med. 2018 Sep 26;15(9):e1002656. doi: 10.1371/journal.pmed.1002656. eCollection 2018 Sep.
Obesity increases the risk of adverse delivery outcomes. Whether weight loss induced by bariatric surgery influences these risks remains to be determined. The objective was to investigate the risk of adverse delivery outcomes among post-surgery women compared with women without bariatric surgery history but with similar characteristics.
We identified 801,443 singleton live-born term births (≥37 gestational weeks) in the Swedish Medical Birth Register between 1 January 2006 and 31 December 2013, of which 1,929 were in women with a history of bariatric surgery and a pre-surgery weight available from the Scandinavian Obesity Surgery Registry. For each post-surgery delivery, up to 5 control deliveries were matched by maternal pre-surgery BMI (early-pregnancy BMI used for controls), age, parity, smoking, education, height, country of birth, and delivery year (N post-surgery deliveries:matched controls = 1,431:4,476). The main outcome measures were mode of delivery, induction of labor, post-term pregnancy (≥42 + 0 gestational weeks), epidural analgesia, fetal distress, labor dystocia, peripartum infection, obstetric anal sphincter injury (perineal tear grade III-IV), and postpartum hemorrhage. Among the women with a history of bariatric surgery, the mean pre-surgery BMI was 42.6 kg/m2, the median surgery-to-conception interval was 1.4 years, and the mean BMI loss between surgery and early pregnancy was 13.5 kg/m2 (38 kg). Compared to matched control women, post-surgery women were less likely to have cesarean delivery (18.2% versus 25.0%, risk ratio [RR] 0.70, 95% CI 0.60-0.80), especially emergency cesarean (6.8% versus 15.1%, RR 0.40, 95% CI 0.31-0.51). Post-surgery women also had lower risks of instrumental delivery (5.0% versus 6.5%, RR 0.73, 95% CI 0.53-0.98), induction of labor (23.4% versus 34.0%, RR 0.68, 95% CI 0.59-0.78), post-term pregnancy (4.2% versus 10.3%, RR 0.40, 95% CI 0.30-0.53), obstetric anal sphincter injury (1.5% versus 2.9%, RR 0.46, 95% CI 0.25-0.81), and postpartum hemorrhage (4.6% versus 8.0%, RR 0.58, 95% CI 0.44-0.76). Since this study was not randomized, a limitation is the possibility of selection bias, despite our efforts using careful matching.
Bariatric-surgery-induced weight loss was associated with lower risks for adverse delivery outcomes in term births.
肥胖增加了不良分娩结局的风险。减重手术引起的体重减轻是否会影响这些风险仍有待确定。本研究的目的是调查与无减重手术史但具有相似特征的女性相比，手术后女性不良分娩结局的风险。
我们在瑞典医疗出生登记处（2006 年 1 月 1 日至 2013 年 12 月 31 日）中确定了 801443 例单胎足月活产（≥37 孕周），其中 1929 例有减重手术史，且术前体重可从斯堪的纳维亚肥胖手术登记处获得。对于每例手术后分娩，通过母亲术前 BMI（对照组采用早孕 BMI）、年龄、产次、吸烟、教育程度、身高、出生地和分娩年份，最多匹配 5 例对照分娩（手术后分娩：匹配对照=1431:4476）。主要结局指标为分娩方式、引产、过期妊娠（≥42+0 孕周）、硬膜外镇痛、胎儿窘迫、产程延长、围产期感染、产科肛门括约肌损伤（会阴裂伤 III-IV 度）和产后出血。在有减重手术史的女性中，术前 BMI 平均为 42.6kg/m2，手术至受孕的中位间隔为 1.4 年，手术至早孕期间平均 BMI 下降 13.5kg/m2（38kg）。与匹配的对照组女性相比，手术后女性剖宫产的可能性较小（18.2%对 25.0%，风险比 [RR]0.70，95%置信区间 [CI]0.60-0.80），尤其是急诊剖宫产（6.8%对 15.1%，RR0.40，95%CI0.31-0.51）。手术后女性的器械分娩风险也较低（5.0%对 6.5%，RR0.73，95%CI0.53-0.98）、引产（23.4%对 34.0%，RR0.68，95%CI0.59-0.78）、过期妊娠（4.2%对 10.3%，RR0.40，95%CI0.30-0.53）、产科肛门括约肌损伤（1.5%对 2.9%，RR0.46，95%CI0.25-0.81）和产后出血（4.6%对 8.0%，RR0.58，95%CI0.44-0.76）。由于本研究未随机进行，因此存在选择偏倚的可能性，尽管我们已尽力通过仔细匹配来降低这种可能性。
减重手术引起的体重减轻与足月分娩的不良分娩结局风险降低相关。
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