Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Wunschbaby Institut Feichtinger, Lainzerstrasse 6, Vienna, Austria.
BMC Pregnancy Childbirth. 2018 Dec 27;18(1):507. doi: 10.1186/s12884-018-2124-3.
Bariatric surgery (BS) is regarded to be the most effective treatment of obesity with long lasting beneficial effects including weight loss and improvement of metabolic disorders. A considerable number of women undergoing BS are at childbearing age.Although the surgery mediated weight loss has a positive effect on pregnancy outcome, the procedures might be associated with adverse outcomes as well, for example micronutrient deficiencies, iron or B12 deficiency anemia, dumping syndrome, surgical complications such as internal hernias, and small for gestational age (SGA) offspring, possibly due to maternal undernutrition. Also, there is no international consensus concerning the ideal time to conception after BS. Hence, the present narrative review intents to summarize the available literature concerning the most common challenges which arise before and during pregnancy after BS, such as fertility related considerations, vitamin and nutritional deficiencies and their adequate compensation through supplementation, altered glucose metabolism and its implications for gestational diabetes screening, the symptoms and treatment of dumping syndrome, surgical complications and the impact of BS on pregnancy outcome. The impact of different bariatric procedures on pregnancy and fetal outcome will also be discussed, as well as general considerations concerning the monitoring and management of pregnancies after BS.Whereas BS leads to the mitigation of many obesity-related pregnancy complications, such as gestational diabetes mellitus (GDM), pregnancy induced hypertension and fetal macrosomia; those procedures pose new risks which might lead to adverse outcomes for mothers and offspring, for example nutritional deficiencies, anemia, altered maternal glucose metabolism and small for gestational age children.
减重手术（BS）被认为是治疗肥胖症最有效的方法，其长期有益效果包括体重减轻和改善代谢紊乱。相当数量的接受 BS 的女性处于生育年龄。虽然手术介导的体重减轻对妊娠结局有积极影响，但手术也可能与不良结局相关，例如微量营养素缺乏、铁或 B12 缺乏性贫血、倾倒综合征、手术并发症（如内疝）和小于胎龄儿（SGA），这可能是由于母亲营养不良所致。此外，BS 后受孕的理想时间尚无国际共识。因此，本叙述性综述旨在总结有关 BS 前后妊娠期间出现的最常见挑战的现有文献，例如与生育相关的考虑因素、维生素和营养缺乏及其通过补充进行适当补偿、葡萄糖代谢改变及其对妊娠期糖尿病筛查的影响、倾倒综合征的症状和治疗、手术并发症以及 BS 对妊娠结局的影响。还将讨论不同的减重手术对妊娠和胎儿结局的影响，以及 BS 后妊娠监测和管理的一般注意事项。BS 虽然减轻了许多与肥胖相关的妊娠并发症，如妊娠期糖尿病（GDM）、妊娠高血压和胎儿巨大儿；但这些手术带来了新的风险，可能会对母亲和胎儿产生不良后果，例如营养缺乏、贫血、母体葡萄糖代谢改变和小于胎龄儿。
