Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel.
Surg Obes Relat Dis. 2019 Feb;15(2):324-332. doi: 10.1016/j.soard.2018.11.018. Epub 2018 Nov 23.
Up to 80% of patients who undergo bariatric surgery are women of childbearing age. Coupled with improved fertility in women with obesity after bariatric surgery, pregnancy postbariatric surgery has become increasingly more common. Although numerous studies have evaluated associations of bariatric surgery with pregnancy outcomes, the effect of maternal nutritional status on maternal and perinatal outcomes is not well established. We used Medline and Embase databases and a manual search of references for articles published until June 2018 to conduct a systematic review on nutritional status after bariatric surgery and its association with maternal and perinatal outcomes. Of the 306 initially identified articles, 27 met the study inclusion criteria, comprising 2056 women with pregnancies after bariatric surgery. Deficiencies were reported in maternal concentrations of vitamins A, B1, B6, B12, C, D, K, iron, calcium, selenium, and phosphorous. The only adverse events documented for these deficiencies encountered during pregnancy were anemia (vitamin B12, iron), night blindness (vitamin A), and urinary tract infections (vitamin A, D). This systematic review suggests that various micronutrient deficiencies are common among pregnant postbariatric surgery patients. Nevertheless, despite the concern that these deficiencies could adversely affect pregnancy outcomes (e.g., lower neonatal birth weight), evidence of such is lacking. Further prospective studies are warranted to confirm our findings and better delineate the optimal supplementation regimen during pregnancy after bariatric surgery.
多达 80%接受减肥手术的患者是育龄妇女。加上肥胖女性减肥手术后生育能力的提高，减肥手术后的怀孕变得越来越常见。尽管许多研究评估了减肥手术与妊娠结局的关联，但母亲营养状况对母婴结局的影响尚未得到很好的确立。我们使用 Medline 和 Embase 数据库以及对截至 2018 年 6 月发表的文章的参考文献的手动搜索，对减肥手术后的营养状况及其与母婴结局的关联进行了系统评价。在最初确定的 306 篇文章中，有 27 篇符合研究纳入标准，包括 2056 名接受减肥手术后怀孕的女性。报告了母亲体内维生素 A、B1、B6、B12、C、D、K、铁、钙、硒和磷等营养素浓度的不足。在怀孕期间发现这些缺乏症的唯一不良事件是贫血（维生素 B12、铁）、夜盲症（维生素 A）和尿路感染（维生素 A、D）。这项系统评价表明，各种微量营养素缺乏症在减肥手术后怀孕的患者中很常见。尽管有人担心这些缺乏症可能会对妊娠结局产生不利影响（例如，新生儿出生体重降低），但缺乏证据支持这一观点。需要进一步的前瞻性研究来证实我们的发现，并更好地阐明减肥手术后妊娠期间的最佳补充方案。
