J Acad Nutr Diet. 2019 Nov;119(11):1921-1943. doi: 10.1016/j.jand.2019.02.008. Epub 2019 Apr 27.
While obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined.
A systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy.
A comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included.
Outcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores.
Thirteen of 246 studies were included. Compared to body mass index-matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent.
Bariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.
肥胖会给孕妇及其后代带来特定的急性和长期风险，而减重手术对妊娠结局的影响尚不确定。
按照营养与饮食学会循证分析库的程序进行系统评价，以确定减重手术对母婴健康的影响。
对 PubMed 进行全面的文献检索，以确定 2000 年至 2015 年间发表的研究，这些研究检查了减重手术后妊娠的健康影响。包括实验研究和有对照组的观察性研究。
感兴趣的结局是妊娠期间体重增加、产妇并发症（即妊娠期糖尿病、先兆子痫、子痫、高血压和产后出血）、流产和/或死胎、剖宫产、出生体重（克）、出生体重类别（即巨大儿、低出生体重儿、小于胎龄儿和大于胎龄儿）、胎龄和早产、婴儿疾病和并发症（即围产儿死亡、新生儿重症监护病房入院、新生儿疾病和先天畸形率）和阿普加评分。
在 246 项研究中，有 13 项研究被纳入。与没有手术的体重指数匹配对照组相比，妊娠前的减重手术降低了婴儿出生时的体重（克），但对产妇总的妊娠体重增加或阿普加评分没有影响。手术并未增加不良结局的风险，如流产和/或死胎、早产或婴儿并发症。手术对产妇并发症、婴儿出生体重类别和手术分娩率的影响不一致。
减重手术是治疗母体肥胖的有效方法，但可能存在某些手术特有的风险。需要更多的数据来确定临床指南。手术对妊娠结局的长期影响尚不清楚。
