Department of Social and Preventive Medicine, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
Institut National de Santé Publique du Québec, Montreal, Quebec, Canada.
Am J Clin Nutr. 2019 Nov 1;110(5):1168-1174. doi: 10.1093/ajcn/nqz195.
Data on the relationship between bariatric surgery and risk of birth defects are conflicting.
We studied the association of bariatric surgery with birth defects in future pregnancies in a large cohort of women.
We carried out a retrospective cohort study of 2,194,348 pregnancies that occurred between 1989 and 2016 in Quebec, Canada. We identified women who had bariatric surgery before pregnancy, and included nonobese women with no surgery as a comparison group. We estimated risk ratios (RRs) and 95% CIs for the associations between bariatric surgery and the risk of birth defects, using log-binomial regression models adjusted for maternal age, comorbidities, parity, whether there was a multiple birth, socioeconomic deprivation, and the presence of folic acid food fortification.
In this study, 1845 deliveries were among women who had bariatric surgery before pregnancy (0.08%). Having bariatric surgery was associated with 1.20 times the risk of birth defects in later pregnancies (95% CI: 1.01, 1.43), compared with having no surgery or obesity. Obesity without having bariatric surgery was, in contrast, more weakly associated with birth defects (RR: 1.09; 95% CI: 1.07, 1.12). The association with bariatric surgery was greater for heart (RR: 1.47; 95% CI: 1.02, 2.12) and musculoskeletal defects (RR: 1.32; 95% CI: 1.02, 1.71). Associations were primarily present before folic acid food fortification was implemented (RR: 2.03; 95% CI: 1.41, 2.92), but not after (RR: 1.05; 95% CI: 0.86, 1.28).
Having bariatric surgery was a risk factor for birth defects, and particularly heart and musculoskeletal defects. After fortification, however, an association was no longer present. Future studies are needed to determine whether micronutrient supplementation underpins the difference in the changing results pre- and postfortification.
关于减重手术与出生缺陷风险之间的关系的数据存在争议。
我们在一个大型的女性队列中研究了减重手术与未来妊娠中出生缺陷的关系。
我们对 1989 年至 2016 年间在加拿大魁北克发生的 2194348 例妊娠进行了回顾性队列研究。我们确定了在妊娠前接受过减重手术的女性，并将没有手术的非肥胖女性作为对照组。我们使用对数二项式回归模型，根据母亲的年龄、合并症、产次、是否多胎妊娠、社会经济剥夺情况以及叶酸食物强化的存在情况，调整了模型，以估计减重手术与出生缺陷风险之间的比值比（RR）和 95%置信区间（CI）。
在这项研究中，1845 例分娩发生在妊娠前接受过减重手术的女性中（0.08%）。与未手术或肥胖相比，接受减重手术与后期妊娠中出生缺陷的风险增加 1.20 倍（95%CI：1.01，1.43）。相比之下，肥胖而未接受减重手术与出生缺陷的相关性较弱（RR：1.09；95%CI：1.07，1.12）。减重手术与心脏（RR：1.47；95%CI：1.02，2.12）和肌肉骨骼缺陷（RR：1.32；95%CI：1.02，1.71）的相关性更大。这些关联主要存在于叶酸食物强化实施之前（RR：2.03；95%CI：1.41，2.92），但在之后不存在（RR：1.05；95%CI：0.86，1.28）。
接受减重手术是出生缺陷的一个危险因素，特别是心脏和肌肉骨骼缺陷。然而，在强化之后，这种关联不再存在。需要进一步的研究来确定微量营养素补充是否是强化前后结果变化的基础。
