Division of Rheumatology, University of Washington, Seattle, Washington.
Department of Pediatrics, University of California, San Diego, La Jolla, California; California Preterm Birth Initiative, University of California San Francisco, San Francisco, California.
Surg Obes Relat Dis. 2021 Feb;17(2):406-413. doi: 10.1016/j.soard.2020.09.016. Epub 2020 Sep 29.
Autoimmune rheumatic diseases (ARDs) and bariatric surgery are each risk factors for adverse birth outcomes. To date, no study has investigated their combined impact on birth outcomes.
The objective of this study was to evaluate the impact of bariatric surgery on pregnancy outcomes in women with an ARD. As a secondary comparison, we assessed the risk of bariatric surgery on the same outcomes in women without an ARD.
Records maintained by the California Office of Statewide Health Planning and Development.
This cohort study included infants born between 20-44 weeks of gestation in California between 2011-2018. Risks of adverse pregnancy outcomes were evaluated for women with a history of bariatric surgery as compared to women without a history of bariatric surgery, stratified by ARD, using log-linear regression with a Poisson distribution.
The study included 3,574,165 infants, of whom 10,823 (0.3%) were born to women who had an ARD and 13,529 (0.38%) to women with a history of bariatric surgery. There were 155 infants born to women (0.0043%) with both an ARD and a history of bariatric surgery. In women with an ARD and without bariatric surgery, the prevalence of preterm births was 18%, compared to 17.4% in women with both ARD and bariatric surgery; in women without ARD but with prior bariatric surgery, the prevalence of preterm births was 13.7%, compared to 8.2% in women without bariatric surgery. Except for neonatal intensive care unit (NICU) admissions, women with an ARD and history of bariatric surgery were not at a statistically increased risk of having other adverse pregnancy outcomes as compared to women with an ARD and no history of bariatric surgery.
Our study shows that women with ARD already have a high occurrence of several adverse birth outcomes, and this was not further increased by a history of bariatric surgery. The infants born to women with a history of ARD and bariatric surgery were admitted to the NICU significantly more than the infants born to women with an ARD and no history of bariatric surgery.
自身免疫性风湿性疾病（ARDs）和减肥手术都是不良妊娠结局的危险因素。迄今为止，尚无研究调查它们对妊娠结局的综合影响。
本研究旨在评估减肥手术对患有 ARD 的女性妊娠结局的影响。作为次要比较，我们评估了减肥手术对无 ARD 的女性相同结局的风险。
加利福尼亚州全州卫生规划和发展办公室保存的记录。
这项队列研究纳入了 2011 年至 2018 年间加利福尼亚州 20-44 周龄妊娠的婴儿。使用泊松分布的对数线性回归，比较有 ARD 病史和无 ARD 病史的女性之间不良妊娠结局的风险，分层考虑 ARD。
研究纳入了 3574165 名婴儿，其中 10823 名（0.3%）出生于患有 ARD 的女性，13529 名（0.38%）出生于有减肥手术史的女性。有 155 名婴儿出生于同时患有 ARD 和减肥手术史的女性（0.0043%）。在患有 ARD 且无减肥手术史的女性中，早产的发生率为 18%，而同时患有 ARD 和减肥手术史的女性为 17.4%；在没有 ARD 但有减肥手术史的女性中，早产的发生率为 13.7%，而没有减肥手术史的女性为 8.2%。除新生儿重症监护病房（NICU）入院外，与患有 ARD 且无减肥手术史的女性相比，同时患有 ARD 和减肥手术史的女性发生其他不良妊娠结局的风险并未统计学增加。
本研究表明，患有 ARD 的女性已经存在多种不良出生结局的高发生率，减肥手术史并未进一步增加。与患有 ARD 且无减肥手术史的女性相比，同时患有 ARD 和减肥手术史的女性分娩的婴儿入住 NICU 的比例显著更高。
