Women's Health Department, North Bristol NHS Trust, UK; Translational Health Sciences, University of Bristol, UK.
Translational Health Sciences, University of Bristol, UK.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:10-17. doi: 10.1016/j.ejogrb.2021.02.031. Epub 2021 Mar 3.
To assess the impact of type of bariatric surgery on pregnancy outcomes.
This is a national prospective observational study using the UK Obstetric Surveillance System (UKOSS). Data collection was undertaken in 200 consultant-led NHS maternity units between November 2011 and October 2012 (gastric banding), and April 2014 and March 2016 (gastric bypass and sleeve gastrectomy). Participants were pregnant women following gastric banding (n = 127), gastric bypass (n = 134) and sleeve gastrectomy (n = 29). Maternal and perinatal outcomes were compared using generalised linear and linear mixed models. Maternal outcomes included gestational weight gain, pre-eclampsia, gestational diabetes, anaemia, surgical complications. Perinatal outcomes included birthweight, small/large for gestational age (SGA/LGA), preterm birth, stillbirth.
Maternal: Women pregnant after gastric banding and sleeve gastrectomy had a lower risk of anaemia compared with gastric bypass (banding (16 %) vs bypass (39 %): p = 0.002, sleeve (21 %) vs bypass: p = 0.04). Gestational diabetes risk was lower after gastric banding compared with gastric bypass (7 % vs 16 %, p = 0.03) despite women with banding having significantly greater weight at booking as well as gestational weight gain. Women pregnant after gastric banding and sleeve gastrectomy had a lower risk of surgical complications than after gastric bypass (banding (0.9 %) vs bypass (11.4 %): p = 0.03, sleeve (0.0 %) vs bypass: p = 0.06). Perinatal: Infants born to mothers after gastric banding had a higher birthweight than those born to mothers after gastric bypass (mean difference = 260 g (125-395), p < 0.001). Infants were more likely to be LGA if their mothers had gastric banding compared with gastric bypass or sleeve gastrectomy (banding (21 %) vs bypass (5 %): p = 0.006; banding vs sleeve (3 %): p = 0.03). Risk of preterm birth was higher in women with gastric banding compared with gastric bypass (13 % vs 8 %, p = 0.04).
Women planning bariatric surgery should be counselled regarding the differing impacts of different types of procedure on any future pregnancy. Pre-existing gastric bypass is associated with higher rates of potentially serious surgical complications during pregnancy.
评估不同减重手术类型对妊娠结局的影响。
这是一项全国性前瞻性观察研究，使用英国产科监测系统（UKOSS）。数据采集于 2011 年 11 月至 2012 年 10 月（胃带）和 2014 年 4 月至 2016 年 3 月（胃旁路和袖状胃切除术）期间在 200 家由顾问主导的国民保健制度产科单位进行。参与者为胃带（n=127）、胃旁路（n=134）和袖状胃切除术（n=29）后怀孕的妇女。使用广义线性和线性混合模型比较母婴结局。母婴结局包括妊娠体重增加、子痫前期、妊娠期糖尿病、贫血、手术并发症。围产儿结局包括出生体重、小于胎龄儿（SGA/LGA）、早产、死产。
产妇：与胃旁路术相比，胃带和袖状胃切除术的妇女贫血风险较低（胃带（16%）vs 胃旁路（39%）：p=0.002，袖状胃（21%）vs 胃旁路：p=0.04）。与胃旁路术相比，胃带术治疗的妊娠期糖尿病风险较低（7% vs 16%，p=0.03），尽管带术治疗的妇女在预约时以及妊娠体重增加方面的体重明显更大。与胃旁路术相比，胃带和袖状胃切除术的妇女发生手术并发症的风险较低（胃带（0.9%）vs 胃旁路（11.4%）：p=0.03，袖状胃（0.0%）vs 胃旁路：p=0.06）。围产儿：与胃旁路术相比，胃带术治疗的母亲所生婴儿的出生体重更高（平均差异=260 克（125-395），p<0.001）。与胃旁路术或袖状胃切除术相比，胃带术治疗的母亲所生婴儿更有可能为巨大儿（胃带（21%）vs 胃旁路（5%）：p=0.006；胃带 vs 袖状胃（3%）：p=0.03）。与胃旁路术相比，胃带术治疗的妇女早产风险较高（13% vs 8%，p=0.04）。
计划进行减重手术的女性应就不同手术类型对未来任何妊娠的不同影响进行咨询。既往胃旁路术与妊娠期间潜在严重手术并发症的发生率较高有关。
