University of Montreal Hospital Research Centre, Department of Social and Preventive Medicine, School of Public Health, Montreal, Quebec, Canada.
National Public Health Institute of Quebec, Montreal, Quebec, Canada.
Ann Surg. 2021 Sep 1;274(3):e230-e235. doi: 10.1097/SLA.0000000000004973.
We assessed whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity.
Obesity is a risk factor for severe maternal morbidity, but the potential for bariatric surgery to reduce the risk has not been studied.
We analyzed a retrospective cohort of 2,412,075 deliveries between 1989 and 2019 in Quebec, Canada. The main exposure measures were bariatric surgery before pregnancy and obesity without bariatric surgery, compared with no obesity. The outcome was severe maternal morbidity, a composite of life-threatening pregnancy complications. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between bariatric surgery and severe maternal morbidity, adjusted for maternal characteristics.
A total of 2654 deliveries (0.1%) were in women who had bariatric surgery, and 70,041 (29.0 per 1000) were in women who had severe maternal morbidity. Risk of severe maternal morbidity was not significantly elevated for bariatric surgery (RR 1.20; 95% CI 0.98-1.46), but was greater for obesity compared with no obesity (RR 1.60; 95% CI 1.55-1.64). Bariatric surgery was not associated with morbidities such as severe preeclampsia, sepsis, and cardiac complications compared with no obesity, but obesity was associated with elevated risks of these and other severe morbidities. Bariatric surgery was associated, however, with intensive care unit admission, compared with no obesity.
Pregnant women with prior bariatric surgery have similar risks as nonobese women for most types of severe maternal morbidity, except for intensive care unit admission.
我们评估妊娠前减重手术是否可降低严重孕产妇发病率，使其风险水平与非肥胖人群相当。
肥胖是严重孕产妇发病率的一个危险因素，但减重手术降低风险的潜力尚未得到研究。
我们分析了加拿大魁北克省 1989 年至 2019 年间 2412075 例分娩的回顾性队列。主要暴露措施为妊娠前减重手术和无减重手术的肥胖，与非肥胖进行比较。结局为严重孕产妇发病率，即危及生命的妊娠并发症的综合指标。我们根据产妇特征，调整了减重手术与严重孕产妇发病率之间关联的风险比（RR）和 95%置信区间（CI）。
共有 2654 例（0.1%）分娩的产妇接受了减重手术，70041 例（29.0/1000）产妇发生了严重孕产妇发病率。与非肥胖相比，减重手术并未显著增加严重孕产妇发病率的风险（RR 1.20；95%CI 0.98-1.46），但肥胖的风险更高（RR 1.60；95%CI 1.55-1.64）。与非肥胖相比，减重手术与严重子痫前期、败血症和心脏并发症等严重疾病的发病率无关，但肥胖与这些及其他严重疾病的发病率升高有关。然而，与非肥胖相比，减重手术与重症监护病房（ICU）入院相关。
与非肥胖人群相比，妊娠前接受过减重手术的孕妇在大多数严重孕产妇发病率类型方面的风险相似，除 ICU 入院外。
