Department of Physical Therapy, University of Utah, 520 Wakara Way, Salt Lake City, UT, USA.
Department of Exercise Sciences, Brigham Young University, 271 SFH, Provo, UT, USA.
Int J Obes (Lond). 2022 Jan;46(1):107-112. doi: 10.1038/s41366-021-00964-6. Epub 2021 Sep 10.
BACKGROUND/OBJECTIVES: While an increased risk for substance use disorders (SUD) and also for several adverse pregnancy and birth outcomes in patients who have undergone bariatric surgery have been well documented when considered separately, an association between these important risk factors has not been investigated. This study explored the potential dependence of these two bariatric surgery-related risks.
SUBJECTS/METHODS: This study was a retrospective cohort study with adult women (18-45) who underwent bariatric surgery between 1996 and 2016 and who gave birth after surgery between 1996 and 2018. The study population consisted of 1849 post-bariatric surgery women with 3010 reported post-surgical births. Subjects with post-surgical, prenatal SUD were identified based on diagnosis codes extracted within the 10 months prior to delivery. Using random-effects logistic regression with retrospective cohort data, preterm birth, low birth weight, macrosomia, Caesarian delivery, congenital anomalies, and neonatal intensive care unit admission were considered as outcomes.
About 10% (n = 289) of women had an SUD diagnosis within 10 months prior to child delivery. Women with SUD during pregnancy had significantly more pregnancy and birth complications compared to women without SUD: preterm birth (OR = 2.08, p = 0.03, 95% CI: 1.07-4.03), low birth weight (OR = 3.41, p < 0.01, 95% CI: 1.99-5.84), Caesarian delivery (OR = 9.71, p < 0.01, 95% CI: 2.69-35.05), and neonatal intensive care unit admission (OR = 3.87, p < 0.01, 95% CI: 2.04-7.34). Women with SUD had lower risk for macrosomia than women without SUD (OR = 0.07, p = 0.02, 95% CI: 0.01-0.70).
Results from this study demonstrated that post-bariatric surgery women who had SUD during pregnancy had significantly more pregnancy- and birth-related complications than post-surgery pregnant women without SUD, despite the reduction in macrosomia. Where possible, greater prenatal surveillance of post-surgery women with SUD should be considered.
背景/目的：虽然已经有充分的文献记载，表明接受过减重手术的患者会增加物质使用障碍（SUD）的风险，以及多种不良的妊娠和分娩结局的风险，但这些重要风险因素之间的关联尚未得到研究。本研究探讨了这两种与减重手术相关的风险之间的潜在相关性。
受试者/方法：这是一项回顾性队列研究，纳入了 1996 年至 2016 年间接受减重手术且在术后 1996 年至 2018 年间分娩的成年女性。研究人群由 1849 名接受过减重手术后的女性组成，其中 3010 名女性报告了术后分娩情况。基于分娩前 10 个月内提取的诊断代码，确定了术后、产前 SUD 患者。使用随机效应逻辑回归分析回顾性队列数据，将早产、低出生体重、巨大儿、剖宫产、先天畸形和新生儿重症监护病房入院视为结局。
约 10%（n=289）的女性在分娩前 10 个月内被诊断为 SUD。与没有 SUD 的女性相比，有 SUD 的孕妇在妊娠和分娩并发症方面显著更多：早产（OR=2.08，p=0.03，95%CI：1.07-4.03）、低出生体重（OR=3.41，p<0.01，95%CI：1.99-5.84）、剖宫产（OR=9.71，p<0.01，95%CI：2.69-35.05）和新生儿重症监护病房入院（OR=3.87，p<0.01，95%CI：2.04-7.34）。与没有 SUD 的女性相比，有 SUD 的女性发生巨大儿的风险较低（OR=0.07，p=0.02，95%CI：0.01-0.70）。
本研究结果表明，与没有 SUD 的术后孕妇相比，接受过减重手术且在孕期有 SUD 的女性，尽管巨大儿的风险降低，但妊娠和分娩相关并发症显著更多。在可能的情况下，应考虑对术后有 SUD 的女性进行更多的产前监测。
