Department of Obstetrics and Gynecology and the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, the Permanente Medical Group, and the Kaiser Permanente Northern California Division of Research, Oakland, and the Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California.
Obstet Gynecol. 2023 Mar 1;141(3):583-591. doi: 10.1097/AOG.0000000000005088. Epub 2023 Feb 2.
To evaluate perinatal outcomes associated with pregnancy after bariatric surgery within a large integrated health care system using propensity score matching.
We conducted a retrospective cohort study that evaluated perinatal outcomes in pregnant patients after bariatric surgery from January 2012 through December 2018. History of bariatric surgery was identified by using International Classification of Diseases codes and a clinical database. Primary outcomes were preterm birth (PTB), gestational hypertension, preeclampsia, impaired glucose tolerance or gestational diabetes, a large-for-gestational-age (LGA) or small-for-gestational-age (SGA) neonates, and cesarean birth. Propensity scores were estimated by using logistic regression that accounted for age at delivery, prepregnancy body mass index, year of delivery, parity, neighborhood deprivation index, race and ethnicity, insurance status, initiation of prenatal visit in the first trimester, smoking during pregnancy, chronic hypertension, and preexisting diabetes. Five patients in the control group were matched to each patient in the case group on linear propensity score, and modified Poisson regression was used to adjust for covariates. Sensitivity analyses by timing and type of surgery were performed.
We identified a case cohort of 1,591 pregnancies in patients after bariatric surgery and a matched cohort of 7,955 pregnancies in patients who had not undergone bariatric surgery. Demographic characteristics were similar in both groups. In multivariate models, pregnancy after bariatric surgery was associated with a decreased risk of preeclampsia (7.5% vs 10.2%, adjusted relative risk [aRR] 0.72, 95% CI 0.60-0.86), gestational diabetes or impaired fasting glucose (23.5% vs 35.0%, aRR 0.73, 95% CI 0.66-0.80), and LGA (10.6% vs 19.9%, aRR 0.56, 95% CI 0.48-0.65) and an increased risk of SGA (10.9% vs 6.6%, aRR 1.51, 95% CI 1.28-1.78). No significant differences were observed in PTB, gestational hypertension and cesarean delivery.
Pregnancy after bariatric surgery in a racially and ethnically diverse cohort of patients is associated with decreased risk of preeclampsia, gestational diabetes or impaired fasting glucose, and LGA neonates; it is also associated with an increased risk of SGA neonates compared with pregnant patients in a matched control group.
在一个大型综合医疗保健系统中，使用倾向评分匹配评估与减重手术后妊娠相关的围产期结局。
我们进行了一项回顾性队列研究，评估了 2012 年 1 月至 2018 年 12 月期间接受过减重手术的孕妇的围产期结局。通过国际疾病分类代码和临床数据库来识别减重手术史。主要结局是早产（PTB）、妊娠高血压、先兆子痫、葡萄糖耐量受损或妊娠糖尿病、巨大儿（LGA）或小于胎龄儿（SGA）新生儿和剖宫产。通过考虑分娩年龄、孕前体重指数、分娩年份、产次、社区贫困指数、种族和民族、保险状况、首次产前检查在孕早期、怀孕期间吸烟、慢性高血压和孕前糖尿病的逻辑回归来估计倾向得分。在对照组中，每个患者都与病例组中的 5 名患者进行线性倾向评分匹配，并使用修正泊松回归来调整协变量。还进行了按手术时间和类型的敏感性分析。
我们确定了 1591 例接受过减重手术的孕妇的病例队列和 7955 例未接受过减重手术的孕妇的匹配队列。两组的人口统计学特征相似。在多变量模型中，减重手术后妊娠与先兆子痫的风险降低相关（7.5%对 10.2%，调整后的相对风险[aRR]0.72，95%置信区间[CI]0.60-0.86）、妊娠糖尿病或空腹血糖受损（23.5%对 35.0%，aRR 0.73，95%CI 0.66-0.80）和 LGA（10.6%对 19.9%，aRR 0.56，95%CI 0.48-0.65），而 SGA（10.9%对 6.6%，aRR 1.51，95%CI 1.28-1.78）的风险增加。PTB、妊娠高血压和剖宫产之间没有显著差异。
在种族和民族多样化的患者队列中，减重手术后妊娠与先兆子痫、妊娠糖尿病或空腹血糖受损和 LGA 新生儿的风险降低有关；与匹配对照组中的孕妇相比，它还与 SGA 新生儿的风险增加有关。
