Department of Human Physiology and Pathophysiology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warsaw, Poland.
Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine-National Research Institute, Szaserów 128 St., 04-141 Warsaw, Poland.
Medicina (Kaunas). 2023 Oct 19;59(10):1864. doi: 10.3390/medicina59101864.
One in three women of reproductive age is obese. The mainstay treatment for obesity is bariatric surgery, and the following weight reduction results in a decrease in pregnancy adverse effects, including gestational diabetes mellitus, pregnancy-induced hypertension, and macrosomia. However, nutritional and vitamin deficiencies due to changes in the gastrointestinal tract after bariatric surgery are associated with an increase in the risk of fetal growth retardation and small for gestational-age neonates. The purpose of this review was to analyze the available recent literature on the subject of the management of pregnancy after bariatric surgery. We searched for available articles from 2007 to 2023 and chose articles of the greatest scientific and clinical value. Micronutrient, vitamin, and protein supplementation is recommended in the prenatal period and throughout the pregnancy. It is advised that pregnant women with a history of bariatric surgery should be provided with regular specialist dietary care. There is still a lack of recommendations about the optimum gestational weight gain after different types of bariatric surgery and for patients of different metabolic statuses. Women of reproductive age undergoing bariatric procedures should be provided with appropriate counseling about adequate contraception, the recommended time-to-conception interval, and the positive and negative influence of bariatric surgery on perinatal outcomes.
三分之一的育龄妇女肥胖。肥胖的主要治疗方法是减肥手术，减肥后可以降低妊娠不良后果的风险，包括妊娠期糖尿病、妊娠高血压和巨大儿。然而，减肥手术后胃肠道的变化导致营养和维生素缺乏，这与胎儿生长迟缓以及小于胎龄儿的风险增加有关。本综述的目的是分析减肥手术后妊娠管理的现有最新文献。我们从 2007 年到 2023 年搜索了可用的文章，并选择了最具科学和临床价值的文章。建议在产前和整个孕期补充微量营养素、维生素和蛋白质。建议为有减肥手术史的孕妇提供定期的专业饮食护理。对于不同类型的减肥手术和不同代谢状态的患者，关于最佳妊娠期体重增加的建议仍然缺乏。对于接受减肥手术的育龄妇女，应提供充分的避孕措施、建议的受孕间隔时间、减肥手术对围产期结局的积极和消极影响的适当咨询。
