Martínez González Ángel, Riobo Gestido Alba, Miguel Toquero Raquel, Fernández Fernández Emilia, González Nunes Manuella, Morales Gorria María José
Servicio de Endocrinología y Nutrición. Complejo Hospitalario Universitario de Pontevedra.
Complejo Hospitalario Universitario de Vigo.
Nutr Hosp. 2024 Feb 15;41(1):78-85. doi: 10.20960/nh.04639.
Objective: to determine the effect of gestational weight gain and perinatal outcomes in obese women who underwent and did not undergo bariatric surgery. Material and methods: a retrospective observational cohort study was conducted. The gestational weight gain was classified as insufficient, adequate or excessive according to the guidelines of the United States Institute of Medicine: 4.99-9.07 kg for body mass index (BMI) > 30 kg/m2. Weight gain was calculated as the difference between the weight at the first visit of the 1st trimester and the weight at the visit of the 3rd trimester. Outcomes examined included antepartum variables (gestational diabetes, gestational hypertension, preeclampsia, premature rupture of membranes, placenta previa, placental abruption, intrauterine growth retardation, chorioammionitis, spontaneous abortion), intrapartum variables (induced delivery, vaginal delivery, vacuum, forceps delivery, cesarean section, shoulder dystocia), postpartum variables (postpartum hemorrhage, need for postpartum transfusion, postpartum anemia, need for emergency care, maternal death, postpartum tear, postpartum thrombosis) and neonatal variables (preterm delivery, weight percentile > 90, weight percentile < 10, Apgar score < 7, malformations). Using the statistical package SPSS 22.0, a statistical analysis of the data was performed. Results: two hundred and fifty-six women were recruited; 38 (14.58 %) were pregnant after bariatric surgery and 218 (85.15 %) were pregnant women with obesity who had not been operated on. Of the pregnant women with obesity who had not been operated on, 119 (46.68 %) had grade 1 obesity (BMI 30-34.9), and 99 (38.67 %) had grade 2 and 3 obesity (BMI > 35). A global and subgroup analysis was performed. In the overall analysis, 78 (30.46 %) had insufficient gain, 117 (45.70 %) had adequate gain, and 61 (23.82 %) excessive gain. Overall, insufficient weight gain was associated with a lower probability of gestational hypertension (p < 0.015) and forceps delivery (p < 0.000) and large for gestational age newborn (p < 0.000). On the other hand, insufficient weight gain was associated with a higher probability of intrauterine growth retardation (p 0.044), peripartum infection (0.022), preterm delivery (0.006), and delivery < 35 weeks (p 0.016). Excessive weight gain was associated with a higher probability of gestational hypertension (p 0.025), induced labor (p 0.009), forceps delivery (p 0.011) and large for gestational age newborn (p 0.006). Pregnancies after bariatric surgery had fewer overall complications compared to the other groups. Conclusions: insufficient and excessive weight gain worsens perinatal outcomes. Adequate weight gain does not increase complications and produces some benefits.
确定接受和未接受减肥手术的肥胖女性孕期体重增加情况及其对围产期结局的影响。材料与方法：进行一项回顾性观察队列研究。根据美国医学研究所的指南，将孕期体重增加分为不足、充足或过多：体重指数（BMI）>30kg/m²者为4.99 - 9.07kg。体重增加量计算为孕早期首次就诊时的体重与孕晚期就诊时的体重之差。所检查的结局包括产前变量（妊娠期糖尿病、妊娠期高血压、先兆子痫、胎膜早破、前置胎盘、胎盘早剥、胎儿生长受限、绒毛膜羊膜炎、自然流产）、产时变量（引产、阴道分娩、真空吸引、产钳助产、剖宫产、肩难产）、产后变量（产后出血、产后输血需求、产后贫血、急诊需求、孕产妇死亡、产后撕裂、产后血栓形成）以及新生儿变量（早产、体重百分位数>90、体重百分位数<10、阿氏评分<7、畸形）。使用统计软件包SPSS 22.0对数据进行统计分析。结果：招募了256名女性；38名（14.58%）为减肥手术后怀孕者，218名（85.15%）为未接受手术的肥胖孕妇。在未接受手术的肥胖孕妇中，119名（46.68%）为1级肥胖（BMI 30 - 34.9），99名（38.67%）为2级和3级肥胖（BMI>35）。进行了总体和亚组分析。在总体分析中，78名（30.46%）体重增加不足，117名（45.70%）体重增加充足，61名（23.82%）体重增加过多。总体而言，体重增加不足与妊娠期高血压（p<0.015）、产钳助产（p<0.000）和大于胎龄新生儿（p<0.000）的发生率较低相关。另一方面，体重增加不足与胎儿生长受限（p 0.044）、围产期感染（0.022）、早产（0.006）以及孕周<35周分娩（p 0.016）的发生率较高相关。体重增加过多与妊娠期高血压（p 0.025）、引产（p 0.009）、产钳助产（p 0.011）和大于胎龄新生儿（p 0.006）的发生率较高相关。与其他组相比，减肥手术后的妊娠总体并发症较少。结论：体重增加不足和过多会使围产期结局恶化。体重增加充足不会增加并发症，且有一些益处。
