Vazhiyelethil Jesni, Minisha Fathima, Al Obaidly Sawsan, AlQubaisi Mai, Salama Husam, Ali Najah, Khenyab Najat, Mohan Suruchi, Pallivalappil Abdul Rouf, Al-Dewik Nader, Al Rifai Hilal, Farrell Tom
Department of Obstetrics and Gynecology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha Qatar. Email:
Department of Pediatrics and Neonatology, Women's Wellness and Research Centre, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2024 Jan 22;2024(1):2. doi: 10.5339/qmj.2024.2. eCollection 2024.
Bariatric surgery is performed in obese women of reproductive age to help achieve a healthy prepregnancy weight to reduce the complications associated with obesity in pregnancy. However, these procedures can impact maternal nutrition and gestational weight gain (GWG). This study evaluates the maternal and neonatal outcomes in women with prepregnancy bariatric surgery and determines the impact on GWG.
This study included 24 weeks gestation or more pregnancies, with a maternal BMI at delivery of 30 kg/m or more. It was categorized into two groups based on whether they had prepregnancy bariatric surgery (exposed) or not (unexposed). The outcomes included gestational diabetes (GDM), gestational hypertension (GHT), mode of delivery, preterm birth (PTB), GWG, birthweight (BW) and customized BW centiles, low birthweight (LBW), congenital anomalies, and admission to the neonatal intensive unit (NICU). Categorization was also done based on the adequacy of GWG (low, adequate, and excess).
A total of 8,323 women were included in the study, 194 of whom had prepregnancy bariatric surgery. After adjusting for confounders, the exposed group had a mean GWG 1.33 kg higher than the unexposed group (95% CI 0.55-2.13, p = 0.001). The exposed group had higher odds of PTB (aOR 1.78, 95% CI 1.16-2.74, p = 0.008), CD (aOR 6.52, 95% CI 4.28-9.93, p < 0.001), LBW in term babies (aOR 2.60, 95% CI 1.34-5.03, p = 0.005), congenital anomalies (aOR 2.64, 95% CI 1.21-5.77, p = 0.015), low APGAR score (aOR 3.75, 95% CI 1.12-12.5, p = 0.032) and 80.4g lesser birthweight (95% CI -153.0, -5.8; p = 0.034). More women in the low GWG category had LBW babies (28.6% versus 6.7% in the high GWG group, p = 0.033), lowest mean BW and median BW centiles (2775 grams versus 3289 grams in the high GWG group, p = 0.004 and 57.5% versus 74.5% in the high GWG group, p = 0.040, respectively).
The findings of this study highlight differences in perinatal outcomes such as preterm birth, low birth weight, congenital anomalies, cesarean deliveries, and gestational weight gain between post-bariatric women and controls. These insights can help inform the planning and provision of appropriate maternity care to enhance patient safety and outcomes. The results of this study can also guide the counseling of reproductive age-group women who are planning to undergo bariatric surgery.
对育龄肥胖女性实施减肥手术，有助于她们在孕前达到健康体重，以减少孕期肥胖相关并发症。然而，这些手术可能会影响孕产妇营养和孕期体重增加（GWG）。本研究评估孕前接受减肥手术的女性的母婴结局，并确定其对GWG的影响。
本研究纳入妊娠24周及以上、分娩时孕产妇体重指数（BMI）为30kg/m或更高的孕妇。根据孕前是否接受减肥手术（暴露组）或未接受（非暴露组）将其分为两组。结局包括妊娠期糖尿病（GDM）、妊娠期高血压（GHT）、分娩方式、早产（PTB）、GWG、出生体重（BW）和定制的BW百分位数、低出生体重（LBW）、先天性异常以及新生儿重症监护病房（NICU）收治情况。还根据GWG是否充足（低、充足和过度）进行分类。
本研究共纳入8323名女性，其中194名孕前接受了减肥手术。在对混杂因素进行调整后，暴露组的平均GWG比非暴露组高1.33kg（95%CI 0.55-2.13，p = 0.001）。暴露组发生PTB（调整后比值比[aOR]1.78，95%CI 1.16-2.74，p = 0.008）、剖宫产（aOR 6.52，95%CI 4.28-9.93，p < 0.001）、足月儿LBW（aOR 2.60，95%CI 1.34-5.03，p = 0.005）、先天性异常（aOR 2.64，95%CI 1.21-5.77，p = 0.015）、低阿氏评分（aOR 3.75，95%CI 1.12-12.5，p = 0.032）以及出生体重低80.4g（95%CI -153.0，-5.8；p = 0.034）的几率更高。GWG低分组中更多女性分娩出LBW婴儿（28.6%，而GWG高分组为6.7%，p = 0.03），平均BW和BW中位数百分位数最低（分别为2775克，而GWG高分组为3289克，p = 0.004；以及57.5%，而GWG高分组为74.5%，p = 0.040）。
本研究结果突出了减肥手术后女性与对照组在早产、低出生体重、先天性异常、剖宫产和孕期体重增加等围产期结局方面的差异。这些见解有助于为规划和提供适当的孕产妇护理提供信息，以提高患者安全性和结局。本研究结果还可为计划接受减肥手术的育龄女性的咨询提供指导。
