Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Instituto de Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade Do Porto, Porto, Portugal.
Obes Surg. 2024 May;34(5):1432-1441. doi: 10.1007/s11695-024-07147-y. Epub 2024 Mar 11.
It is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood.
Retrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders.
Pregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147). Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069).
Pregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies.
据估计，大多数接受减重手术的人是育龄妇女；然而，其对妊娠结局的影响尚未完全了解。
这是一项在葡萄牙一家三级中心进行的回顾性观察性研究，纳入了两组参与者：（1）有减重手术史的孕妇（n=89）和（2）BMI≥35kg/m2但无既往减重手术史的孕妇（n=176）。数据来自病历。采用多变量分析来调整混杂因素。
减重手术后妊娠与较低的妊娠期糖尿病风险（15.7% vs. 30.1%，p=0.002）和剖宫产风险（20.7% vs. 33.5%，p=0.007）相关，且妊娠期体重增加更多（10.58±9.95 vs. 7.33±6.00kg，p<0.001）。减重手术组中妊娠体重增加≤10.0kg的孕妇早产风险更高（16.7% vs. 2.5%，p=0.031）。两组妊娠期高血压疾病无显著差异（4.5% vs. 11.4%，p=0.147）。减重手术后妊娠与新生儿体重百分位较低相关（34.24±21.09 vs. 48.77±27.94，p<0.001），胎儿生长受限风险更高（5.6% vs. 0.6%，p=0.018），巨大儿风险更低（0.0% vs. 7.5%，p=0.005）。两组胎儿生长受限儿（12.5% vs. 7.0%，p=0.127）和巨大儿（2.3% vs. 6.4%，p=0.069）发生率均无显著差异。
减重手术后妊娠既有风险也有获益，这应由医疗保健提供者进行考虑。减重手术后妊娠需要个体化护理，以确保适当的妊娠期体重并避免微量营养素缺乏。
