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后代婴幼儿早期体重增加与孕前代谢和减肥手术的关系。

The association of higher offspring early-childhood weight gain with prepregnancy metabolic and bariatric surgery.

机构信息

Columbia College, Columbia University in the City of New York, New York, New York, USA.

Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA.

出版信息

Obesity (Silver Spring). 2024 Nov;32(11):2012-2023. doi: 10.1002/oby.24166.

Abstract

OBJECTIVE

The objective of this study was to assess maternal gestational outcomes and offspring growth trajectories following prepregnancy metabolic and bariatric surgery (MBS) compared with non-MBS controls.

METHODS

Single-center deliveries between January 2020 and March 2023 with prepregnancy Roux-en-Y gastric bypass (herein referred to as "bypass"), sleeve gastrectomy (herein referred to as "sleeve"), and non-MBS controls were included. Offspring growth trajectories were compared with the World Health Organization child growth standards. Linear mixed models assessed MBS-bypass and MBS-sleeve offspring weight, length, and BMI trajectories with a prepregnancy BMI 27 to 37 kg/m and propensity score-matched controls.

RESULTS

The study included 440 participants with prepregnancy MBS (MBS-bypass, 185; MBS-sleeve, 225; 76% Hispanic/Latino) and 13,434 non-MBS controls. Gestational weight gain and gestational diabetes mellitus were similar, whereas hypertensive disorders of pregnancy were more common after MBS. The post-MBS offspring had lower birth weight but higher weight gain at 24 months (sleeve, +1.4 kg [95% CI: 1.0-1.9]; bypass, +0.5-0.7 kg [95% CI: 0.0-1.2]) compared with non-MBS groups. Male children had higher weight gain than females. The post-MBS-sleeve but not the post-MBS-bypass offspring had higher BMI z scores.

CONCLUSIONS

The higher early-life weight gain and sex differences in the post-MBS-sleeve group compared with the post-MBS-bypass group provide a window toward elucidating pathways to mitigate intergenerational metabolic risk transfer.

摘要

目的

本研究旨在评估与非代谢和减重手术(MBS)对照组相比,孕前 MBS 后母婴的妊娠结局和后代生长轨迹。

方法

纳入 2020 年 1 月至 2023 年 3 月间单中心分娩的孕前 Roux-en-Y 胃旁路术(以下简称“旁路”)、袖状胃切除术(以下简称“袖套”)和非 MBS 对照组患者。后代生长轨迹与世界卫生组织儿童生长标准进行比较。线性混合模型评估了孕前 BMI 为 27 至 37kg/m 且具有倾向评分匹配对照的 MBS-旁路和 MBS-袖套后代体重、身长和 BMI 轨迹。

结果

本研究共纳入 440 名孕前 MBS 患者(MBS-旁路 185 例,MBS-袖套 225 例,76%为西班牙裔/拉丁裔)和 13434 名非 MBS 对照组。两组的妊娠体重增加和妊娠糖尿病相似,但 MBS 后妊娠高血压疾病更为常见。与非 MBS 组相比,MBS 后后代出生体重较低,但 24 个月时体重增加更多(袖套:+1.4kg[95%CI:1.0-1.9];旁路:+0.5-0.7kg[95%CI:0.0-1.2])。男性儿童体重增加高于女性。MBS-袖套后而非 MBS-旁路后后代的 BMI z 评分更高。

结论

与 MBS-旁路后相比,MBS-袖套后后代更早的体重增长更高,且存在性别差异,为阐明减轻代际代谢风险传递的途径提供了一个窗口。

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