Osiakwan Shavonne E, Jones Kiana S, Reddy Swathi B, Omotosho Philip, Skertich Nicholas J, Torquati Alfonso
Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Department of Surgery, Rush University Medical Center, Chicago, Illinois.
Surg Obes Relat Dis. 2025 Apr;21(4):509-515. doi: 10.1016/j.soard.2024.11.012. Epub 2024 Dec 16.
Metabolic bariatric surgery is the most effective therapy for severe obesity, which affects the health of millions, most of whom are women of child-bearing age. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most common bariatric procedures and are associated with durable weight loss and comorbidity resolution. Although obstetric outcomes broadly improve, the safety profile comparing the impact of RYGB and SG on obstetric outcomes is underexplored.
To compare obstetric outcomes in women who gave birth post-RYGB versus SG to determine whether there are differences in perinatal outcomes.
United States, all patients within commercial, Medicare, Medicaid, government, and cash payor systems.
The PearlDiver-Mariner database was used to identify women aged 18-52 years who underwent RYGB or SG between 2010 and 2020 and became pregnant within 2 years of surgery. Outcomes were defined by the presence of 1 or more pregnancy-related complications including gestational diabetes, preeclampsia, and hysterectomy. A 1:1 propensity-matched analysis was performed.
In total, 16,911 individuals, 10,675 (63.1%) and 6236 (36.9%) underwent SG and RYGB, respectively. Obstetric complication rates were 28.3% in the SG versus 32.1% in the RYGB group (P < .01). The RYGB group had an increased relative odds of experiencing an obstetric complication compared with the SG group (odds ratio 1.26; 95% confidence interval 1.14-1.38).
Although both are safe, RYGB was associated with a greater obstetric complication rate than SG. These findings can help women and surgeons decide which procedure to pursue and inform discussions regarding the timing of pregnancy after surgery.
代谢性减肥手术是治疗重度肥胖最有效的方法，重度肥胖影响着数百万人的健康，其中大多数是育龄妇女。 Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）是最常见的减肥手术，可实现持久的体重减轻并解决合并症。尽管产科结局总体上有所改善，但比较RYGB和SG对产科结局影响的安全性尚缺乏充分研究。
比较RYGB术后与SG术后分娩的妇女的产科结局，以确定围产期结局是否存在差异。
美国，商业保险、医疗保险、医疗补助、政府及现金支付系统覆盖的所有患者。
利用PearlDiver-Mariner数据库识别2010年至2020年间接受RYGB或SG手术且在术后2年内怀孕的18至52岁女性。结局定义为出现1种或更多与妊娠相关的并发症，包括妊娠期糖尿病、先兆子痫和子宫切除术。进行1:1倾向评分匹配分析。
总共16,911例患者，分别有10,675例（63.1%）和6,236例（36.9%）接受了SG和RYGB手术。SG组产科并发症发生率为28.3%，RYGB组为32.1%（P <.01）。与SG组相比，RYGB组发生产科并发症的相对几率更高（优势比1.26；95%置信区间1.14 - 1.38）。
虽然两种手术都是安全的，但RYGB的产科并发症发生率高于SG。这些发现有助于女性和外科医生决定选择哪种手术，并为术后妊娠时机的讨论提供参考。
