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中华肥胖与代谢病电子杂志 ›› 2022, Vol. 08 ›› Issue (01) : 56 -60. doi: 10.3877/cma.j.issn.2095-9605.2022.01.010

综述

减重手术对术后妊娠影响的研究进展
高宇蝶1, 刘嘉2, 王秀芳2, 王存川3, 杨华3,(), 李瑞满2,(), 中国肥胖代谢外科研究协作组   
  1. 1. 510632 广州,暨南大学第一临床医学院
    2. 510630 广州,暨南大学附属第一医院妇产科
    3. 510630 广州,暨南大学附属第一医院减重中心
  • 收稿日期:2021-12-03 出版日期:2022-02-28
  • 通信作者: 杨华, 李瑞满
  • 基金资助:
    国家重点研发计划(2019YFC0121904)

Research Progress on the Effects of Bariatric Surgery on Postoperative Pregnancy.

Yudie Gao1, Jia Liu2, Xiufang Wang2, Cunchuan Wang3, Wah Yang3,(), Ruiman Li2,(), Chinese Obesity and Metabolic Surgery Collaborative   

  1. 1. The First Clinical Medical College of Ji'nan University, Guangzhou 510632, China
    2. The obstetrics and gynecology department, the First Affiliated Hospital of Ji'nan University, Guangzhou 510630, China
    3. Bariatric Cente, the First Affiliated Hospital of Ji'nan University, Guangzhou 510630, China
  • Received:2021-12-03 Published:2022-02-28
  • Corresponding author: Wah Yang, Ruiman Li
引用本文:

高宇蝶, 刘嘉, 王秀芳, 王存川, 杨华, 李瑞满, 中国肥胖代谢外科研究协作组. 减重手术对术后妊娠影响的研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2022, 08(01): 56-60.

Yudie Gao, Jia Liu, Xiufang Wang, Cunchuan Wang, Wah Yang, Ruiman Li, Chinese Obesity and Metabolic Surgery Collaborative. Research Progress on the Effects of Bariatric Surgery on Postoperative Pregnancy.[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2022, 08(01): 56-60.

肥胖严重影响人类的身心健康,特别是育龄期妇女,近年来妊娠期肥胖的患病率急剧上升,产妇肥胖也是产科发病率和死亡率的主要原因之一。随着减重手术的流行,越来越多的育龄期肥胖妇女选择在接受减重手术后怀孕,因此研究减重手术后的妊娠结局是必要的。本文旨在综合探讨关于减重手术对肥胖妇女妊娠相关影响的研究证据,得出结论,减重手术对生育能力有积极的影响,减重手术能恢复正常的月经周期,改善不孕;能通过降低妊娠期糖尿病和子痫前期的发生率来减少肥胖相关妊娠并发症。尽管减重手术后的妊娠结局并非全部获益,术后并发症发生的可能存在,但总而言之,这种利大于弊的结局已被大量研究证实。当然,减重术后也必须由多学科团队进行共同管理。

Obesity has seriously affected human physical and mental health, especially in women of childbearing age. The incidence rate of obesity in pregnancy has risen sharply in recent years, and maternal obesity is also one of the main causes of morbidity and mortality. With the prevalence of bariatric surgery, more and more women with obesity at childbearing age choose to get pregnant after bariatric surgery. Therefore, it is necessary to study the pregnancy outcomes after bariatric surgery. This review article aims to comprehensively explore the research evidence on the impact of bariatric surgery on pregnancy in women with obesity and conclude that bariatric surgery affects fertility positively. Bariatric surgery can restore the normal menstrual cycle and improve infertility. It is possible to reduce obesity-related pregnancy complications by reducing the incidence of gestational diabetes and preeclampsia. Although the pregnancy outcome after weight loss is not all beneficial, the occurrence of postoperative complications may still exist. However, in general, the effect of these benefits has outweighed the disadvantages and has been confirmed by many studies. Of course, it should be also be managed by a multidisciplinary team.

[1]
刘金刚, 郑成竹, 王勇. 中国肥胖和2型糖尿病外科治疗指南(2014) [J]. 中国实用外科杂志, 2014, 34(11): 1005-1010.
[2]
Vitner D, Harris K, Maxwell C, et al. Obesity in pregnancy: a comparison of four national guidelines [J]. J Matern Fetal Neonatal Med, 2019, 32(15): 2580-2590.
[3]
Marchi J, Berg M, Dencker A, et al. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews [J]. Obes Rev, 2015, 16(8): 621-638.
[4]
Ibiebele I, Gallimore F, Schnitzler M, et al. Perinatal outcomes following bariatric surgery between a first and second pregnancy: a population data linkage study [J]. Bjog, 2020, 127(3): 345-354.
[5]
Akhter Z, Rankin J, Ceulemans D, et al. Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis [J]. PLoS Med, 2019, 16(8): e1002866.
[6]
Chevrot A, Lesage N, Msika S, et al. Digestive surgical complications during pregnancy following bariatric surgery: Experience of a center for perinatology and obesity [J]. Gynecol Obstet Biol Reprod (Paris), 2016, 45(4): 372-379.
[7]
中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版) [J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[8]
杨华, 陈缘, 董志勇, 等. 中国肥胖代谢外科数据库:2020年度报告[J/CD]. 中华肥胖与代谢病电子杂志, 2021, 7(1): 1-7.
[9]
Maxwell C, Gaudet L, Cassir G, et al. guideline no. 391-pregnancy and maternal obesity part 1: pre-conception and prenatal care [J]. Obstet Gynaecol Can, 2019, 41(11): 1623-1640.
[10]
Ciangura C, Coupaye M, Deruelle P, et al. Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery [J]. Obes Surg, 2019, 29(11): 3722-3734.
[11]
Yang W, Zhu S, Cheng Z, et al. Laparoscopic Roux-en-Y gastric bypass for excess weight and diabetes: a multicenter retrospective cohort study in China [J]. Mini-invasive Surgery, 2021, 5: 11.
[12]
杨华, 张鹏, 董志勇, 等. 中国肥胖代谢外科手术方式推荐立场声明[J/CD]. 中华肥胖与代谢病电子杂志, 2021, 7(1): 8-12.
[13]
Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists [J]. Surg Obes Relat Dis, 2020, 16(2): 175-247.
[14]
ACOG practice bulletin no. 105: bariatric surgery and pregnancy [J]. Obstet Gynecol, 2009, 113(6): 1405-1413.
[15]
Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use [J]. MMWR Recomm Rep, 2016, 65(3): 1-103.
[16]
Heusschen L, Krabbendam I, van der Velde JM, et al. A matter of timing-pregnancy after bariatric surgery [J]. Obes Surg, 2021, 31(5): 2072-2079.
[17]
Chang RJ. A practical approach to the diagnosis of polycystic ovary syndrome [J]. Am J Obstet Gynecol, 2004, 191(3): 713-717.
[18]
Kim JH, Kim O, Jung H, et al. Body mass index, menstruation, acne, and hirsutism of polycystic ovary syndrome in women: A cross-sectional study[J]. Health Care Women Int, 2021: 1-13.
[19]
Kasum M, Orešković S, Čehić E, et al. The role of female obesity on in vitro fertilization outcomes [J]. Gynecol Endocrinol, 2018, 34(3): 184-188.
[20]
Brönnimann A, Jung MK, Niclauss N, et al. The Impact of Pregnancy on Outcomes After Bariatric Surgery [J]. Obes Surg, 2020, 30(8): 3001-3009.
[21]
Lainez NM, Coss D. Obesity, Neuroinflammation, and Reproductive Function [J]. Endocrinology, 2019, 160(11): 2719-2736.
[22]
Milone M, De Placido G, Musella M, et al. Incidence of successful pregnancy after weight loss interventions in infertile women: a systematic review and meta-analysis of the literature [J]. Obes Surg, 2016, 26(2): 443-451.
[23]
Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? [J]. Am J Obstet Gynecol, 2018, 218(6): 573-580.
[24]
Johansson K, Cnattingius S, Näslund I, et al. Outcomes of pregnancy after bariatric surgery [J]. N Engl J Med, 2015, 372(9): 814-824.
[25]
Gadani R, Khaitan M, Rekha PD, et al. Pregnancy outcomes post-bariatric surgery-a single-centre retrospective study from India [J]. Obes Surg, 2021, 31(8): 3692-3699.
[26]
Maslin K, Douek I, Greenslade B, et al. Nutritional and perinatal outcomes of pregnant women with a history of bariatric surgery: a case series from a UK centre [J]. J Hum Nutr Diet, 2020, 33(3): 386-395.
[27]
Eerdekens A, Debeer A, Van Hoey G, et al. Maternal bariatric surgery: adverse outcomes in neonates [J]. Eur J Pediatr, 2010, 169(2): 191-196.
[28]
Via MA, Mechanick JI. Nutritional and micronutrient care of bariatric surgery patients: current evidence update [J]. Curr Obes Rep, 2017, 6(3): 286-296.
[29]
Rottenstreich A, Elchalal U, Kleinstern G, et al. maternal and perinatal outcomes after laparoscopic sleeve gastrectomy [J]. Obstet Gynecol, 2018, 131(3): 451-456.
[30]
Parent B, Martopullo I, Weiss NS, et al. Bariatric surgery in women of childbearing age, timing between an operation and birth, and associated perinatal complications [J]. JAMA Surg, 2017, 152(2): 128-135.
[31]
Hammeken LH, Betsagoo R, Jensen AN, et al. Nutrient deficiency and obstetrical outcomes in pregnant women following Roux-en-Y gastric bypass: A retrospective Danish cohort study with a matched comparison group [J]. Eur J Obstet Gynecol Reprod Biol, 2017, 216: 56-60.
[32]
Balestrin B, Urbanetz AA, Barbieri MM, et al. pregnancy after bariatric surgery: a comparative study of post-bariatric pregnant women versus non-bariatric obese pregnant women [J]. Obes Surg, 2019, 29(10): 3142-3148.
[33]
Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery [J]. Obesity (Silver Spring), 2013, 21 Suppl 1(1): S1-27.
[34]
Shawe J, Ceulemans D, Akhter Z, et al. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care [J]. Obes Rev, 2019, 20(11): 1507-1522.
[35]
Vanheule G, Ceulemans D, Vynckier AK, et al. Micronutrient supplementation in pregnancies following bariatric surgery: a practical review for clinicians [J]. Obes Surg, 2021, 31(10): 4542-4554.
[36]
Carbonne B, Sentilhes L, Vayssière C. Intra uterine growth retardation: guidelines for clinical practice—Introduction [J]. Gynecol Obstet Biol Reprod (Paris), 2013, 42(8): 868-869.
[37]
Falcone V, Stopp T, Feichtinger M, et al. Pregnancy after bariatric surgery: a narrative literature review and discussion of impact on pregnancy management and outcome [J]. BMC Pregnancy Childbirth, 2018, 18(1): 507.
[38]
Neel A, Cunningham CE, Teale GR. A routine third trimester growth ultrasound in the obese pregnant woman does not reliably identify fetal growth abnormalities: A retrospective cohort study [J]. Aust N Z J Obstet Gynaecol, 2021, 61(1): 116-122.
[39]
Narayanan RP, Syed AA. Pregnancy following bariatric surgery-medical complications and management [J]. Obes Surg, 2016, 26(10): 2523-2529.
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