Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis
Pregnancy after bariatric surgery and adverse perinatal outcomes: A systematic review and meta-analysis
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DOI：
10.1371/journal.pmed.1002866
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发表时间：
2019-08-01
期刊：
影响因子：
15.8
通讯作者：
Heslehurst, Nicola
中科院分区：
文献类型：
--
作者：
Akhter, Zainab;Rankin, Judith;Heslehurst, Nicola
背景：怀孕前接受减肥手术的女性较少出现与肥胖相关的并发症，如妊娠期糖尿病和高血压。然而，减肥手术，特别是吸收不良的手术，可能会使患者容易受到对胎儿健康发育至关重要的营养缺乏的影响。这项系统性综述和荟萃分析的目的是调查减肥手术后怀孕与不良围产儿结局之间的关系。方法检索Medline、Embase、QicINFO、CINAHL、Scope us和Google Scholar，检索时间从最初到2019年6月，辅以手工检索参考文献、引文和期刊。观察研究比较了减肥手术后的围产儿结局和未做过减肥手术的孕妇。值得关注的结果是围产期死亡率、先天异常、早产、胎龄大小(SGA/LGA)和新生儿重症监护病房(NICU)入院。使用随机效应荟萃分析计算合并效应大小。在有数据的情况下，结果按减肥手术的类型进行分组。我们包括33项研究，其中14,880例在减肥手术后怀孕，3,979,978例对照。围产儿死亡率(1.38，95%可信区间1.03-1.85，p=0.031)、先天畸形(1.29，95%可信区间1.04-1.59，p=0.019)、早产(1.57，95%可信区间1.38-1.79，p&t；0.001)、新生儿重症监护室入院(1.41，95%可信区间1.25-1.59，p<；0.001)均增加。早产儿在减肥手术后减少(OR0.46，95%CI0.35-0.60，p<；0.001)。胃分流术后胃动脉的ORS增加(2.72，95%CI2.32~3.20，p<；0.001)，胃分流术后LgA降低(0.24，95%CI0.14~0.41，p<；0.001)。减肥手术后出生的婴儿(所有类型加在一起)的体重比没有减肥手术的母亲出生的婴儿轻200克以上(加权平均差异-242.42克，95%CI-307.43到-177.40克，p<；0.001)。除LGA外，所有结果的异质性都很低(I-2和lt；40%)。我们研究的局限性是，作为对现有研究的荟萃分析，结果受到纳入研究和可用数据的质量、未测量的混杂因素以及某些结果的少量研究的限制。结论在我们对观察研究的系统回顾中，我们发现妊娠前的减肥手术，特别是胃旁路手术，与一些不良围产儿结局的风险增加有关。这表明，接受过减肥手术的妇女可能受益于特定的先入为主和妊娠营养支持，以及加强对胎儿生长发育的监测。未来的研究应该探索限制性手术与吸收不良手术相比，在不影响母体结局的情况下，是否会产生更好的围产儿结局。如果是这样的话，这可能是育龄女性的首选手术。
Background Women who undergo bariatric surgery prior to pregnancy are less likely to experience comorbidities associated with obesity such as gestational diabetes and hypertension. However, bariatric surgery, particularly malabsorptive procedures, can make patients susceptible to deficiencies in nutrients that are essential for healthy fetal development. The objective of this systematic review and meta-analysis is to investigate the association between pregnancy after bariatric surgery and adverse perinatal outcomes. Methods and findings Searches were conducted in Medline, Embase, PsycINFO, CINAHL, Scopus, and Google Scholar from inception to June 2019, supplemented by hand-searching reference lists, citations, and journals. Observational studies comparing perinatal outcomes post-bariatric surgery to pregnancies without prior bariatric surgery were included. Outcomes of interest were perinatal mortality, congenital anomalies, preterm birth, postterm birth, small and large for gestational age (SGA/LGA), and neonatal intensive care unit (NICU) admission. Pooled effect sizes were calculated using random-effects meta-analysis. Where data were available, results were subgrouped by type of bariatric surgery. We included 33 studies with 14,880 pregnancies post-bariatric surgery and 3,979,978 controls. Odds ratios (ORs) were increased after bariatric surgery (all types combined) for perinatal mortality (1.38, 95% confidence interval [CI] 1.03-1.85, p = 0.031), congenital anomalies (1.29, 95% CI 1.04-1.59, p = 0.019), preterm birth (1.57, 95% CI 1.38-1.79, p < 0.001), and NICU admission (1.41, 95% CI 1.25-1.59, p < 0.001). Postterm birth decreased after bariatric surgery (OR 0.46, 95% CI 0.35-0.60, p < 0.001). ORs for SGA increased (2.72, 95% CI 2.32-3.20, p < 0.001) and LGA decreased (0.24, 95% CI 0.14-0.41, p < 0.001) after gastric bypass but not after gastric banding. Babies born after bariatric surgery (all types combined) weighed over 200 g less than those born to mothers without prior bariatric surgery (weighted mean difference -242.42 g, 95% CI -307.43 to -177.40 g, p < 0.001). There was low heterogeneity for all outcomes (I-2 < 40%) except LGA. Limitations of our study are that as a meta-analysis of existing studies, the results are limited by the quality of the included studies and available data, unmeasured confounders, and the small number of studies for some outcomes. Conclusions In our systematic review of observational studies, we found that bariatric surgery, especially gastric bypass, prior to pregnancy was associated with increased risk of some adverse perinatal outcomes. This suggests that women who have undergone bariatric surgery may benefit from specific preconception and pregnancy nutritional support and increased monitoring of fetal growth and development. Future studies should explore whether restrictive surgery results in better perinatal outcomes, compared to malabsorptive surgery, without compromising maternal outcomes. If so, these may be the preferred surgery for women of reproductive age.