減肥術(shù)后12個(gè)月內(nèi)需避免懷孕

A study presented at this year's European Congress on Obesity (held online, 10-13 May) supports recommendations to avoid pregnancy for 12 months after bariatric (obesity) surgery due to an association with adverse outcomes in pregnancy including an elevated risk of preterm birth. The study is by Dr Laura Heusschen, Vitalys Obesity Clinic, part of Rijnstate Hospital, Arnhem, The Netherlands, and colleagues.

在今年的歐洲肥胖大會(huì)上，一組研究人員提出：減肥(肥胖)手術(shù)后12個(gè)月內(nèi)，婦女應(yīng)當(dāng)避免懷孕——因?yàn)槿绻蛔⒁猓@會(huì)與不良妊娠結(jié)局有關(guān)，包括早產(chǎn)風(fēng)險(xiǎn)升高。這項(xiàng)研究是由荷蘭阿納姆國立醫(yī)院維塔利斯肥胖診所的勞拉·海森(Laura Heusschen)醫(yī)生及其同事開展的。

More than half of all female patients who undergo bariatric surgery are of reproductive age, and the resulting weight loss improves fertility, as well as reducing the risk of gestational diabetes and hypertensive disorders during pregnancy. It also lowers the chance of the baby having a high birth weight, which is associated with an increased risk of complications for both mother and child.

接受減肥手術(shù)的女性患者中，有一半以上是育齡女性，由此帶來的體重減輕可以提高生育能力，也可以降低妊娠期糖尿病和妊娠期高血壓疾病的風(fēng)險(xiǎn)。這也降低了嬰兒高出生體重的幾率，這與增加母嬰并發(fā)癥的風(fēng)險(xiǎn)有關(guān)。

Current recommendations for women undergoing bariatric surgery are that they should avoid pregnancy for 12 to 24 months after the operation to avoid problems caused by ongoing active weight loss and an increased risk of malnutrition due to a markedly reduced calorie intake. This is most likely to occur within the first 12 months after surgery and can decrease the nutritional supply to the growing fetus; potentially affecting its development and resulting in a reduced birth weight and greater likelihood of preterm birth.

目前對接受減肥手術(shù)的婦女的建議是，術(shù)后12至24個(gè)月內(nèi)應(yīng)避免懷孕，以避免持續(xù)主動(dòng)減肥造成的問題，以及由于熱量攝入明顯減少而增加營養(yǎng)不良的風(fēng)險(xiǎn)。這種情況最有可能發(fā)生在手術(shù)后的頭12個(gè)月內(nèi)，如果懷孕會(huì)減少對生長中胎兒的營養(yǎng)供應(yīng);可能影響其發(fā)育，導(dǎo)致出生體重減輕和早產(chǎn)的可能性增加。

The authors note, however: "Previous studies found no associations between the time from surgery to conception and adverse pregnancy or neonatal outcomes. In fact, most studies confirm that the risk of these outcomes is not increased during the first 12 months after bariatric surgery compared to later pregnancies."

然而，作者指出：“以前的研究并沒有發(fā)現(xiàn)從手術(shù)到受孕的時(shí)間與不良妊娠或新生兒結(jié)局之間的聯(lián)系。事實(shí)上，大多數(shù)研究證實(shí)，與后期懷孕相比，在減肥手術(shù)后的頭12個(gè)月，這些后果的風(fēng)險(xiǎn)并不會(huì)增加。”

The aim of this retrospective multi-centre cohort study was to evaluate pregnancy and birth outcomes by surgery-to-conception interval and by adherence to the recommendations for gestational weight gain of the National Academy of Medicine. Births were categorised based on surgery-to-conception interval and gestational weight gain, with the primary outcome variables gestational age at delivery, preterm birth, birth weight, and weight-for-age percentile.

這項(xiàng)回顧性多中心隊(duì)列研究的目的是通過手術(shù)-受孕間隔和遵循美國國家醫(yī)學(xué)研究院(National Academy of Medicine)關(guān)于妊娠體重增加的建議來評估妊娠和分娩結(jié)果。根據(jù)手術(shù)受孕間隔和妊娠體重增加對新生兒進(jìn)行分類，主要結(jié)果變量為分娩時(shí)胎齡、早產(chǎn)、出生體重和年齡體重百分比。

The team also found an association between 'inadequate' gestational weight gain (40.6% were in this category) and lower gestational age at delivery (266.5 days vs 273.8 days) and lower neonatal birth weight (3061 grams vs 3217 grams) compared to pregnancies in the 'adequate' weight gain group. Inadequate gestational weight gain was also associated with a higher rate of preterm births (15.9% vs 6.0%) than pregnancies with adequate gestational weight gain.

研究小組還發(fā)現(xiàn)，與體重增加充足組的孕婦相比，“妊娠體重增加不足”(40.6%屬于這一類別)與分娩時(shí)胎齡較低(266.5天VS 273.8天)和新生兒出生體重較低(3061克 VS 3217克)之間存在關(guān)聯(lián)。與妊娠體重增加充足的孕婦相比，妊娠體重增加不足的孕婦早產(chǎn)率也更高(15.9% VS 6.0%)。

The authors conclude: "Our findings support the recommendation to avoid pregnancy for 12 months after bariatric surgery...We should encourage women who wish to conceive after bariatric surgery to avoid pregnancy until their weight has stabilised to minimise the risk of inadequate gestational weight gain. In order to break the vicious cycle of obesity and its health consequences, it is important that future research and clinical care focus on the prevention of babies being born small for gestational age after bariatric surgery."

作者總結(jié)說：“我們的研究結(jié)果建議在減肥手術(shù)后12個(gè)月內(nèi)避免懷孕……我們應(yīng)該鼓勵(lì)那些希望在減肥手術(shù)后懷孕的婦女避免懷孕，直到她們的體重穩(wěn)定下來，以最大限度地降低妊娠體重增加不足的風(fēng)險(xiǎn)。為了打破肥胖的惡性循環(huán)及其健康后果，今后的研究和臨床護(hù)理重點(diǎn)放在防止嬰兒在減肥手術(shù)后胎齡小的問題上。”