减肥术后12个月内需避免怀孕

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.

在今年的欧洲肥胖大会上，一组研究人员提出：减肥(肥胖)手术后12个月内，妇女应当避免怀孕——因为如果不注意，这会与不良妊娠结局有关，包括早产风险升高。这项研究是由荷兰阿纳姆国立医院维塔利斯肥胖诊所的劳拉·海森(Laura Heusschen)医生及其同事开展的。

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.

接受减肥手术的女性患者中，有一半以上是育龄女性，由此带来的体重减轻可以提高生育能力，也可以降低妊娠期糖尿病和妊娠期高血压疾病的风险。这也降低了婴儿高出生体重的几率，这与增加母婴并发症的风险有关。

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.

目前对接受减肥手术的妇女的建议是，术后12至24个月内应避免怀孕，以避免持续主动减肥造成的问题，以及由于热量摄入明显减少而增加营养不良的风险。这种情况最有可能发生在手术后的头12个月内，如果怀孕会减少对生长中胎儿的营养供应;可能影响其发育，导致出生体重减轻和早产的可能性增加。

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：“以前的研究并没有发现从手术到受孕的时间与不良妊娠或新生儿结局之间的联系。事实上，大多数研究证实，与后期怀孕相比，在减肥手术后的头12个月，这些后果的风险并不会增加。”

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.

这项回顾性多中心队列研究的目的是通过手术-受孕间隔和遵循美国国家医学研究院(National Academy of Medicine)关于妊娠体重增加的建议来评估妊娠和分娩结果。根据手术受孕间隔和妊娠体重增加对新生儿进行分类，主要结果变量为分娩时胎龄、早产、出生体重和年龄体重百分比。

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.

研究小组还发现，与体重增加充足组的孕妇相比，“妊娠体重增加不足”(40.6%属于这一类别)与分娩时胎龄较低(266.5天VS 273.8天)和新生儿出生体重较低(3061克 VS 3217克)之间存在关联。与妊娠体重增加充足的孕妇相比，妊娠体重增加不足的孕妇早产率也更高(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."

作者总结说：“我们的研究结果建议在减肥手术后12个月内避免怀孕……我们应该鼓励那些希望在减肥手术后怀孕的妇女避免怀孕，直到她们的体重稳定下来，以最大限度地降低妊娠体重增加不足的风险。为了打破肥胖的恶性循环及其健康后果，今后的研究和临床护理重点放在防止婴儿在减肥手术后胎龄小的问题上。”