Jade Eccles-Smith, Alison Griffin, H David McIntyre, Marloes Dekker Nitert, Helen L Barrett
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There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies.</p><p><strong>Objective: </strong>This study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA).</p><p><strong>Study design: </strong>A statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery.</p><p><strong>Results: </strong>Of the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). In the adjusted model, pre-pregnancy bariatric surgery was associated with a lower risk of LGA (OR 0.54, 95% CI 0.44-0.66) and higher risk of SGA (OR 1.78, 95% CI 1.46-2.17).</p><p><strong>Conclusions: </strong>These data suggest that pre-pregnancy bariatric surgery was associated with a reduction in several obesity related pregnancy complications at the expense of more pre-term births and SGA offspring.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Pregnancy and offspring outcomes after pre-pregnancy bariatric surgery.\",\"authors\":\"Jade Eccles-Smith, Alison Griffin, H David McIntyre, Marloes Dekker Nitert, Helen L Barrett\",\"doi\":\"10.1016/j.ajog.2024.08.044\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Bariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies.</p><p><strong>Objective: </strong>This study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA).</p><p><strong>Study design: </strong>A statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery.</p><p><strong>Results: </strong>Of the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). 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引用次数: 0
摘要
背景:减肥手术是国际上治疗肥胖症的一种方法,可实现显著、持续的体重减轻。越来越多的妇女在接受减肥手术后怀孕,但孕产妇和胎儿的结果却不尽相同:本研究旨在描述孕前减肥手术的类型,分析与匹配妇女相比,孕产妇、妊娠和后代的结果,并评估孕前减肥手术对胎儿生长的影响,尤其是小于胎龄(SGA)和大于胎龄(LGA)的比例:研究设计:进行了一项全州医院和围产期数据登记关联的横断面匹配研究。2013年至2018年期间,共登记了n=1,677名孕前接受过减肥手术的妇女的n=2,018例分娩,其中n=1,282例被纳入,并与年龄、奇偶数、吸烟状况和体重指数(BMI)相匹配的未接受减肥手术的妇女按1:10进行分析。每位妇女在接受减肥手术后的首次单胎妊娠均用于分析。对国际疾病统计分类第十次修订版代码(ICD-10AM)中的妊娠和新生儿结果以及新生儿出生记录中的相关结果进行了分析。采用多变量逻辑回归法估计SGA和LGA与孕前减肥手术之间的关系:在1282名妇女中,93%接受了腹腔镜袖带胃切除术。后代的绝对出生体重较低(3223g ± 605g vs 3418g ± 595g;p结论:这些数据表明,孕前减肥手术与后代出生体重之间存在关联:这些数据表明,孕前减肥手术可减少与肥胖相关的几种妊娠并发症,但代价是更多的早产儿和SGA后代。
Pregnancy and offspring outcomes after pre-pregnancy bariatric surgery.
Background: Bariatric surgery is internationally performed as a treatment option in obesity to achieve significant and sustained weight loss. There is an increasing number of women having pregnancies after bariatric surgery with mixed maternal and fetal outcomes, with a limited number of large, matched studies.
Objective: This study aimed to describe the type of pre-pregnancy bariatric surgery, to analyse maternal, pregnancy and offspring outcomes compared to matched women and to assess the impact of pre-pregnancy bariatric surgery on fetal growth, particularly proportions of small for gestational (SGA) and large for gestational age (LGA).
Study design: A statewide hospital and perinatal data register linked cross-sectional matched study was performed. In total, n=2,018 births in n=1,677 women with pre-pregnancy bariatric surgery were registered between 2013 and 2018, of those n=1,282 were included and analysed with 1:10 to age, parity, smoking status and Body Mass Index (BMI) matched women without bariatric surgery. The first singleton pregnancy following bariatric surgery for each woman was used for analysis. Pregnancy and neonatal outcomes from International Statistical Classification of Diseases Tenth revision codes (ICD-10AM) and neonatal birth records for outcomes of interest were analysed. Multivariable logistic regression was used to estimate the association between SGA and LGA and pre-pregnancy bariatric surgery.
Results: Of the n=1,282 women, 93% had undergone laparoscopic sleeve gastrectomy. Offspring had lower absolute birthweight (3223g ± 605g vs 3418g ± 595g; p<0.001), fewer LGA (8.6% vs 14.1%; p<0.001) and more SGA infants (10.7% vs 7.3%; p<0.001) than offspring born to matched women. Offspring were more likely to be born preterm (10.5% vs 7.8%; p=0.007) to mothers with pre-pregnancy bariatric surgery. Fewer women with previous bariatric surgery were diagnosed with GDM (15% vs 20%; p<0.001) or pregnancy induced hypertension (3.7% vs 5.4%; p=0.01). In the adjusted model, pre-pregnancy bariatric surgery was associated with a lower risk of LGA (OR 0.54, 95% CI 0.44-0.66) and higher risk of SGA (OR 1.78, 95% CI 1.46-2.17).
Conclusions: These data suggest that pre-pregnancy bariatric surgery was associated with a reduction in several obesity related pregnancy complications at the expense of more pre-term births and SGA offspring.
期刊介绍:
The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare.
Focus Areas:
Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders.
Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases.
Content Types:
Original Research: Clinical and translational research articles.
Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology.
Opinions: Perspectives and opinions on important topics in the field.
Multimedia Content: Video clips, podcasts, and interviews.
Peer Review Process:
All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.