PDF(Pubmed)
Abstract：
BACKGROUND: Maternal obesity is associated with adverse outcome for pregnancy and childbirths. While bariatric surgery may improve fertility and reduce the risk of certain pregnancy-related complications such as hypertension and gestational diabetes mellitus, there is a lack of evidence on the optimal nutritional monitoring and supplementation strategies in pregnancy following bariatric surgery. We aimed to assess the impact of bariatric surgery on micronutrients in post-bariatric pregnancy and possible differences between gastric bypass surgery and sleeve gastrectomy.
METHODS: In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5).
RESULTS: The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030).
CONCLUSIONS: Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
METHODS: In this prospective case control study, we recruited 204 pregnant women (bariatric surgery n = 59 [gastric bypass surgery n = 26, sleeve gastrectomy n = 31, missing n = 2] and controls n = 145) from Akershus university hospital in Norway. Women with previous bariatric surgery were consecutively invited to study participation at referral to the clinic for morbid obesity and the controls were recruited from the routine ultrasound screening in gestational week 17-20. A clinical questionnaire was completed and blood samples were drawn at mean gestational week 20.4 (SD 4.5).
RESULTS: The women with bariatric surgery had a higher pre-pregnant BMI than controls (30.8 [SD 6.0] vs. 25.2 [5.4] kg/m2, p < 0.001). There were no differences between groups regarding maternal weight gain (bariatric surgery 13.3 kg (9.6) vs. control 14.8 kg (6.5), p = 0.228) or development of gestational diabetes (n = 3 [5%] vs. n = 7 [5%], p = 1.000). Mean levels of vitamin K1 was lower after bariatric surgery compared with controls (0.29 [0.35] vs. 0.61 [0.65] ng/mL, p < 0.001). Multiadjusted regression analyses revealed an inverse relationship between bariatric surgery and vitamin K1 (B -0.26 ng/mL [95% CI -0.51, -0.04], p = 0.047) with a fivefold increased risk of vitamin K1 deficiency in post-bariatric pregnancies compared with controls (OR 5.69 [1.05, 30.77] p = 0.044). Compared with sleeve gastrectomy, having a previous gastric bypass surgery was associated with higher risk of vitamin K1 deficiency (OR 17.1 [1.31, 223.3], p = 0.030).
CONCLUSIONS: Post-bariatric pregnancy is negatively associated with vitamin K1 with a higher risk of vitamin K1 deficiency in pregnancies after gastric bypass surgery compared with after sleeve gastrectomy. Vitamin K1 deficiency in post-bariatric pregnancy have potential risk of hypocoaguble state in mother and child and should be explored in future studies.
摘要：
背景：母亲肥胖与妊娠和分娩的不良结局有关。虽然减肥手术可以提高生育能力并降低某些妊娠相关并发症如高血压和妊娠期糖尿病的风险，缺乏关于减肥手术后妊娠期最佳营养监测和补充策略的证据.我们旨在评估减肥手术对减肥后妊娠微量营养素的影响，以及胃旁路手术和袖状胃切除术之间可能的差异。
方法：在这项前瞻性病例对照研究中，我们从挪威Akershus大学医院招募了204名孕妇(减重手术n=59[胃旁路手术n=26,袖状胃切除术n=31,缺失n=2]和对照组n=145).以前进行过减肥手术的妇女被连续邀请参加转诊到病态肥胖的诊所进行研究，对照组从妊娠17-20周的常规超声筛查中招募。完成临床问卷调查，并在平均孕周20.4（SD4.5）抽取血液样本。
结果：进行减肥手术的妇女的孕前BMI高于对照组（30.8[SD6.0]与25.2[5.4]kg/m2,p<0.001)。两组之间在孕妇体重增加方面没有差异（减肥手术13.3kg（9.6）与对照14.8kg(6.5),p=0.228)或妊娠期糖尿病的发展(n=3[5%]vs.n=7[5%]，p=1.000)。与对照组相比，减肥手术后维生素K1的平均水平较低（0.29[0.35]vs.0.61[0.65]ng/mL，p<0.001)。多重调整回归分析显示，减肥手术与维生素K1呈负相关（B-0.26ng/mL[95％CI-0.51，-0.04]，p=0.047），与对照组相比，减重妊娠后维生素K1缺乏的风险增加了五倍（OR5.69[1.05，30.77]p=0.044）。与袖状胃切除术相比，以前做过胃旁路手术与维生素K1缺乏症的风险更高（OR17.1[1.31,223.3]，p=0.030)。
结论：减肥后妊娠与维生素K1呈负相关，与袖状胃切除术后妊娠相比，胃旁路手术后妊娠中维生素K1缺乏的风险更高。减重妊娠后维生素K1缺乏具有母婴低凝状态的潜在风险，应在未来的研究中进行探讨。
方法：在这项前瞻性病例对照研究中，我们从挪威Akershus大学医院招募了204名孕妇(减重手术n=59[胃旁路手术n=26,袖状胃切除术n=31,缺失n=2]和对照组n=145).以前进行过减肥手术的妇女被连续邀请参加转诊到病态肥胖的诊所进行研究，对照组从妊娠17-20周的常规超声筛查中招募。完成临床问卷调查，并在平均孕周20.4（SD4.5）抽取血液样本。
结果：进行减肥手术的妇女的孕前BMI高于对照组（30.8[SD6.0]与25.2[5.4]kg/m2,p<0.001)。两组之间在孕妇体重增加方面没有差异（减肥手术13.3kg（9.6）与对照14.8kg(6.5),p=0.228)或妊娠期糖尿病的发展(n=3[5%]vs.n=7[5%]，p=1.000)。与对照组相比，减肥手术后维生素K1的平均水平较低（0.29[0.35]vs.0.61[0.65]ng/mL，p<0.001)。多重调整回归分析显示，减肥手术与维生素K1呈负相关（B-0.26ng/mL[95％CI-0.51，-0.04]，p=0.047），与对照组相比，减重妊娠后维生素K1缺乏的风险增加了五倍（OR5.69[1.05，30.77]p=0.044）。与袖状胃切除术相比，以前做过胃旁路手术与维生素K1缺乏症的风险更高（OR17.1[1.31,223.3]，p=0.030)。
结论：减肥后妊娠与维生素K1呈负相关，与袖状胃切除术后妊娠相比，胃旁路手术后妊娠中维生素K1缺乏的风险更高。减重妊娠后维生素K1缺乏具有母婴低凝状态的潜在风险，应在未来的研究中进行探讨。
