减重术后妊娠的特点及管理经验:4例分析  

Characteristics and management experience of pregnancy after bariatric surgery:analysis of four cases

作　　者：冯岩岩 朱云珊 陈锐 王晓茜 黄振宇 Feng Yanyan;Zhu Yunshan;Chen Rui;Wang Xiaoqian;Huang Zhenyu(Department of Obstetrics and Gynecology,Beijing Tsinghua Changgung Hospital,Beijing 102218,China)

机构地区：[1]北京清华长庚医院妇产科,北京102218

出　　处：《中华围产医学杂志》2025年第2期150-154,共5页Chinese Journal of Perinatal Medicine

基　　金：美国中华医学基金(21-417)。

摘　　要：目的总结减重手术对妊娠的影响以及妊娠期管理策略。方法回顾性纳入2021年1月至2023年12月在北京清华长庚医院妇产科分娩的4例减重术后妊娠患者。总结患者减重手术术式、减重手术至妊娠的间隔时间、妊娠期并发症、新生儿出生状况等。采用描述性统计分析。结果4例患者中2例初产妇,2例经产妇。减重手术前均为肥胖(体重指数≥27.5 kg/m^(2)),均接受袖状胃切除术。本次妊娠前有3例患者体重指数已降至正常,1例患者妊娠前仍处于肥胖水平(体重指数30.5 kg/m^(2))。3例患者减重手术至妊娠的间隔时间超过1年(分别为14、14和60个月),另1例减重术后10个月即妊娠。3例在孕早期出现正细胞性贫血,血红蛋白最低为101~106 g/L,经营养指导及药物治疗后在分娩前血红蛋白均恢复正常;1例患者在孕26周出现先兆晚期流产,经保胎治疗成功;1例患者孕27周诊断为妊娠期糖尿病,给予饮食和运动指导,血糖控制满意。4例患者口服葡萄糖耐量试验空腹血糖(3.8~4.5 mmol/L)和服糖后2 h血糖(3.5~6.1 mmol/L)均偏低。4例患者均足月分娩,无小于胎龄儿发生。结论减重术后妊娠容易发生母体营养素缺乏和血糖波动,建议多学科协作管理并给予个体化营养指导,以降低相关并发症的风险。ObjectiveTo summarize the characteristics and management experience of pregnancy after bariatric surgery.MethodsA retrospective analysis was conducted on four pregnant patients who had undergone pre-pregnant bariatric surgery and delivered at the Department of Obstetrics and Gynecology,Beijing Tsinghua Changgung Hospital,from January 2021 to December 2023.The analysis included the type of bariatric surgery,the interval between bariatric surgery and pregnancy,pregnancy complications,and neonatal birth conditions.Descriptive statistical analysis was used.ResultsAmong the four patients,two were primiparas and two were multiparas.All patients were obese(body mass index≥27.5 kg/m^(2))before undergoing sleeve gastrectomy.Before the current pregnancy,three patients had a normal body mass index,while one patient remained obese(body mass index 30.5 kg/m^(2)).The interval between bariatric surgery and pregnancy exceeded one year for three patients(14,14,and 60 months,respectively),while one patient became pregnant 10 months after surgery.Three patients developed normocytic anemia in early pregnancy,with the lowest hemoglobin levels of 101 to 106 g/L.After nutritional guidance and medication,hemoglobin levels returned to normal before delivery.One patient experienced a threatened late miscarriage at 26 weeks of gestation,which was successfully managed with tocolytic therapy.One patient was diagnosed with gestational diabetes at 27 weeks of gestation and achieved satisfactory blood glucose control through dietary and exercise guidance.Oral glucose tolerance tests for all four patients showed low fasting blood glucose levels(3.8-4.5 mmol/L)and 2-hour postprandial blood glucose levels(3.5-6.1 mmol/L).All four patients delivered at term,with no cases of small for gestational age infants.ConclusionsPregnancy after bariatric surgery is prone to maternal nutrient deficiencies and blood glucose fluctuations.Multidisciplinary collaborative management and individualized nutritional guidance are recommended to reduce the risk of rel

关 键 词：减重手术 妊娠结局 围产期管理 

分 类 号：R71[医药卫生—妇产科学]