Читать книгу Gestational Diabetes - Группа авторов - Страница 45

Although a detailed review of its role in young women planning pregnancy is beyond the scope of this review, bariatric surgery must be acknowledged as the most effective means of reducing body weight in severely obese women. Dalfra et al. [73] noted that overall pregnancy outcomes were generally favorable and that bariatric surgery was more successful than lifestyle modification in improving outcomes. In their comparison of varying surgical approaches, they noted that roux-en-Y-gastric-bypass and biliary pancreatic diversion, despite producing greater weight loss, were associated with more maternal complications, nutritional defects, and episodes of intestinal obstruction than laparoscopic gastric banding. They also noted potentially favorable overall maternal and childhood outcomes but recommended caution and close clinical surveillance during pregnancy in view of the rate of complications.

Another recent review [74] showed reduced rates of GDM, LGA infants, and hypertensive disorders of pregnancy. However, these positive effects were offset by an increase in SGA infants, intrauterine growth restriction, and preterm deliveries. Malabsorptive surgical approaches, accompanied by greater weight loss, demonstrated a greater reduction in LGA, but also a greater increase in SGA, suggesting that a balanced therapeutic approach is required.