BACKGROUND Worldwide, the prevalence of obesity in women of reproductive age is increasing. Bariatric surgery is currently viewed as the most effective, long-term solution for this problem. Preconception bariatric surgery can reduce the prevalence of obesity-related subfertility and adverse maternal, pregnancy and birth outcomes. Maternal health during the periconception period is crucial for optimal gametogenesis and for embryonic and fetal development which also affects health in the later lives of both mother and offspring. Although preconception bariatric surgery improves several pregnancy outcomes, it can also increase the prevalence of pregnancy complications due to excessive and rapid weight loss. This can lead to iatrogenic malnutrition with vitamin deficiencies and derangements in metabolic and endocrine homeostasis. Thus, bariatric surgery can greatly influence periconception maternal health with consequences for reproduction, pregnancy and health in later life. However, its influence on periconception maternal health itself has never been reviewed systematically. OBJECTIVE AND RATIONALE The aim of this review was to investigate associations between bariatric surgery and determinants of periconception maternal health such as endocrine changes, fertility, vitamin status, irregular menstrual cycles, miscarriages and congenital malformations. SEARCH METHODS Medline, Embase, PubMed, Web of Science, Google Scholar and the Cochrane databases were used for the literature search until 1 November 2020. The search strategy terms included, among others, bariatric surgery, hormones, fertility, malformations, miscarriages and vitamin status. We searched for human studies that were written in English. s, reviews, meta-analyses and conference papers were excluded. The ErasmusAGE score was used to assess the quality of the included studies. OUTCOMES A total of 51 articles were analysed. The mean quality score was 5 (range 2–8). After bariatric surgery, hormonal axes normalized and menstrual cycle regularity was restored, resulting in increased fertility. Overall, there were no short-term risks for reproductive outcomes such as the increased risk of miscarriages or congenital malformations. However, the risk of vitamin deficiencies was generally increased after bariatric surgery. A meta-analysis of 20 studies showed a significant decrease in infertility (risk difference (RD) −0.24, 95% confidence interval (CI) −0.42, −0.05) and menstrual cycle irregularities (RD −0.24, 95% CI −0.34, −0.15) with no difference in rates of miscarriage (RD 0.00, 95% CI −0.09, 0.10) and congenital malformations (RD 0.01, 95% CI −0.02, 0.03). WIDER IMPLICATIONS The current systematic review and meta-analysis show associations between bariatric surgery and periconception maternal health and underlines the need for providing and personalizing preconception care for women after bariatric surgery. We recommend preconception care including the recommendation of postponing pregnancy until weight loss has stabilized, irrespective of the surgery-to-pregnancy interval, and until vitamin status is normalized. Therefore, regular monitoring of vitamin status and vitamin supplementation to restore deficiencies is recommended. Furthermore, this systematic review emphasizes the need for a long-term follow-up research of these women from the periconception period onwards as well as their pregnancies and offspring, to further improve care and outcomes of these mothers and children.

中文翻译：

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减肥手术对围孕期产妇健康的影响：系统评价和荟萃分析

背景技术在世界范围内，育龄妇女的肥胖患病率正在增加。减肥手术目前被认为是解决这一问题的最有效、最长期的解决方案。孕前减肥手术可以减少与肥胖相关的不孕症的发生率以及不良的孕产妇、妊娠和分娩结局。围孕期的母亲健康对于最佳配子发生以及胚胎和胎儿发育至关重要，这也影响母亲和后代后期的健康。尽管孕前减肥手术可以改善一些妊娠结局，但由于过度快速减肥，它也会增加妊娠并发症的发生率。这可能导致医源性营养不良、维生素缺乏以及代谢和内分泌稳态紊乱。因此，减肥手术会极大地影响孕前产妇的健康，从而对生育、怀孕和晚年的健康产生影响。然而，它对围孕期孕产妇健康的影响从未被系统地审查过。目的和理由 本综述的目的是调查减肥手术与围孕期产妇健康的决定因素之间的关联，例如内分泌变化、生育能力、维生素状态、月经周期不规则、流产和先天性畸形。检索方法 Medline、Embase、PubMed、Web of Science、Google Scholar 和 Cochrane 数据库用于文献检索，直至 2020 年 11 月 1 日。检索策略术语包括减肥手术、激素、生育力、畸形、流产和维生素等状态。我们搜索了用英语编写的人类研究。s、评论、荟萃分析和会议论文被排除在外。ErasmusAGE评分用于评估纳入研究的质量。结果 共分析了 51 篇文章。平均质量得分为 5（范围 2-8）。减肥手术后，荷尔蒙轴恢复正常，月经周期规律恢复，从而提高了生育能力。总体而言，生殖结果没有短期风险，例如流产或先天性畸形的风险增加。然而，减肥手术后维生素缺乏的风险通常会增加。对 20 项研究的荟萃分析显示不孕症（风险差异 (RD) -0.24, 95% 置信区间 (CI) -0.42, -0.05）和月经周期不规律（RD -0.24, 95% CI -0.34, -0。15) 流产率 (RD 0.00, 95% CI -0.09, 0.10) 和先天畸形率 (RD 0.01, 95% CI -0.02, 0.03) 没有差异。更广泛的影响 目前的系统评价和荟萃分析显示减肥手术与围孕期产妇健康之间存在关联，并强调需要为减肥手术后的女性提供和个性化的孕前护理。我们建议孕前护理，包括建议推迟怀孕直到体重减轻稳定，无论手术到怀孕的间隔如何，直到维生素状态正常化。因此，建议定期监测维生素状态和补充维生素以恢复缺陷。此外，