Skip to main content
Top
Published in: Obesity Surgery 4/2011

01-04-2011 | Clinical Research

Anemia During Pregnancy after Silastic Ring Roux-en-Y Gastric Bypass: Influence of Time to Conception

Authors: Roseli Mieko Yamamoto Nomura, Maria Carolina Gonçalves Dias, Ana Maria Kondo Igai, Letícia Vieira Paiva, Marcelo Zugaib

Published in: Obesity Surgery | Issue 4/2011

Login to get access

Abstract

Background

Bariatric surgery before pregnancy may help prevent obesity-related gestational complications. However, maternal malnutrition is not without potential risks during pregnancy. The objective was to evaluate the influence of time to conception after silastic ring Roux-en-Y gastric bypass (SRYGB) on maternal anemia.

Methods

Patients who underwent SRYGB for morbid obesity and who subsequently became pregnant were followed up at the prenatal. Thirty pregnancies occurred between July 2001 and September 2009. The patients were analyzed according to time to conception after bariatric surgery: 17 patients with time to conception <4 years (48 months) and 13 patients with ≥4 years.

Results

First trimester hemoglobin levels were significantly lower in patients with time to conception ≥4 years (48 months) (median 9.6 g/dL, range 5.8–13.2 g/dL) than in patients with time to conception <4 years (median 11.1 g/dL, range 9.8–13.6 g/dL; p = 0.047). The need for intravenous iron therapy or packed red cell transfusion was significantly more frequent among women who became pregnant ≥4 years after SRYGB compared to <4 years (30.8% vs. 0%, p = 0.026).

Conclusion

Pregnancy after 4 years of SRYGB is associated with maternal anemia and the need for more strict iron supplementation.
Literature
1.
go back to reference Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002;100:959–64.CrossRefPubMed Myles TD, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstet Gynecol. 2002;100:959–64.CrossRefPubMed
2.
go back to reference Pasquali R, Pelusi C, Genghini S, et al. Obesity and reproductive disorders in women. Hum Reprod Update. 2003;9:359–72.CrossRefPubMed Pasquali R, Pelusi C, Genghini S, et al. Obesity and reproductive disorders in women. Hum Reprod Update. 2003;9:359–72.CrossRefPubMed
3.
go back to reference Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol. 2004;190:1091–7.CrossRefPubMed Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol. 2004;190:1091–7.CrossRefPubMed
4.
go back to reference Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diab Care. 2007;30:2070–6.CrossRef Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diab Care. 2007;30:2070–6.CrossRef
5.
go back to reference Richards DS, Miller DK, Goodman GN. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987;32:172–6.PubMed Richards DS, Miller DK, Goodman GN. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987;32:172–6.PubMed
6.
go back to reference Weintraub AY, Levy A, Levi I, et al. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008;103:246–51.CrossRefPubMed Weintraub AY, Levy A, Levi I, et al. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008;103:246–51.CrossRefPubMed
7.
go back to reference Scanlon KS, Yip R, Schieve LA, et al. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol. 2000;96:741–8.CrossRefPubMed Scanlon KS, Yip R, Schieve LA, et al. High and low hemoglobin levels during pregnancy: differential risks for preterm birth and small for gestational age. Obstet Gynecol. 2000;96:741–8.CrossRefPubMed
8.
go back to reference Levy A, Fraser D, Katz M, et al. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005;122:182–6.CrossRefPubMed Levy A, Fraser D, Katz M, et al. Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery. Eur J Obstet Gynecol Reprod Biol. 2005;122:182–6.CrossRefPubMed
9.
go back to reference Lee HS, Kim MS, Kim MH, et al. Iron status and its association with pregnancy outcome in Korean pregnant women. Eur J Clin Nutr. 2006;60:1130–5.CrossRefPubMed Lee HS, Kim MS, Kim MH, et al. Iron status and its association with pregnancy outcome in Korean pregnant women. Eur J Clin Nutr. 2006;60:1130–5.CrossRefPubMed
10.
go back to reference Ren A, Wang J, Ye RW, et al. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. Int J Gynaecol Obstet. 2007;98:124–8.CrossRefPubMed Ren A, Wang J, Ye RW, et al. Low first-trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns. Int J Gynaecol Obstet. 2007;98:124–8.CrossRefPubMed
11.
go back to reference Beard JL, Hendricks MK, Perez EM, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.PubMed Beard JL, Hendricks MK, Perez EM, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.PubMed
12.
go back to reference Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139–42.PubMed Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139–42.PubMed
13.
go back to reference Faintuch J, Ishida RK, Jacabi M, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg. 2007;142:962–8.CrossRefPubMed Faintuch J, Ishida RK, Jacabi M, et al. Increased gastric cytokine production after Roux-en-Y gastric bypass for morbid obesity. Arch Surg. 2007;142:962–8.CrossRefPubMed
14.
go back to reference Institute of Medicine (US). Assessment of gestational weight gain. In: Nutrition during pregnancy. Washington: National Academy Press; 1990. p. 63–95. Institute of Medicine (US). Assessment of gestational weight gain. In: Nutrition during pregnancy. Washington: National Academy Press; 1990. p. 63–95.
15.
go back to reference Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg. 2008;18:1023–7.CrossRefPubMed Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg. 2008;18:1023–7.CrossRefPubMed
16.
go back to reference Kalfarentzos F, Kechagias I, Soulikia K, et al. Weight loss following vertical banded gastroplasty: intermediate results of a prospective study. Obes Surg. 2001;11:265–70.CrossRefPubMed Kalfarentzos F, Kechagias I, Soulikia K, et al. Weight loss following vertical banded gastroplasty: intermediate results of a prospective study. Obes Surg. 2001;11:265–70.CrossRefPubMed
17.
go back to reference Ruz M, Carrasco F, Rojas P, et al. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90:527–32.CrossRefPubMed Ruz M, Carrasco F, Rojas P, et al. Iron absorption and iron status are reduced after Roux-en-Y gastric bypass. Am J Clin Nutr. 2009;90:527–32.CrossRefPubMed
18.
go back to reference Mizón C, Ruz M, Csendes A, et al. Persistent anemia after Roux-en-Y gastric bypass. Nutrition. 2007;23:277–80.CrossRefPubMed Mizón C, Ruz M, Csendes A, et al. Persistent anemia after Roux-en-Y gastric bypass. Nutrition. 2007;23:277–80.CrossRefPubMed
19.
go back to reference Varma S, Baz W, Badine E, et al. Need for parenteral iron therapy after bariatric surgery. Surg Obes Relat Dis. 2008;4:715–9.CrossRefPubMed Varma S, Baz W, Badine E, et al. Need for parenteral iron therapy after bariatric surgery. Surg Obes Relat Dis. 2008;4:715–9.CrossRefPubMed
20.
go back to reference Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.CrossRefPubMed Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.CrossRefPubMed
21.
go back to reference Amaral JF, Thompson WR, Caldwell MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201:186–93.CrossRefPubMed Amaral JF, Thompson WR, Caldwell MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201:186–93.CrossRefPubMed
22.
go back to reference Faintuch J, Dias MC, De Souza Fazio E, et al. Pregnancy nutritional indices and birth weight after Roux-en-Y gastric bypass. Obes Surg. 2009;19:583–9.CrossRefPubMed Faintuch J, Dias MC, De Souza Fazio E, et al. Pregnancy nutritional indices and birth weight after Roux-en-Y gastric bypass. Obes Surg. 2009;19:583–9.CrossRefPubMed
23.
go back to reference Patel JA, Patel NA, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:39–45.CrossRefPubMed Patel JA, Patel NA, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:39–45.CrossRefPubMed
24.
go back to reference American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405–13. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405–13.
25.
go back to reference Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25:219–27.CrossRefPubMed Dixon JB, Dixon ME, O'Brien PE. Elevated homocysteine levels with weight loss after Lap-Band surgery: higher folate and vitamin B12 levels required to maintain homocysteine level. Int J Obes Relat Metab Disord. 2001;25:219–27.CrossRefPubMed
26.
go back to reference Nomura RM, Alves EA, Zugaib M. Maternal complications associated with type of delivery in a university hospital. Rev Saúde Pública. 2004;38:9–15.CrossRefPubMed Nomura RM, Alves EA, Zugaib M. Maternal complications associated with type of delivery in a university hospital. Rev Saúde Pública. 2004;38:9–15.CrossRefPubMed
27.
go back to reference Sheiner E, Balaban E, Dreiher J, et al. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg. 2009;19:1286–92.CrossRefPubMed Sheiner E, Balaban E, Dreiher J, et al. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg. 2009;19:1286–92.CrossRefPubMed
28.
go back to reference Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455–60.PubMed Liu S, Liston RM, Joseph KS, et al. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176:455–60.PubMed
29.
go back to reference Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scand. 2008;87:662–8.CrossRefPubMed Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scand. 2008;87:662–8.CrossRefPubMed
30.
go back to reference Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257S–64.PubMed Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257S–64.PubMed
32.
go back to reference Dias MC, Fazio Ede S, De Oliveira FC, et al. Body weight changes and outcome of pregnancy after gastroplasty for morbid obesity. Clin Nutr. 2009;28:169–72.CrossRefPubMed Dias MC, Fazio Ede S, De Oliveira FC, et al. Body weight changes and outcome of pregnancy after gastroplasty for morbid obesity. Clin Nutr. 2009;28:169–72.CrossRefPubMed
33.
go back to reference Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.CrossRefPubMed Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.CrossRefPubMed
Metadata
Title
Anemia During Pregnancy after Silastic Ring Roux-en-Y Gastric Bypass: Influence of Time to Conception
Authors
Roseli Mieko Yamamoto Nomura
Maria Carolina Gonçalves Dias
Ana Maria Kondo Igai
Letícia Vieira Paiva
Marcelo Zugaib
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Obesity Surgery / Issue 4/2011
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-011-0376-3

Other articles of this Issue 4/2011

Obesity Surgery 4/2011 Go to the issue