Skip to main content

Advertisement

SpringerLink
Log in

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

  • Clinical Research
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  Google Scholar 

  2. Pasquali R, Pelusi C, Genghini S, et al. Obesity and reproductive disorders in women. Hum Reprod Update. 2003;9:359–72.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus. Diab Care. 2007;30:2070–6.

    Article  Google Scholar 

  5. Richards DS, Miller DK, Goodman GN. Pregnancy after gastric bypass for morbid obesity. J Reprod Med. 1987;32:172–6.

    CAS  PubMed  Google Scholar 

  6. Weintraub AY, Levy A, Levi I, et al. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008;103:246–51.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. 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.

    Article  CAS  PubMed  Google Scholar 

  11. Beard JL, Hendricks MK, Perez EM, et al. Maternal iron deficiency anemia affects postpartum emotions and cognition. J Nutr. 2005;135:267–72.

    CAS  PubMed  Google Scholar 

  12. Corwin EJ, Murray-Kolb LE, Beard JL. Low hemoglobin level is a risk factor for postpartum depression. J Nutr. 2003;133:4139–42.

    CAS  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Institute of Medicine (US). Assessment of gestational weight gain. In: Nutrition during pregnancy. Washington: National Academy Press; 1990. p. 63–95.

  15. Beard JH, Bell RL, Duffy AJ. Reproductive considerations and pregnancy after bariatric surgery: current evidence and recommendations. Obes Surg. 2008;18:1023–7.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. Mizón C, Ruz M, Csendes A, et al. Persistent anemia after Roux-en-Y gastric bypass. Nutrition. 2007;23:277–80.

    Article  PubMed  Google Scholar 

  19. Varma S, Baz W, Badine E, et al. Need for parenteral iron therapy after bariatric surgery. Surg Obes Relat Dis. 2008;4:715–9.

    Article  PubMed  Google Scholar 

  20. Love AL, Billett HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol. 2008;83:403–9.

    Article  PubMed  Google Scholar 

  21. Amaral JF, Thompson WR, Caldwell MD, et al. Prospective hematologic evaluation of gastric exclusion surgery for morbid obesity. Ann Surg. 1985;201:186–93.

    Article  CAS  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. Patel JA, Patel NA, et al. Pregnancy outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2008;4:39–45.

    Article  PubMed  Google Scholar 

  24. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 105: bariatric surgery and pregnancy. Obstet Gynecol. 2009;113:1405–13.

    Google Scholar 

  25. 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.

    Article  CAS  PubMed  Google Scholar 

  26. Nomura RM, Alves EA, Zugaib M. Maternal complications associated with type of delivery in a university hospital. Rev Saúde Pública. 2004;38:9–15.

    Article  PubMed  Google Scholar 

  27. Sheiner E, Balaban E, Dreiher J, et al. Pregnancy outcome in patients following different types of bariatric surgeries. Obes Surg. 2009;19:1286–92.

    Article  PubMed  Google Scholar 

  28. 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  Google Scholar 

  29. Pallasmaa N, Ekblad U, Gissler M. Severe maternal morbidity and the mode of delivery. Acta Obstet Gynecol Scand. 2008;87:662–8.

    Article  PubMed  Google Scholar 

  30. Bothwell TH. Iron requirements in pregnancy and strategies to meet them. Am J Clin Nutr. 2000;72:257S–64.

    CAS  PubMed  Google Scholar 

  31. Milman N. Prepartum anaemia: prevention and treatment. Ann Hematol. 2008;87:949–59.

    Article  CAS  PubMed  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. Toh SY, Zarshenas N, Jorgensen J. Prevalence of nutrient deficiencies in bariatric patients. Nutrition. 2009;25:1150–6.

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, Av Dr Enéas de Carvalho Aguiar 255, 10th floor, suite 10037, São Paulo, SP, Brazil

    Roseli Mieko Yamamoto Nomura, Ana Maria Kondo Igai, Letícia Vieira Paiva & Marcelo Zugaib

  2. Division of Nutrition and Dietetics and Nutrology Group, Hospital das Clinicas, da Faculdade de Medicina da Universidade de São Paulo, Av Dr Enéas de Carvalho Aguiar 255, 2nd floor, São Paulo, SP, Brazil

    Maria Carolina Gonçalves Dias

Authors
  1. Roseli Mieko Yamamoto Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Carolina Gonçalves Dias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Maria Kondo Igai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Letícia Vieira Paiva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcelo Zugaib
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roseli Mieko Yamamoto Nomura.

Additional information

Financial Disclosure

The authors declare that they have no conflict of interest. No funding or grants were received for this project.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nomura, R.M.Y., Dias, M.C.G., Igai, A.M.K. et al. Anemia During Pregnancy after Silastic Ring Roux-en-Y Gastric Bypass: Influence of Time to Conception. OBES SURG 21, 479–484 (2011). https://doi.org/10.1007/s11695-011-0376-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-011-0376-3

Keywords

Search

Navigation