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CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(10): e562-e567
DOI: 10.1055/s-0043-1776026
Original Article
High Risk Pregnancy

Iron Deficiency Anemia in Pregnancy after Bariatric Surgery: Etiology, Risk Factors, and How to Manage It

Anemia ferropriva na gestação após cirurgia bariátrica: Etiologia, fatores de risco e como tratar
Carolina de Freitas Alves Amaral-Moreira 
1   Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Guilherme Redezuk 
1   Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Belmiro Gonçalves Pereira 
1   Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Anderson Borovac-Pinheiro 
1   Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
,
Patricia Moretti Rehder 
1   Departamento de Tocoginecologia da Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Abstract

Objective Pregnancy after bariatric surgery is a reality of the 21st century and therefore is essential that all obstetricians know how to manage it. The most prevalent nutritional deficiency is iron deficiency and, consequently, anemia. Although bariatric surgery and pregnancy are already risk factors for anemia, we evaluated in our study if there were any other risk factors and actions to improve hemoglobin levels in this population.

Methods We performed a retrospective cohort study, and performed frequency measurements and analyzes of odds ratio, X2 and Fisher exact test to evaluate the risk factors.

Results We evaluated 44 pregnancies after bariatric surgery, with an incidence of anemia of 62%, and the only identifiable risk factor for anemia was being black. As for the treatment, the iron salt used for oral supplementation did not associate with anemia risk, and in 27% of the patients, the adjustment of the oral dosage was enough for improvement in hemoglobin levels, but in 36% supplementation with intravenous iron was necessary.

Conclusion Being black is a risk factor for anemia. The type of iron salt does not correlate with the incidence of anemia, and for the treatment and improvement of iron dosages, it seems an effective increase in iron intake.

Resumo

Objetivo A gestação após cirurgia bariátrica é uma realidade do século XXI e, portanto, é de suma importância que os obstetras saibam conduzir o pré-natal dessas gestantes. A deficiência nutricional mais prevalente nessa população é a deficiência de ferro, que tem como consequência a anemia. Apesar da própria gestação e da cirurgia serem fatores de risco para anemia ferropriva, realizamos um estudo para avaliar se existem outros fatores que são de risco e quais condutas podem melhorar os níveis de hemoglobina nessa população.

Métodos Trata-se de um estudo de coorte retrospectiva, e foram realizadas medidas de frequência e análise odds ratio, X2, e teste de exato de Fisher para a avaliação dos fatores de risco.

Resultados Foram avaliadas 44 gestações após cirurgia bariátrica com incidência de anemia de 62%, sendo que o único fator de risco identificado foi a etnia preta. O sal de ferro utilizado na reposição não se associou com o risco de anemia. Em somente 27% das gestantes o ajuste da dose oral de ferro foi suficiente para corrigir a anemia, enquanto em 36% foi necessária a suplementação com ferro endovenoso.

Conclusão Ser de etnia preta foi fator de risco para anemia após cirurgia bariátrica e o tipo de sal de ferro para suplementação não se correlacionou com a incidência de anemia. Para o tratamento da anemia, somente o ajuste da dose da medicação parece ser suficiente para a resolução desta.

Keywords

Bariatric surgery - Anemia in pregnancy - Anemia after bariatric surgery

Palavras-chave

Cirurgia bariátrica - Anemia na gestação - Anemia após cirurgia bariátrica

Contributions

All authors contributed to the design of the study, were involved in the data collection, data analysis and/or interpretation. Also, all authors contributed to the writing/substantive editing and review of the manuscript and approved the final draft of the manuscript.




Publikationsverlauf

Eingereicht: 29. September 2022

Angenommen: 01. August 2023

Artikel online veröffentlicht:
09. November 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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