title: Anemia during pregnancy after silastic ring Roux-en-Y gastric bypass: influence of time to conception.
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).
  
  
  CONCLUSIONS
  Pregnancy after 4 years of SRYGB is associated with maternal anemia and the need for more strict iron supplementation.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, Av Dr Enéas de Carvalho Aguiar 255, São Paulo, SP, Brazil. roseli.nomura@hotmail.com
authors.forename: Roseli Mieko Yamamoto
authors.initials: RM
authors.lastname: Nomura
authors.forename: Maria Carolina Gonçalves
authors.initials: MC
authors.lastname: Dias
authors.forename: Ana Maria Kondo
authors.initials: AM
authors.lastname: Igai
authors.forename: Letícia Vieira
authors.initials: LV
authors.lastname: Paiva
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D019587:Dietary Supplements; D005260:Female; D005296:Ferrous Compounds / Q000627:therapeutic use*; D005306:Fertilization; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D005296:Ferrous Compounds; D014815:Vitamins; D007501:Iron; C031621:ferrous fumarate