Factors Associated with the Development of Anemia During Pregnancy After Sleeve Gastrectomy
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ORIGINAL CONTRIBUTIONS
Factors Associated with the Development of Anemia During Pregnancy After Sleeve Gastrectomy Tair Ben-Porat 1,2 & Ram Elazary 3 & Shiri Sherf-Dagan 4,5 & Ram Weiss 2 & Gabriel Levin 6 & Misgav Rottenstreich 7 & Nasser Sakran 8 & Amihai Rottenstreich 6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Nutritional deficiencies, particularly anemia, are commonly encountered following bariatric surgery. While anemia during pregnancy is associated with various adverse maternal and perinatal outcomes, the factors associated with its occurrence following bariatric surgery have not been established. We explored the factors associated with the development of anemia during pregnancy after laparoscopic sleeve gastrectomy (SG). Materials and Methods We reviewed the records of women who underwent SG and delivered during 2010–2018 in a single university hospital. Results Of 121 women, 68 (56.2%) had evidence of anemia (hemoglobin < 11.0 g/dL) prior to delivery, with significantly lower hemoglobin levels compared with those (n = 53) without anemia (median 9.9 vs. 11.4 g/dL, P < 0.001). Significantly lower hemoglobin levels were found among those with pre-delivery anemia, both at the pre-operative stage (median 12.9 vs. 13.3 g/dL, P = 0.02) and at early pregnancy (median 12.0 vs. 12.6 g/dL, P = 0.05), compared with those without anemia. In multivariate analysis, a lower pre-operative hemoglobin level was the only independent factor associated with pre-delivery anemia (OR (95% CI) 1.59 (1.05, 2.40), P = 0.03). The rate of blood transfusion was significantly higher in women with pre-delivery anemia than in women without anemia (7.4% vs. 0, P = 0.04). Conclusions Anemia during pregnancy after SG was common; pre-operative hemoglobin level was identified as an independent predictor of its occurrence. Efforts should be invested to implement anemia risk stratification before surgery among reproductiveage women, and to optimize maternal nutritional status prior to pregnancy, as well as during the prenatal course. Keywords Bariatric surgery . Sleeve gastrectomy . Pregnancy . Anemia . Risk factors
Introduction The increasing global prevalence of obesity is a pandemic health problem [1]. Its worldwide prevalence has more than doubled in the last two decades and has reached 39% of the global population [1]. Weight loss procedures have become
the most effective treatment for morbid obesity, due to their demonstrated efficacy in achieving long-term sustained weight loss, improving obesity-related comorbidities and quality of life, and reducing all-cause mortality [2, 3]. Up to 80% of persons who undergo bariatric surgery (BS) are women of childbearing age [4]. Furthermore, fertility in
Tair Ben-Porat and Ram Elazary contributed equally to this work. * Amihai Rottenstreich [email protected] 1
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Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel
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Department of Nutrition, Hadassah-Hebrew University Medical Center, Ein-Kerem C
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