Maternal Ferritin Levels Crucial for Pregnancy Outcomes Post Bariatric Surgery: Study

In the study published in Obesity Surgery, the researchers suggest careful prescription and close monitoring of iron supplementation during pregnancy in women who have undergone bariatric surgery (BS).

8% of the newborns were premature, and 19% were small-for-gestational-age (SGA). Increased ferritin levels in the third trimester were linked to SGA newborns, suggesting meticulous management of iron supplementation. Pre-pregnancy nutritional assessments appeared to reduce the odds of SGA births.

Bariatric surgery, a highly effective obesity treatment, has become increasingly common in recent years, with a growing number of women of reproductive age undergoing these procedures. While bariatric surgery offers numerous health benefits, including improved metabolic control and reduced risk of obesity-related complications, its impact on pregnancy outcomes has been a subject of ongoing investigation.

The risks carried by pregnancy after bariatric surgery include SGA newborn and prematurity. However, there is no clear understanding of the underlying mechanisms in pregnant women after BS.

Cécile Ciangura, Sorbonne University, Paris, France, and colleagues conducted a single-center retrospective observational cohort study including all women with a first and single pregnancy after bariatric surgery who completed at least one biological and clinical nutritional assessment during pregnancy between 2010 and 2016.

The quarterly biological assessment comprised blood count, calcium, ferritin, parathyroid hormone, 25OH vitamin D, albumin, fasting glucose, prealbumin, vitamin A, vitamin B12, zinc, and folic acid.

The following were the key findings of the study:

· Among 120 pregnancies analyzed, two-thirds underwent gastric bypass (Roux-en-Y and one-anastomosis) and one-third a restrictive procedure (adjustable gastric band or sleeve gastrectomy). The median preoperative BMI was 43.8 kg/m2, and the mean age at pregnancy was 32.6 ± 5.3 years.

· Weight loss and time from surgery to pregnancy were 35.1 ± 15.4 kg and 2.9 years, respectively.

· 8% of women gave birth prematurely, and 19% of newborns were SGA.

· Univariate analysis shows that ferritin was significantly higher in mothers with SGA than those without SGA (35.5 versus 15 ng/ml) in the third trimester of pregnancy.

· Women who received pre-pregnancy nutritional assessment seemed less likely to give birth to an SGA newborn (32% versus 54%).

"Iron supplementation should be carefully prescribed and closely monitored during pregnancy in women who have undergone bariatric surgery," the researchers concluded.

Reference:

Lecot-Connan, T., Jeannin, AC., Baptiste, A. et al. Pregnancy Outcomes After Bariatric Surgery: Importance of Maternal Ferritin on Birth Weight. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07285-3