Relationship between the Nutritional Status of Vitamin A per Trimester of Pregnancy with Maternal Anthropometry and Anemia after Roux-en-Y Gastric Bypass

Abstract

The aim of this study was to compare the nutritional status of vitamin A per trimester of pregnancy, as well as to assess its influence on pre-pregnancy BMI, total gestational weight gain (TGWG) and presence of anemia in women who had previously undergone Roux-en-Y gastric bypass (RYGB). An analytical, longitudinal and retrospective study comprising 30 pregnant women who had previously undergone RYGB was undertaken. In all trimesters of pregnancy, the serum concentrations of retinol, β-carotene, stages of vitamin A deficiency (VAD), night blindness (NB), anemia and anthropometric variables were assessed. VAD in pregnancy affected 90% of women, 86.7% developed NB and 82.8% had mild VAD. TGWG above/below the recommended range was related to the low serum concentrations of β-carotene (p = 0.045) in the second trimester and women with TGWG above the recommended range showed 100% of inadequacy of this nutrient in the third trimester. Among the pregnant women with anemia, 90.9% had VAD and 86.4% had NB. This study highlights the importance of monitoring the nutritional status of vitamin A in prenatal care, due to its relationship with TGWG and the high percentage of VAD and NB found since the beginning of pregnancy. It also reaffirms the use of the cut-off <1.05 μmol/L for determining VAD.

Maternal serum retinol, 25(OH)D and 1,25(OH)2D concentrations during pregnancy and peak bone mass and trabecular bone score in adult offspring at 26-year follow-up

“…In line with previous studies [13, 42], we observed a modest decline in retinol levels throughout pregnancy, which may be attributed to hemodilution, and depletion of maternal stores due to fetal demands. The fact that the majority of women were smokers could contribute to the inferior vitamin A status, as smoking seems to attenuate serum levels of beta-carotene [43].…”

Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care

“…This supplement should contain the following at a minimum: copper (2 mg), zinc (15 mg), selenium (50 μg), folic acid (5 mg), iron (45‐60 mg or >18 mg after AGB), thiamine (>12 mg), vitamin E (15 mg), and beta‐carotene (vitamin A, 5000 IU) (level 4). The retinol form of vitamin A should be avoided during pregnancy due to teratogenicity risk (level 2+), and supplementation should be adjusted to maintain concentrations within normal limits (level 2−) …”

“…Given the risk associated with potential deficiencies in the periconception period, the following indices should be checked at least every 3 months in women planning to become pregnant after BS: serum folate or red blood cell folate (level 2−), serum vitamin B12 or transcobalamin (level 2−), serum ferritin, iron studies (including transferrin saturation), full blood count (level 2−), and serum vitamin A levels (level 2−) . In addition, the following should be monitored every 6 months: prothrombin time, international normalized ratio (INR) (level 2+), serum 25‐hydroxyvitamin D with calcium, phosphate, magnesium, and parathyroid hormone (PTH) (level 4), serum protein and albumin (level 2−), renal function and liver function tests (level 4), serum vitamin E (level 4), serum zinc, copper, and selenium (level 4).…”

“…During pregnancy, serum levels of many micronutrients and macronutrients will decrease as a result of the expanding maternal blood volume and increasing demands of the growing fetus. Therefore, it is recommended to check the following indices at least once per trimester and use pregnancy‐specific ranges: serum folate (level 2−); serum vitamin B12 (level 2−); serum ferritin, iron studies including transferrin saturation and full blood count (level 2−); serum vitamin D with calcium, phosphate, magnesium, and PTH (level 4); serum vitamin A (level 2−); prothrombin time, INR, and serum vitamin K1 concentration (level 2+); serum protein and albumin (level 2−); and renal function and liver function tests (level 4). In addition, we advise to monitor serum vitamin E, serum zinc, copper, and selenium (level 4) during the first trimester.…”

Maternal Nutritional Status and Pregnancy Outcomes Post-bariatric Surgery

“…Numerous studies showed that post-bariatric, pregnant women are more susceptible to developing anemia due to the increased demand and inadequate intake [13,15,65]. For instance, twenty-four women were grouped under the four bariatric surgeries they underwent; 69% developed anemia and underwent malabsorptive bariatric surgery (e.g., RYGB and LSG with duodenojejunal bypass) compared to AGB and LSG [13].…”