Pregnancy following gastric bypass surgery for morbid obesity

Background: Surgical treatment for severe obesity is sometimes recommended. Many long-term risks, particularly to adolescents and to subsequent pregnancies, are still being determined. Case: A 23-year-old woman, gravida 6, para 2, treated for morbid obesity during adolescence with gastric bypass surgery, presented at 6 weeks' gestation with severe microcytic anemia. Significant iron and cobalamin deficiencies were found. Although the vitamin B₁₂ deficiency responded to parenteral treatment, the iron deficiency was refractory to oral supplementation because of malabsorption. By 30 weeks' gestation, the patient required blood transfusions to correct the progressive anemia. Subsequently, she delivered a healthy male infant at term. Conclusion: Severe iron deficiency anemia resulting from malabsorption can complicate pregnancy following gastric bypass surgery for morbid obesity. For women of childbearing age, this potential adverse effect must be considered.