Objective. To demonstrate if pregestational obesity in populations living at low and at high altitudes was associated with hemoglobin (Hb) reduction and if changes are observed in each of the trimesters of pregnancy. Methods. We used a database containing information from 1’712,639 pregnant women belonging to each of the 24 departments of Peru obtained during the period 2012 to 2017. Pre-pregnancy Weight and height were determined, and BMI was calculated and expressed as weight in kilograms divided by the square of height in meters. Data about weight gain during pregnancy was also recorded. Hemoglobin was measured using hemocue. Data are presented as uncorrected hemoglobin concentration (g/dL) as well as corrected hemoglobin concentration (g/dL) after adjusting its value by altitude as recommended by World Health Organization. Data were analyzed using bivariate and multivariate analysi...

Objective. To demonstrate if pregestational obesity in populations living at low and at high altitudes was associated with hemoglobin (Hb) reduction and if changes are observed in each of the trimesters of pregnancy. Methods. We used a database containing information from 1’712,639 pregnant women belonging to each of the 24 departments of Peru obtained during the period 2012 to 2017. Pre-pregnancy Weight and height were determined, and BMI was calculated and expressed as weight in kilograms divided by the square of height in meters. Data about weight gain during pregnancy was also recorded. Hemoglobin was measured using hemocue. Data are presented as uncorrected hemoglobin concentration (g/dL) as well as corrected hemoglobin concentration (g/dL) after adjusting its value by altitude as recommended by World Health Organization. Data were analyzed using bivariate and multivariate analysi...

Iron is essential for health; its deficiency and excess are harmful. Our bodies have a high capacity to store and reuse iron so that its requirement is small (1-2 mg absorbed/day). Hepcidin, a hormone produced in the liver, has an important role in this element’s homeostasis by blocking its transport protein, inhibiting its absorption in the duodenum and its release from the iron stores. During pregnancy, there is a new iron requirement for the placenta and fetus. This causes an increase in erythropoiesis; however, hemoglobin concentration decreases due to the greater vascular expansion. This results in hemodilution, which is evident starting the second trimester and returns to pre-gestational values at the end of the third trimester. Maternal iron deficiency anemia becomes a public health problem when it is moderate (7-14,5 g/dL) during pregnancy adversely affect the mother and neonat...

Although the prevalence of anemia has decreased in the last decades, global anemia prevalence remains at around 30 % and is estimated to contribute to nearly 9 % of global years lived with disability. An increased appreciation of the multiple interacting causes of anemia to include nutritional, infectious and genetic causes is not reflected in government programs to address anemia which focus only on iron supplementation, which may underlie their limited effectiveness. Additionally, several studies question the validity of the hemoglobin cut-off points used to define anemia, first proposed in 1969 by the WHO, especially those recommended for use in populations at high altitude (HA), as populations at HA generally exhibit higher hemoglobin levels as one of several possible adaptations to living at HA. Use of this criteria may increase 5-6 times the prevalence of anemia, particularly in po...

Anemia is a worldwide public health problem that affects both the health and survival of people. It is estimated that 25% of the world population suffers it. Although most of the countries have been intervening during fifty years to reduce the rates of anemia, these efforts are unsatisfactory. Among the arguments used to explain this low success, is the low adherence to the consumption of iron supplements. The hepcidin discovery in 2000 has changed our knowledge about the mechanisms that regulate iron homeostasis, which shows that the inflammatory processes, which are responsible for 42% of anemia cases in the world will not respond to the intervention with oral iron, due to the increase in the value of hepcidin by inflammation. In this review it is also argued that the criteria used to determine the cut-off points in children and pregnant women to define iron deficiency anemia do not ag...

Anemia is a worldwide public health problem that affects both the health and survival of people. It is estimated that 25% of the world population suffers it. Although most of the countries have been intervening during fifty years to reduce the rates of anemia, these efforts are unsatisfactory. Among the arguments used to explain this low success, is the low adherence to the consumption of iron supplements. The hepcidin discovery in 2000 has changed our knowledge about the mechanisms that regulate iron homeostasis, which shows that the inflammatory processes, which are responsible for 42% of anemia cases in the world will not respond to the intervention with oral iron, due to the increase in the value of hepcidin by inflammation. In this review it is also argued that the criteria used to determine the cut-off points in children and pregnant women to define iron deficiency anemia do not ag...

Although the prevalence of anemia has decreased in the last decades, global anemia prevalence remains at around 30 % and is estimated to contribute to nearly 9 % of global years lived with disability. An increased appreciation of the multiple interacting causes of anemia to include nutritional, infectious and genetic causes is not reflected in government programs to address anemia which focus only on iron supplementation, which may underlie their limited effectiveness. Additionally, several studies question the validity of the hemoglobin cut-off points used to define anemia, first proposed in 1969 by the WHO, especially those recommended for use in populations at high altitude (HA), as populations at HA generally exhibit higher hemoglobin levels as one of several possible adaptations to living at HA. Use of this criteria may increase 5-6 times the prevalence of anemia, particularly in po...