Anemia gestacional y descenso fisiológico de hemoglobina en mujeres que viven a gran altitud
DOI:
https://doi.org/10.35319/conr.20268146Palabras clave:
Anemia gestacional, hemoglobina en altura, multiparidad, factores clínicos, salud materna fetalResumen
La anemia gestacional constituye un problema de salud pública, especialmente en contextos de altitud, donde los niveles de hemoglobina presentan variaciones fisiológicas relevantes. El monitoreo de su evolución durante el embarazo permite identificar cambios hematológicos y orientar intervenciones oportunas. El objetivo fue analizar la variación de los niveles de hemoglobina entre el primer y el tercer trimestre, su asociación con factores clínicos y antecedentes obstétricos en gestantes atendidas en centros integrales de salud del Distrito 1 de la ciudad de El Alto, Bolivia, gestión 2024. Se realizó un estudio cuantitativo, observacional, longitudinal y analítico, basado en la revisión retrospectiva de historias clínicas. Se incluyeron 251 expedientes completos con registros de hemoglobina. Se observó una disminución promedio de 0.59 g dL-1 entre el primer y tercer trimestre (p < 0.05), junto con un incremento de la prevalencia de anemia de 62.2 a 83.3 % (p <0.05). La clasificación hematológica evidencio un aumento principalmente en la categoría moderada. No se identificó asociación estadísticamente significativa entre la presencia de anemia y edad materna, índice de masa corporal, periodo intergenésico, antecedente de aborto ni diagnóstico de infección genitourinaria. Los resultados refieren una disminución de hemoglobina durante la gestación en mujeres residentes a gran altitud, compatible con el descenso fisiológico esperado, pero acompañada de una elevada prevalencia de anemia según puntos de corte ajustados por altitud. Se recomienda reforzar el control prenatal y ajustar los puntos de corte diagnósticos considerando la altitud, para mejorar la identificación y el manejo de la anemia en gestantes de altura.
Descargas
Citas
Anaemia in women and children [Internet]. World Health Organization. 2025 [cited September 5, 2025]. Retrieved from: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children
Sowe A, Wood E, Gautam SK. Maternal anemia as a predictor of childhood anemia: evidence from Gambian health data. Nutrients 2025;17(5):879. DOI: https://doi.org/10.3390/nu17050879
Teichman J, Nisenbaum R, Lausman A, Sholzberg M. Suboptimal iron deficiency screening in pregnancy and the impact of socioeconomic status in a high-resource setting. Blood Adv 2021;5(22): 4666-73. DOI: https://doi.org/10.1182/bloodadvances.2021004352
Mei Z, Addo OY, Jefferds MED, Flores-Ayala RC, Brittenham GM. Physiologically based trimester-specific serum ferritin thresholds for iron deficiency in US pregnant women. Blood Adv 2024;8(14):3745-53. DOI: https://doi.org/10.1182/bloodadvances.2024013460
Angeles Oblitas MY; Ortiz Montalvo YJ, Ortiz Romaní KJ, Leon Fernandez MS. Prevalencia de anemia ferropénica y factores asociados en embarazadas peruanas. Index Enferm 2023; 32(4): e14558. DOI: https://doi.org/10.58807/indexenferm20235827
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins: Practice Bulletin, Number 233, Anemia in Pregnancy. Obstet Gynecol 2021;138(2):e55-e64. DOI: https://doi.org/10.1097/AOG.0000000000004477
Addo OY, Yu EX, Williams AM, Young MF, Sharma AJ, Mei Z, et al. Evaluation of hemo-globin cutoff levels to define anemia among healthy individuals. JAMA Netw Open 2021;4(8): e2119123. DOI: https://doi.org/10.1001/jamanetworkopen.2021.19123
Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open 2022;5(2):e2147046. DOI: https://doi.org/10.1001/jamanetworkopen.2021.47046
Flores-Venegas SR, Germes-Piña F, Levario-Carrillo M. Complicaciones obstétricas y perina-tales en pacientes anémicas. Ginecol Obstet Mex 2019;87(2):85-92. https://doi.org/10.24245/gom.v87i2.2436
Lauer JM, Bhaise S, Dhurde V, Gugel A, Shah M, Hibberd PL, et al. Maternal anemia during preg-nancy and infant birth outcomes: a prospective cohort study in Eastern Maharashtra, India. Curr Dev Nutr 2024;8(11):104476. https://doi.org/10.1016/j.cdnut.2024.104476
Tunçalp Ӧ, Pena-Rosas JP, Lawrie T, Bucagu M, Oladapo OT, Portela A, et al. WHO recommend-dations on antenatal care for a positive pregnancy experience-going beyond survival. BJOG 2017; 124(6): 860-2. DOI: https://doi.org/10.1111/1471-0528.14599
Castellanos Hernández D, Borja Velázquez M, Rosales Ortiz S. Anemia ferropénica en el embarazo: esquema de sulfato ferroso intermitente en comparación con el continuo. Ginecol Obstet Mex 2024;92(1):1-7. DOI: https://doi.org/10.24245/gom.v92i1.8876
Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica 2020;105(5):1232-9. DOI: https://doi.org/10.3324/haematol.2019.2208 30
Lam MC, Khandakar B, Heon I, Hussain F, Feldman K, Kaplowitz E, et al. Daily versus alter-nate-day iron supplementation for pregnant women with iron deficiency anemia: a randomized controlled trial. Am J Perinatol 2025;42(6):699-707. DOI: https://doi.org/10.1055/a-2405-1381
McCarthy EK, Schneck D, Basu S, Xenopoulos-Oddsson A, McCarthy FP, Kiely ME, et al. Longitudinal evaluation of iron status during pregnancy: a prospective cohort study in a high-resource setting. Am J Clin Nutr 2024;120(5): 1259-68. DOI: https://doi.org/10.1016/j.ajcnut.2024.08.010
Cueva Rossell ML, Reyna Gallegos SL, Villanue-va Espinoza ME. Factores asociados a anemia en gestantes ingresadas en hospitales de referencia Puno, Perú. Nutr Clin Diet Hosp 2024;44(2):180-7. DOI: https://doi.org/10.12873/442cueva
Laflamme EM. Maternal hemoglobin concentra-tion and pregnancy outcome: a study of the effects of elevation in El Alto, Bolivia. Mcgill J Med 2011;13(1):47.
Caihuara Villafuerte MF, Ortega Blanco MA, Arteaga Vera FAM. Ferropenic anemia. Prevalence in Pregnant and Puerperas. Integral Health Center Santiago de Presto. September 2017 to February 2018. Arch Boliv Med 2018;29(97): 75-89.
World Health Organization. Guideline on haemoglobin cutoffs to define anaemia in indivi-duals and populations [Internet]. Geneva: World Health Organization; 2024. Disponible en: https://www.who.int/publications/i/item/9789240088542
Vásquez-Velásquez C, Gonzales GF. Evaluation of the hemoglobin cutoff point for anemia in adult women residents of different altitudinal levels in Peru. PLoS One 2024;19(7):e0307502. DOI: https://doi.org/10.1371/journal.pone.0307502
Araoz R, Alvarez G, Villarroel L, Quispe T, Quisbert E, Amaru R. Valores hematológicos en mujeres gestantes residentes a 3.600 msnm. Rev Méd (La Paz) 2018;24(1):27-33.
Sharma D, Amgain K, Panta PP, Pokhrel B. Hemoglobin levels and anemia evaluation among pregnant women in the remote and rural high lands of mid-western Nepal: a hospital based study. BMC Pregnancy Childbirth 2020;20(1):182. DOI: https://doi.org/10.1186/s12884-020-02870-7
Ministerio de Salud. Atención integrada al continuo del curso de la vida [Internet]. La Paz: Ministerio de Salud; 2021 [citado 2024 May 22]. Disponible en: https://es.scribd.com/document/615134878/Continuo-de-La-Vida-2021
Zeng Y, He G. Association of blood parameters in early pregnancy with anemia during late pregnancy: a multicenter cohort study in China. J Matern Fetal Neonatal Med 2024;37(1):2299110. DOI: https://doi.org/10.1080/14767058.2023.2299110
Ohuma EO, Young MF, Martorell R, Ismail LC, Peña-Rosas JP, Purwar M, et al. International values for haemoglobin distributions in healthy pregnant women. EClinicalMedicine 2020;29-30: 100660. DOI: https://doi.org/10.1016/j.eclinm.2020.100660
Sun M, Gu T, Wu T, Gong X, Li X, Huang J, et al. Variation patterns of hemoglobin levels by gestational age during pregnancy: a cross-sectio-nal analysis of a multi-center retrospective cohort study in China. Nutrients 2023;15(6):1383. DOI: https://doi.org/10.3390/nu15061383
Churchill D, Nair M, Stanworth SJ, Knight M. The change in haemoglobin concentration between the first and third trimesters of pregnancy: a popular-tion study. BMC Pregnancy Childbirth 2019;19 (1):359. DOI: https://doi.org/10.1186/s12884-019-2495-0
Abdullahi AS, Suliman A, Khan MA, Khair H, Ghazal-Aswad S, Elbarazi I, et al. Temporal trends of hemoglobin among pregnant women: The Mutaba'ah study. PLoS One 2023;18(12): e0295549. DOI: https://doi.org/10.1371/journal.pone.0295549
Tan J, He G, Qi Y, Yang H, Xiong Y, Liu C, et al. Prevalence of anemia and iron deficiency anemia in Chinese pregnant women (iron women): a national cross-sectional survey. BMC Pregnancy Childbirth 2020;20(1):670. DOI: https://doi.org/10.1186/s12884-020-03359-z
Cohen JH, Haas JD. Hemoglobin correction factors for estimating the prevalence of iron deficiency anemia in pregnant women residing at high altitudes in Bolivia. Rev Panam Salud Publica 1999;6(6):392-9. DOI: https://doi.org/10.1590/s1020-49891999001100004
Imai K. Parity-based assessment of anemia and iron deficiency in pregnant women. Taiwan J Obstet Gynecol 2020;59(6):838-841. DOI: https://doi.org/10.1016/j.tjog.2020.09.010
Alreshidi MA, Haridi HK. Prevalence of anemia and associated risk factors among pregnant women in an urban community at the North of Saudi Arabia. J Prev Med Hyg 2021;62(3):E653-E663. DOI: https://doi.org/10.15167/2421-4248/jpmh2021.62.3.1880
Eltayeb R, Binsaleh NK, Alsaif G, Ali RM, Alyahyawi AR, Adam I. Hemoglobin levels, anemia, and their associations with body mass index among pregnant women in Hail Maternity Hospital, Saudi Arabia: A cross-sectional study. Nutrients 2023;15(16):3508. DOI: https://doi.org/10.3390/nu15163508
Anato A, Reshid M. Effect of nutrition education and iron-folic acid supplementation on anemia among pregnant women in Ethiopia: a quasi-experimental study. Sci Rep 2025;15(1):3556. DOI: https://doi.org/10.1038/s41598-025-87957-x
Wu L, Sun R, Liu Y, Liu Z, Chen H, Shen S, et al. High hemoglobin level is a risk factor for maternal and fetal outcomes of pregnancy in Chinese women: A retrospective cohort study. BMC Pregnancy Childbirth 2022;22(1):290. DOI: https://doi.org/10.1186/s12884-022-04636-9
Moghaddam Tabrizi F, Barjasteh S. Maternal hemoglobin levels during pregnancy and their association with birth weight of neonates. Iran J Ped Hematol Oncol 2015;5(4):211-7.
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Current Opinion Nursing & Research
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
