Évaluation du statut martial chez la femme enceinte atteinte de la maladie de Crohn dans la localité de Mostaganem (Algérie)

Abstract

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect the entire digestive tract, from the oral cavity to the anus. When it occurs in pregnant women, its association with the profound physiological changes of gestation. «Particularly increased blood volume and heightened erythropoietic demands» significantly raises the risk of iron metabolism imbalance. This imbalance can progress to iron deficiency anemia, with consequences for the mother (fatigue, bleeding risk, infections) and the fetus (growth restriction, prematurity, low birth weight). Our study aims to assess iron status in a population of pregnant women with Crohn's disease using several biological parameters of iron balance (serum iron, ferritin, transferrin, transferrin saturation coefficient, and TIBC). The study focuses on six clinical cases of women aged 20 to 33 years, all diagnosed with Crohn's disease during gestation. The results obtained show highly varied biological profiles, ranging from severe iron deficiency to apparently normal values. However, the latter are sometimes difficult to interpret due to the influence of chronic inflammation on ferritin, which may be falsely elevated or normal despite functional iron deficiency. In-depth analysis of the clinical cases highlights the central role of several pathophysiological mechanisms: hepcidin overexpression induced by inflammation, intestinal malabsorption related to damage of the digestive mucosa, and often asymptomatic chronic digestive microbleeding. In conclusion, our work advocates for a rigorously individualized nutritional and therapeutic approach, including iron supplementation tailored to the severity of the deficiency, the inflammatory state of the IBD, and the clinical and biological response. Furthermore, the combined or individual effects of each parameter must be thoroughly analyzed and discussed by a biomedical team to provide a well-suited therapeutic solution for each patient. Intravenous iron may be considered in cases of intolerance or failure of the oral route, under the guidance of a specialist opinion.