Comparing the Chemistry of Malvidin-3-O-glucoside and Malvidin-3,5-O-diglucoside Networks: A Holistic Approach to the Acidic and Basic Paradigms with Implications in Biological Studies.

The kinetics, thermodynamics, and degradation of malvidin mono- and diglucosides were studied following a holistic approach by extending to the basic medium. In acidic conditions, the reversible kinetics of the flavylium cation toward the equilibrium is controlled by the hydration and cis-trans isomerization steps, while in the basic medium, the OH- nucleophilic addition to the anionic quinoidal bases is the slowest step. There is a pH range (transition pHs), between the acidic and basic paradigms, that includes physiological pH (7.4), where degradation reactions occur faster, preventing the system from reaching the equilibrium. The transition pH of the diglucoside is narrower, and in contrast with the monoglucoside, there is no evidence for the formation of colored oligomers among the degradation products. Noteworthy, OH- addition in position 4 to form B42-, a kinetic product that decreases the overall equilibration rate, was observed only for the diglucoside.

Intermolecular Copigmentation of Malvidin-3-O-glucoside with Caffeine in Water: The Effect of the Copigment on the pH-Dependent Reversible and Irreversible Processes.

Intermolecular copigmentation of malvidin-3-O-glucoside with caffeine was studied using a holistic procedure that includes the extension to basic pH values. In moderately basic solutions (7.5 < pH < 9.5) and independently of the copigment presence, there is a pH region where degradation of the quinoidal base and anionic quinoidal bases is faster than hydration and OH- nucleophilic addition, preventing the system from reaching the equilibrium. Intermolecular copigmentation with caffeine reduces significantly the degradation rate of quinoidal bases. In a more basic medium, the equilibrium is reached and degradation occurs from the anionic chalcones. In this case, the addition of caffeine also reduces the degradation rate in the interval 10 < pH < 11.5.

Intermolecular Copigmentation Between Delphinidin 3-O-Glucoside and Chlorogenic Acid: Taking into Account the Existence of Neutral and Negatively Charged Forms of the Copigment.

Stopped flow corroborated by UV-vis measurements allowed for the calculation of the copigmentation constants of delphinidin 3-O-glucoside with the neutral (CP) and negatively charged CP(-) forms of chlorogenic acid. Solutions of delphinidin 3-O-glucoside in the absence and presence of the copigment were equilibrated at several pH values in the acidic region, pH < 6, and reverse pH jumps monitored by stopped flow were carried out by adding sufficient acid to give flavylium cation at pH ≤ 1. This procedure allows for the separation of three contributions: (i) all flavylium cation and quinoidal base species, (ii) all hemiketal species, and (iii) all cis-chalcone species. Reverse pH jumps can also be performed at fixed pH versus copigment addition. The contribution of trans-chalcone, minor species in the present system, requires reverse pH jumps from the equilibrium followed by a common spectrophotometer. The system was also studied by UV-vis as a function of the copigment addition at different pH values. A global fitting of all experimental data allowed for determination of the copigmentation constants with flavylium cation, KAH+CP = 167 M-1, KAH+CP(-) = 338 M-1; and quinoidal base, KACP = 1041 M-1, KACP(-)= 221 M-1. No significant copigmentation was observed for hemiketal and chalcones. Computational calculations confirm different geometries for the interactions of flavylium cation and quinoidal base with the neutral or the negatively charged forms of the copigment as well as predict identical relative order for the binding energies of the four adducts.

Modulating the thermodynamics, kinetics and photochemistry of 7-diethylamino-4'-dimethylaminoflavylium in water/ethanol, SDS and CTAB micelles.

The thermodynamics and kinetics of compound 7-diethylamino-4'-dimethylaminoflavylium were studied in water : ethanol (1 : 1) and water in the presence of SDS and CTAB micelles. The blue flavylium cation is in equilibrium with the pink protonated flavylium cation defined by pKAH2+/AH+ and the yellow trans-chalcone, defined by pKAH+/Ct. The difference between these two pKs gives the pH domain of the flavylium cation, ΔpK = 1.95 in CTAB, ΔpK = 5.6 in water/ethanol (1 : 1) and ΔpK = 8.5 in SDS micelles. On the other hand, the pH domain of the trans-chalcone is limited by pKAH+/Ct and pKCt/Ct-. It is lower in SDS micelles ΔpK = 2.7, increases in ethanol/water (1 : 1) ΔpK = 5.1 and is maximum in CTAB micelles, ΔpK = 6.8. All these effects can be explained by the electric charge present at the micellar surface. Relative energy level diagrams that allow for the explanation of the driving forces for any pH stimuli or light absorption were constructed from the calculated equilibrium constants. Irradiation of the trans-chalcone at 466 nm leads to the formation of the flavylium cation. In water : ethanol (1 : 1), the photochemistry is residual with Φ < 0.00002, while in SDS micelles at pH = 7 light increases the rate of the spontaneous conversion of trans-chalcone to the flavylium cation, with quantum yield Φ = 0.002; photochromism from trans-chalcone to give the flavylium cation with the same quantum yield is also observed in CTAB micelles.

A New Insight into the Degradation of Anthocyanins: Reversible versus the Irreversible Chemical Processes.

The kinetics and thermodynamics of the pH-dependent reversible and irreversible processes leading to color fading of pelargonidin-3-O-glucoside, peonidin-3-O-glucoside, malvidin-3-O-glucoside, and cyanidin-3-O-glucoside dyes in aqueous solutions are reported. Following the addition of base to the flavylium cation, the quinoidal bases disappear by three distinct steps: (i) in an acidic medium by a biexponential process, in which the faster step is controlled by the hydration reaction and the slower one by cis-trans isomerization; the degradation process occurs essentially from the anionic quinoidal base; (ii) in a basic medium (pH > 9.5), in which the disappearance of the anionic bases is monoexponential, with the rate proportional to the hydroxyl concentration (hydroxyl attack), leading to anionic chalcones (cis and trans) at equilibrium─the slower degradation step occurs from the di- and trianionic chalcones; and (iii) in the pH region circa 7.7 < pH < 9.5, in which hydration and hydroxyl attacks are much slower than anionic quinoidal base degradation (which is the rate-controlling step) and the equilibrium cannot be attained.

Natural and Synthetic Flavylium-Based Dyes: The Chemistry Behind the Color.

Flavylium compounds are a well-known family of pigments because they are prevalent in the plant kingdom, contributing to colors over a wide range from shades of yellow-red to blue in fruits, flowers, leaves, and other plant parts. Flavylium compounds include a large variety of natural compound classes, namely, anthocyanins, 3-deoxyanthocyanidins, auronidins, and their respective aglycones as well as anthocyanin-derived pigments (e.g., pyranoanthocyanins, anthocyanin-flavan-3-ol dimers). During the past few decades, there has been increasing interest among chemists in synthesizing different flavylium compounds that mimic natural structures but with different substitution patterns that present a variety of spectroscopic characteristics in view of their applications in different industrial fields. This Review provides an overview of the chemistry of flavylium-based compounds, in particular, the synthetic and enzymatic approaches and mechanisms reported in the literature for obtaining different classes of pigments, their physical-chemical properties in relation to their pH-dependent equilibria network, and their chemical and enzymatic degradation. The development of flavylium-based systems is also described throughout this Review for emergent applications to explore some of the physical-chemical properties of the multistate of species generated by these compounds.

Achieving Complexity at the Bottom: Molecular Metamorphosis Generated by Anthocyanins and Related Compounds.

The concept of molecular metamorphosis is described. A molecule (flavylium cation) generates a sequence of other different molecules by means of external stimuli. The reversibility of the system allows for the flavylium cation to be recovered by other external stimuli, completing one cycle. Differently from supramolecular chemistry, molecular metamorphosis is not a bottom-up approach. All events occur at the bottom. The procedures to characterize the kinetics and thermodynamics of the cycles are summarized. They are based on direct pH jumps (addition of a base to the flavylium cation) and reverse pH jumps (addition of an acid to equilibrated solutions at higher pH values). Stopped flow is an indispensable tool to characterize these systems. The following metamorphic cycles will be described to illustrate the concept: (i) introducing the flavanone in the metamorphic system and illustrating the concept of a timer at the molecular level; (ii) response of the flavylium-based metamorphosis to light inputs and the write-lock-read-unlock-erase molecular system; (iii) a one-way cycle of direct-reverse pH jumps; (iv) interconversion of the flavylium cation with 2,2'-spirobis[chromene] derivatives; (v) 6,8 A-ring substituent rearrangements.

Strategies used by nature to fix the red, purple and blue colours in plants: a physical chemistry approach.

While identified by the respective flavylium cation, anthocyanins are much more than this molecule. The flavylium cation (generally appearing only at very acidic pH values) is one of the molecules of a complex sequence of pH dependent molecular species reversibly interconnected by different chemical reactions. These species include the red flavylium cation, purple quinoidal base and blue or bluish anionic quinoidal bases. At the common pH of the vacuoles of simpler anthocyanins, the red flavylium cation is present only at very acidic pH values and at moderately acidic pHs there is no significant colour of the purple quinoidal base. Moreover, the blue or bluish anionic quinoidal base appearing around neutral pH values is not stable. Intermolecular (copigmentation) and intramolecular (in acylated anthocyanins) interactions increase the colour hue and yield bathochromic shifts in the absorption bands, permitting to extend the pH domain of the flavylium cation and increase the mole fraction of the quinoidal bases. Metal complexation is another strategy. In particular, the Al3+ cation plays an essential role in the blue colour of hydrangea. The most sophisticated structures are however the metaloanthocyanins, such as the one that gives the blue colour of commelina communis, constituted of six anthocyanins, six flavanones and two metals. In this work we discuss how physical chemical tools are indispensable to account for the chemical behaviour of these complex systems. The experimental procedures and the equations needed to calculate all equilibrium constants of anthocyanins and the consequent pH dependent mole fraction distributions in the absence or presence of copigments are described in detail. Reverse pH jumps monitored by stopped flow have been shown to be an indispensable tool to calculate these parameters.

Light- and pH-regulated Water-soluble Pseudorotaxanes Comprising a Cucurbit[7]uril and a Flavylium-based Axle.

A linear double pyridinium-terminated thread comprising a central chalcone moiety is shown to provide two independent binding sites with similar affinity for cucurbit[7]uril (CB7) macrocycles in water as judged from NMR, UV-Visible and fluorescence spectroscopies. Association results in [2] and [3]pseudorotaxanes, which are both pH and photosensitive. Switching from the neutral chalcone to the cationic flavylium form upon irradiation at 365 nm under acidic conditions provided an enhanced CB7 association (K1:1 increases from 1.2×105  M-1 to 1.5×108  M-1 ), limiting spontaneous on-thread cucurbituril shuttling. This co-conformational change in the [2]pseudorotaxane is reversible in the dark with kobs =4.1×10-4  s-1 . Threading the flavylium moiety into CB7 leads to a dramatic increase in the fluorescence quantum yield, from 0.29 in the free axle to 0.97 in the [2]pseudorotaxane and 1.0 in the [3]pseudorotaxane.

Anthocyanin Color Stabilization by Host-Guest Complexation with p-Sulfonatocalix[n]arenes.

Flavylium-based compounds in their acidic and cationic form bring color to aqueous solutions, while under slightly acidic or neutral conditions they commonly bring discoloration. Selective host-guest complexation between water-soluble p-sulfonatocalix[n]arenes (SCn) macrocycles and the flavylium cationic species can increase the stability of the colored form, expanding its domain over the pH scale. The association constants between SCn and the cationic (acid) and neutral basic forms of flavylium-based compounds were determined through UV-Vis host-guest titrations at different pH values. The affinity of the hosts for synthetic chromophore was found to be higher than for a natural anthocyanin (Oenin). The higher affinity of SC4 for the synthetic flavylium was confirmed by 1H NMR showing a preferential interaction of the flavylium phenyl ring with the host cavity. In contrast with its synthetic counterpart, the flavylium substitution pattern in the anthocyanin seems to limit the inclusion of the guest in the host's binding pocket. In this case, the higher affinity was observed for the octamer (SC8) likely due to its larger cavity and higher number of negatively charged sulfonate groups.

Evolution of Flavylium-Based Color Systems in Plants: What Physical Chemistry Can Tell Us.

Anthocyanins are the basis of the color of angiosperms, 3-deoxyanthocyanins and sphagnorubin play the same role in mosses and ferns, and auronidins are responsible for the color in liverworts. In this study, the color system of cyanidin-3-O-glucoside (kuromanin) as a representative compound of simpler anthocyanins was fully characterized by stopped flow. This type of anthocyanin cannot confer significant color to plants without intra- or intermolecular interactions, complexation with metals or supramolecular structures as in Commelina communis. The anthocyanin's color system was compared with those of 3-deoxyanthocyanins and riccionidin A, the aglycone of auronidins. The three systems follow the same sequence of chemical reactions, but the respective thermodynamics and kinetics are dramatically different.

On the Limits of Anthocyanins Co-Pigmentation Models and Respective Equations.

Anthocyanins co-pigmentation models with application on 1:1 complexes were revisited, and their limitations were critically commented. The flavylium multistate of species is dramatically simplified to a single acid-base equilibrium between flavylium cation and its conjugated base CB, equal to the sum of quinoidal base, hemiketal, and cis and trans-chalcones. Bearing this, a new equation that simultaneously allows calculation of the co-pigmentation constant with flavylium cation (KAH+CP) and with its conjugated base CB (KCBCP) was deduced. This equation can be used at a fixed co-pigment concentration with pH as a variable or at fixed pH and co-pigment concentration variable. A global fitting of all data allows us to calculate both association constants with good accuracy. The model was applied to the co-pigmentation of malvidin-3-glucoside with caffeine and pentagalloyl glucose (PGG). Caffeine gives rise to complexes not only with flavylium cation KAH+CP = 125 ± 7 M-1 but also with CB with KCBCP = 23 ± 3 M-1. PGG complexes exclusively with flavylium cation, KAH+CP = 914 ± 10 M-1, and the possible interaction with quinoidal base is lower than the detection limits that the inherent experimental error permits.

Correction to "New Procedure to Calculate All Equilibrium Constants in Flavylium Compounds: Application to the Copigmentation of Anthocyanins".

[This corrects the article DOI: 10.1021/acsomega.9b01066.].

Chemical evolution of the colour systems generated by riccionidin A, 3-deoxyanthocyanidins and anthocyanins.

The kinetics and thermodynamics (in acidic solutions) of the five chemical species reversibly interconnected by external stimuli (a multistate), such as pH and light, generated by the liverworts colorant riccionidin A were investigated. The degradation products of the multistate formed after 10 days at neutral pH were identified. The behaviour of riccionidin A multistate was compared with previous results reported for the equivalent systems based on 3-deoxyanthocyanidins (found in mosses and ferns) and anthocyanins (ubiquitous in angiosperms). The five chemical species have mutatis mutandis similar structures in the three multistates. The most dramatic difference is the extremely slow interconversion rate between flavylium cation and trans-chalcone in riccionidin A and related compounds multistates (tens of days) when compared with deoxyanthocyanins (a few days) and anthocyanins (several hours), at room temperature. The mole fraction distribution of the five species that constitute the multistate as a function of pH is also different in the three families of compounds. Some considerations regarding the chemical evolution of the three systems are given.

A Photoelectrochemical Study of Bioinspired 2-Styryl-1-Benzopyrylium Cations on TiO2 Nanoparticle Layer for Application in Dye-Sensitized Solar Cells.

In the present work, five 2-styryl-1-benzopyrylium salts and their relative self-assembly processes towards TiO2 nanocrystalline layers were evaluated as photosensitizers in dye-sensitized solar cells (DSSCs). Integration of these 2-styryl-1-benzopyrylium salts with the semiconductor allow for the performance of highly specific functions suitable for smart applications in material science. Spectroscopic and photoelectrochemical measurements conducted on these five bio-inspired dyes, in solution and upon adsorption onto titanium dioxide films, allowed detailed discussion of the anchoring ability of the different donor groups decorating the 2-styryl-1-benzopyrylium core and have demonstrated their ability as photosensitizers. Our results suggest that the introduction of a dimethylamino group in position 4' of the 2-styryl-1-benzopyrylium skeleton can alter the conjugation of the molecule leading to larger absorption in the visible region and a stronger electron injection of the dye into the conduction band of TiO2. Moreover, our experimental data have been supported by theoretical calculations with the aim to study the energy of the excited states of the five compounds. In this specific case, the simulations reported contributed to better describe the properties of the compounds used and to help create the necessary basis for the design of new and targeted bio-inspired molecules.

Ground and excited state properties of furanoflavylium derivatives.

The comparison of the ground-state reactivity of anthocyanins and aurone model compounds (i.e. with and without the furano bridge) has shown that the kinetic paradigm does not depend on the bridge but only on the hydroxyl substituent pattern, independently of the presence of the bridge: (i) bell shaped kinetics for those with two hydroxyl substituents in position 4' and 7, and (ii) four distinct kinetic steps for the mono substituted compounds with a hydroxyl in position 4'. The excited state proton transfer (ESPT) properties of these compounds were also investigated using steady-state and time-resolved spectroscopic techniques. It was found that the ESPT efficiency is significantly higher for the bridged compounds. Interestingly, pH-dependent steady-state fluorescence emission experiments show that in 4',7-dihydroxyfuranoflavylium the hydroxyl group in position 7 is the more acidic one in the excited state, while 1H NMR titration curves indicate a higher acidity constant in the ground state for the proton at the hydroxyl group in position 4'. Differently, the fluorescence emission spectrum of the quinoidal base deprotonated at position 7 is only observed upon excitation of the flavylium cation while the one from the base deprotonated at 4' is observed upon direct excitation.

pH-Dependent Multistate System Generated by a Synthetic Furanoflavylium Compound: An Ancestor of the Anthocyanin Multistate of Chemical Species.

The multistate of chemical species generated by 4'-hydroxy-3,2'-furanoflavylium is similar to that of anthocyanins and related compounds. This furanoflavylium multistate system was fully characterized by UV-visible and NMR spectroscopy, allowing determination of the respective equilibrium and rate constants. In contrast to the multistate generated by flavylium cations derived from anthocyanins and related compounds, the furanoflavylium multistate is characterized by much slower hydration and tautomerization (pyran ring opening-closing). In addition, the cis-trans isomerization of the chalcones of this system (2'-hydroxyaurones) is extremely slow when compared with anthocyanins. The observed similar order of magnitude for tautomerization and isomerization rate constants leads to peculiar kinetics from the flavylium cation (pH = 1) to the stable trans-chalcone (higher pH values). The hemiketal appears and disappears during the first stages of the kinetics, which gives the intermediate cis-chalcone (pseudo-equilibrium). This last species disappears in a much slower process, as fully characterized by 1H NMR, to give the final trans-chalcone.

New Procedure To Calculate All Equilibrium Constants in Flavylium Compounds: Application to the Copigmentation of Anthocyanins.

A new experimental procedure to calculate all equilibrium constants of the multistate of species of anthocyanins and related compounds, including those in basic medium, is reported. The procedure is based on a series of pH jumps monitored by stopped flow from an extended pH range of solutions at pseudo-equilibrium (when there is no significant formation of trans-chalcones) or at equilibrium to pH = 1.0. The experimental procedure is described for the anthocyanin model compound 4'-hydroxyflavylium, which exhibits a peculiar behavior in moderately acidic medium, because the quinoidal base, hemiketal, and cis-chalcone have similar mole fractions at pseudo-equilibrium, permitting good discrimination among these species. The experimental procedure can be extended to the copigmentation phenomenon and allow the calculation of the 1:1 copigmentation constants of the flavylium cation, quinoidal base, hemiketal, and cis- and trans-chalcones (this last from the equilibrium) and their respective ionized forms. The method was applied to calculate the copigmentation constants of the model compound 4'-hydroxyflavylium as well as malvidin-3-glucoside with caffeine. In the last compound, the strongest interaction takes place with the quinoidal base (K = 303 M-1) and flavylium cation (K = 134 M-1) and, to a lesser extent, with the ionized quinoidal base (K = 43 M-1) and cis-chalcone (K = 17 M-1). The caffeine interaction with the hemiketal and the other ionized species is negligible.

Purple-fleshed sweet potato acylated anthocyanins: Equilibrium network and photophysical properties.

Two anthocyanins from purple-fleshed sweet potato were isolated and characterized by LC-MS and NMR analysis. They were identified as peonidin-3-(6'-hydroxybenzoyl)-sophoroside-5-glucoside and peonidin-3-(6'-hydroxybenzoyl-6″-caffeoyl)-sophoroside-5-glucoside. The acid-base dynamics of these acylated anthocyanins was evaluated by means of pH jump techniques. Equilibrium and kinetic constants were determined and, in general, these anthocyanins demonstrated a higher capacity in retaining the red and blue colors at acidic and basic pH values, suggesting a higher resistance to pH variations compared to the parent anthocyanin, peonidin-3-O-glucoside. The presence of acyl groups and additional glucoside moieties seems to determine this particular characteristic. The fluorescence properties of these anthocyanins were evaluated. Overall, the species present at higher pH values (7-9) showed higher fluorescence intensity for both anthocyanins, with an optimum λex/λem pair at λex 610 nm/λem 640 nm. The fluorescence characteristics of these anthocyanins were used to evaluate their location in gastric and intestinal cells by fluorescence microscopy.

Complicaciones obstétricas y perinatales en pacientes con anemia / Obstetric and perinatal complications in anemic patients

Resumen OBJETIVO: Determinar la relación entre complicaciones obstétricas y perinatales con la anemia durante el embarazo. MATERIALES Y MÉTODOS: Estudio ambispectivo, observacional y transversal. Se incluyeron pacientes en trabajo de parto, con embarazo único, atendidas entre marzo y octubre de 2017 en el Hospital General Dr. Salvador Zubirán Anchondo, Chihuahua, Chih. Se excluyeron las pacientes con embarazo complicado por defectos congénitos, que hubieran recibido anticoagulantes, con diagnóstico médico de hemoglobinopatías, hemofilias, preeclampsia, síndrome de HELLP, partos instrumentados y distocias, diabetes gestacional, nefropatías, hepatopatías, tabaquismo y toxicomanías. Complicaciones valoradas: amenaza de aborto, amenaza de parto pretérmino, parto pretérmino, ruptura prematura de membranas, infección de vías urinarias, peso al nacer, valoración de Apgar al minuto y a los 5 minutos, hemorragia obstétrica. Se entrevistó a todas las pacientes para evaluar los antecedentes ginecoobstétricos y se tomó una muestra de sangre venosa para determinar: hemoglobina, hematocrito, cantidad de glóbulos rojos, volumen corpuscular medio, concentración de hemoglobina corpuscular media. Se registraron las mediciones antropométricas, valores de Apgar y complicaciones perinatales del expediente clínico. RESULTADOS: Se estudiaron 1051 pacientes divididas en dos grupos: con anemia (n = 172) y sin anemia (n = 879). Se consideró anemia a la hemoglobina menor de 11 g/dL o hematocrito menor de 33%. Se clasificaron de acuerdo con la OMS como: anemia leve 10-10.9 g/dL, moderada 7-9.9 g/dL y severa menos de 7.0 g/dL. La prevalencia de anemia fue de 16%. La anemia leve se identificó con mayor frecuencia 10% (n = 111), anemia moderada y severa 6% (n = 61). Las complicaciones maternas y neonatales no mostraron asociación con la anemia materna durante el embarazo. La hemotransfusión fue mayor en pacientes con anemia (9 vs 1%). CONCLUSIÓN: Se identificó anemia materna en 16% de los casos y se asoció con necesidad de transfusión de hemoderivados en el posparto o posquirúrgico de cesárea.

Abstract OBJECTIVE: Determinate the association between adverse perinatal outcomes and anemia in pregnant women. MATERIALS AND METHODS: Observational, prospective-retrospective and cross-sectional study. Including women in birth labor attended at Hospital General Dr. Salvador Zubirán Anchondo in Chihuahua City, during March to October 2017. Inclusion criteria considered women with single pregnancy. Exclusion criteria with present conditions: congenital deformities, use of anticoagulants, blood diseases, preeclampsia, HELLP syndrome, instrumental delivery with forceps, dystocia, maternal diabetes, kidney and liver diseases, use of tobacco and other drugs. Adverse perinatal outcomes included were: miscarriage risk, preterm labor, preterm birth, pre labor rupture of membranes, urinary infection, low birth weight, Apgar score at birth and after five minutes, obstetric hemorrhage. Patients were interviewed to evaluate obstetric background; blood venous sample was taken to determine haemoglobin, hematocrit, red blood cells number, medium corpuscular volume, medium corpuscular hemoglobin concentration. Birth data was registered from medical records. RESULTS: Two groups were integrated: with anemia (n=172) and without anemia (n=879). Patients with anemia were those with haemoglobin less than 11 g/dL or hematocrit less than 33% according World Health Organization anemia classification: mild 10-10.9 g/dL, moderate 7-9.9 g/dL and severe less than 7.0 g/dL. Anemia frequency was calculated in 16%, mild anemia frequency was 10% (111 patients), 6% moderate and severe anemia (n = 61). Both groups developed patients with adverse perinatal outcomes. Transfusion of blood products showed higher frequency in anemic patients (9% versus 1% control group). CONCLUSION: Anemia prevalence calculated in 16% associated with transfusion of blood products, during puerperium or after c-section period.