Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial

Paulo Zielinsky, Antônio Luiz Piccoli Jr, Izabele Vian, Ana Maria Zílio, Alexandre Antônio Naujorks, Luiz Henrique Nicoloso, Carolina Weiss Barbisan, Stefano Busato, Mauro Lopes, Caroline Klein, Paulo Zielinsky, Antônio Luiz Piccoli Jr, Izabele Vian, Ana Maria Zílio, Alexandre Antônio Naujorks, Luiz Henrique Nicoloso, Carolina Weiss Barbisan, Stefano Busato, Mauro Lopes, Caroline Klein

Abstract

Background: We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis.

Objective: To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols.

Methods: Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30 mg/100 mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples.

Results: Mean GA was 33 ± 2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277 mg, decreasing to 126 mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV = 1.2 ± 0.4 m/s (0.7-1.6) to 0.9 ± 0.3 m/s (0.6-1.3) (p = 0.018); DDV = 0.21 ± 0.09 m/s (0.15-0.32) to 0.18 ± 0.06 m/s (0.11-0.25) (p = 0.016); RV/LV ratio = 1.3 ± 0.2 (0.9-1.4) to 1.1 ± 0.2 (0.8-1.3) (p=0.004); ductal PI = 2.2 ± 0.03 (2.0-2.7) to 2.4 ± 0.4(2.2-2.9) (p = 0.04)]. In the control group, with GA of 32 ± 4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio.

Conclusion: The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.

Conflict of interest statement

Potential Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1
Figure 1
Assessment of the average maternal consumption of polyphenols through the application of the food frequency questionnaire before (Moment 1) and after (Moment 2) intervention in the intervention and control groups.
Figure 2
Figure 2
Doppler echocardiographic findings in a 29-week fetus before and two weeks after dietary intervention for restriction of foods rich in polyphenols. There is decrease of systolic (0.93 m/s to 0.71 m/s) and diastolic (0.19 m/s to 0.10 m/s) velocities, as well as an increase in the ductal pulsatility index (2.25 to 2.73). LV: left ventricle; VD: right ventricle; PA: Pulmonary Artery; Ao: Aorta; DA: Ductus Arteriosus.
Figure 3
Figure 3
Ductal systolic velocity before (Moment 1) and after (Moment 2) intervention, in the intervention and control groups.
Figure 4
Figure 4
Ductal diastolic velocity before (Moment 1) and after (Moment 2) intervention, in the intervention and control groups.
Figure 5
Figure 5
Assessment of the pulsatility index (PI) before (Moment 1) and after (Moment 2) intervention, in the intervention and control groups.
Figure 6
Figure 6
Follow-up of the ratios between the diameters of the right and left ventricles (RV/LV) before (Moment 1) and after (Moment 2) intervention, in the intervention and control groups.

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