Maternal Restriction of Polyphenols and Fetal Ductal Dynamics in Normal Pregnancy: An Open Clinical Trial

Abstract

BackgroundWe 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. ObjectiveTo test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. MethodsOpen 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 (<30mg/100mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. ResultsMean GA was 33±2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277mg, decreasing to 126mg 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±0.4m/s (0.7-1.6) to 0.9±0.3m/s (0.6-1.3) (p=0.018); DDV=0.21±0.09m/s (0.15-0.32) to 0.18±0.06m/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. ConclusionThe 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.

Herbal Therapy in Pregnancy-What to Expect when you Expect?

“…These findings were consistent with the prospective study results where in 102 fetuses exposed to polyphenol rich maternal diet in late pregnancy, changed fetal ductus arteriosus flow dynamics (higher ductal velocities and higher right-to-left ventricular ratio) were detected when compared with 41 non-exposed ones [135]. The restriction of polyphenols rich food consumption for two weeks in normal late pregnancies resulted in improved ductus arteriosus flow dynamics and right ventricular dimensions [136]. Finally, after maternal restriction of polyphenol rich food during the third semester, complete reversal of ductal constriction was observed in all 51 fetuses with diagnosed constriction of ductus arteriosus [137].…”

Excessive Maternal Orange Intake - A Reversible Etiology of Fetal Premature Ductus Arteriosus Constriction: A Case Report

“…Excessive intake of these dietary components in late gestation may trigger alterations in the fetal DA dynamics. Fetal ductal constriction is reversed by the dietary restriction of polyphenol-rich foods [9,10] .…”

Deleterious effects of maternal ingestion of cocoa upon fetal ductus arteriosus in late pregnancy

“…The histological analysis showed an increase in the avascular media layer, confirming ductal constriction ( Zielinsky et al, 2012a ). Observational studies in humans also showed that polyphenol rich food ingestion on the third trimester of pregnancy caused ductal contriction ( Zielinsky et al, 2010a , b, 2012b ; Zielinsky and Busato, 2013 ) and that the restriction of polyphenols from maternal diet reverted the constrictive effect unto normal flow through the DA even in normal pregnancies ( Zielinsky et al, 2012b , 2013 ). Furthermore, 2 weeks of daily supplementation of polyphenol rich food (total polyphenol of >3100 mg/day) to pregnant ewe caused ductal constriction and decreased plasmatic lipid peroxidation (TBARS) and increased catalase and glutathione peroxidase levels in maternal plasma when compared to normal diet group ( Bubols et al, 2014 ).…”