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

Abstract

Cocoa powder has twice more antioxidants than red wine and three times more than green tea. Ten percent of its weight is made up of flavonoids. Cocoa has antioxidant and anti-inflammatory effects by downregulating cyclooxigenase-2 receptors expression in the endothelium and enhancing nitric oxide bioavailability. There are evidences that while polyphenols ingestion have cardioprotective effects in the adult, it may have deleterious effect on the fetus if ingested by the mother on the third trimester of pregnancy, causing intrauterine fetal ductus arteriosus (DA) constriction. Polyphenols present in many foods and their anti-inflammatory and antinociceptive activities have been shown to be as or more powerful than those of indomethacin. These effects are dependent on the inhibition of modulation of the arachidonic acid and the synthesis of prostaglandins, especially E-2, which is responsible for fetal DA patency. So, we hypothesized that this same mechanism is responsible for the harmful effect of polyphenol-rich foods, such as cocoa, upon the fetal DA after maternal intake of such substances in the third trimester of pregnancy, thereby rising the perspective of a note of caution for pregnant women diet.

Naringin Supplementation during Pregnancy Induces Sex and Region-Specific Alterations in the Offspring’s Brain Redox Status

“…Lastly, as shown in the introduction, the anti-inflammatory and antioxidant properties of polyphenols induced alterations in the closure dynamics of the fetal ductus arteriosus when consumed in high amounts during the third trimester of pregnancy, which is the critical window of development of the fetus’ ductus [ 27 , 28 , 87 ]. Similarly, we have demonstrated that maternal naringin supplementation during the third week of gestation induced redox alterations in the offspring’s brain, mainly on postnatal day 7, which promoted a sex-dependent pro-oxidative milieu in the cerebellum and striatum at this postnatal age.…”

Brazilian Fetal Cardiology Guidelines - 2019

“…122 An experimental single-dose of cocoa administered to rats during the third trimester of gestation caused ductal constriction equivalent to that caused by indomethacin. 123 Normal human fetuses during the third trimester, when exposed to maternal consumption of polyphenols above the 75 th percentile of the average population, exhibit worse ductus arteriosus flow dynamics and increased right-to-left ventricular diameter ratios (higher ductal flow velocities and larger right ventricular diameters), in comparison with those exposed to maternal consumption of polyphenols below the 25 th percentile. 76 Normal human fetuses submitted to guided nutritional intervention (restriction of polyphenol-rich foods) in the third trimester showed, after 2 weeks, decreased ductal systolic and diastolic velocities, increased pulsatility index, and decreased right-to-left ventricular and pulmonary artery to aorta ratios, whereas these parameters did not change during the same period in control fetuses who were not submitted to the intervention.…”

“…An experimental single-dose of cocoa administered to rats during the third trimester of gestation caused ductal constriction equivalent to that caused by indomethacin. 123…”

Foetal ductus arteriosus constriction unrelated to non-steroidal anti-Inflammatory drugs: a case report and literature review

“…Premature intra-uterine DA constriction could be diagnosed in complex congenital heart malformations, including Tetralogy of Fallot and truncus arteriosus. As an isolated defect, it is usually secondary to the use of medication like NSAIDs, isoxsuprine, fluoxetine and some foods rich in polyphenol like herbal teas, dark chocolate, orange juice, red/purple grapes, berries and coffee [8][9][10][11][12].…”