Premature constriction of the fetal ductus arteriosus following the maternal consumption of camomile herbal tea

Sridharan, Shankar; Archer, Nicholas; Manning, Nicky

doi:10.1002/uog.6453

Cited by 31 publications

(26 citation statements)

References 6 publications

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“…1,12,13 We and others have already suggested that maternal ingestion of polyphenol-rich foods (PRF) in late pregnancy, such as herbal teas, grape juice, dark chocolate and others, could be associated to fetal DC. [14][15][16][17][18] Experimental studies in fetal lambs have supported this hypothesis, showing a cause and effect relationship of maternal consumption of green tea and other polyphenol-rich substances with constriction of fetal DA in the animal model. 19 In the human setting, we have demonstrated that fetuses exposed to a maternal diet rich in polyphenols in the third trimester show higher ductal velocities and lower pulsatility indexes (PIs), as well as larger right ventricles, than those exposed to minimal amounts of these substances.…”

Section: Methodsmentioning

confidence: 95%

“…This finding is consistent with the conceptual hypothesis that maternal consumption of substances with anti-inflammatory effects in late pregnancy may have a constrictive action upon the fetal ductus, as a result of prostaglandin biosynthesis inhibition. [1][2][3]14,[16][17][18] There are many evidences supporting this view, such as the demonstration that normal fetuses exposed to a maternal daily diet with higher content of polyphenol substances (above the 75th percentile) have higher ductal velocities and RV/LV ratios than fetuses exposed to lower amounts of PRF (below the 25th percentile). 15,16 A cause and effect relationship between maternal ingestion of polyphenol-rich beverages and fetal DC in late pregnancy has been experimentally shown in an animal model using fetal lambs.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 A cause and effect relationship between maternal ingestion of polyphenol-rich beverages and fetal DC in late pregnancy has been experimentally shown in an animal model using fetal lambs. 19 Case reports in the recent literature have also described fetal DC in the human fetus following maternal consumption of camomile tea and antocyanins, 17,18 with reversion of the effect after suspension of the flavonoid-rich beverages from the diet.…”

Section: Discussionmentioning

confidence: 99%

“…20,22 -27,29 The presumption that fetal DC unrelated to maternal ingestion of NSAID could be associated to maternal intake of PRF has been investigated and the results have corroborated the idea. 8,11,14,[16][17][18] We then designed the present open clinical trial in order to determine if restriction of these substances in fetuses with third trimester DC without maternal intake of NSAID would be followed by reversal of the disorder. The results herein presented are consistent with this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

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Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial

et al. 2011

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Objective: To test the hypothesis that maternal restriction of polyphenolrich foods (PRF), which, like non-steroidal anti-inflammatory drugs (NSAID), inhibit prostaglandin synthesis in the third trimester, reverse fetal ductal constriction (DC). Study Design:An open clinical trial of 51 third trimester fetuses with DC with no history of NSAID intake was designed. All mothers were submitted to a food frequency questionnaire and were oriented to withdrawl PRF, being reassessed after 3 weeks. Doppler parameters were assessed before and after discontinuation of these substances. A control group of 26 third trimester normal fetuses, with no ductus arteriosus (DA) constriction, in which no dietary intervention was offered, was reviewed after 3 weeks. Student's t-test and Wilcoxon's test were used.Result: Mean gestational age was 32±3 weeks (28 to 37 weeks). After discontinuation of PRF (X3 weeks), 48/51 fetuses (96%) showed complete reversal of DC, with decrease in mean ductal systolic velocity (1.74 ± 0.20 m s À1 to 1.31 ± 0.34 m s À1 , P<0.001), mean diastolic velocity (0.33±0.09 m s À1 to 0.21±0.07 m s À1 , P<0.001) and mean right to left ventricular dimension ratio (1.37 ± 0.26 to 1.12 ± 0.17, P<0.001) and increase in mean ductal pulsatility index (PI) (1.98 ± 0.36 to 2.46±0.23, P<0.001). Median daily maternal consumption of PRF was 286 mg per day and decreased after orientation to 0 mg per day, P<0.001. In the control group, with GA of 32±4 w (29-37 w), there was no significant differences in median daily maternal consumption of PRF, mean ductal systolic velocitiy, diastolic velocity, PI and right ventricular to left ventricular diameter ratio (RV/LV) ratio. Keywords: fetal ductal constriction; prostaglandins; pulmonary hypertension; polyphenol-rich foods Introduction Ductal constriction (DC) has long been related to inhibition of the prostaglandin synthesis pathway, mainly as a result of maternal intake of non-steroidal anti-inflammatory drugs (NSAID) in the third trimester of pregnancy. 1-5 Constriction of fetal ductus arteriosus (DA) is a risk factor for pulmonary hypertension in the newborn period, with its known severe consequences. [6][7][8][9][10][11] For several years, many reports have been discussing the high prevalence of DC in the absence of a known trigger effect. 11 It has been discussed that other extrinsic factors, in addition to NSAID, could be involved in the genesis of this important clinical situation. 1,12,13 We and others have already suggested that maternal ingestion of polyphenol-rich foods (PRF) in late pregnancy, such as herbal teas, grape juice, dark chocolate and others, could be associated to fetal DC. [14][15][16][17][18] Experimental studies in fetal lambs have supported this hypothesis, showing a cause and effect relationship of maternal consumption of green tea and other polyphenol-rich substances with constriction of fetal DA in the animal model. 19 In the human setting, we have demonstrated that fetuses exposed to a maternal diet rich in polyphenols in the third trimester show h...

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Section: Methodsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial

et al. 2011

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“…5,6 Very recently, other investigators have reported fetal ductal constriction after maternal ingestion of camomile tea, a substance with high flavonoid content, with reversal of the effect after stopping its intake. 7 For these reasons, it is a 'note of caution' that we raise regarding maternal consumption of polyphenol-rich substances in the third trimester, which is obviously to be thoroughly investigated in future studies.…”

mentioning

confidence: 99%

Response to Galão et al

Zielinsky¹

2010

J Perinatol

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Prenatal effects of maternal consumption of polyphenol‐rich foods in late pregnancy upon fetal ductus arteriosus

Zielinsky¹,

Busato²

2013

Birth Defects Research Pt C

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Fetal circulation has characteristic features, being morphologically and functionally different from extrauterine circulation. The ductus arteriosus plays a fundamental role in directing the blood flow to fetal inferior body parts. Basically, the ductus arteriosus directs 80–85% of the right ventricular output arising from the superior vena cava, coronary sinus, and a small part from the inferior vena cava to descending aorta. Its histological structure is made up predominantly by a thick muscular layer, differently from the aorta and the pulmonary artery, which increases with gestational age. The fibers have a circumferential orientation, especially at the external layers, facilitating and making effective ductal constriction. These factors may generate lumen alterations which may cause fetal and neonatal complications, such as heart failure, hydrops, neonatal pulmonary hypertension, and even death. Classically, maternal administration of indomethacin and/or other antiinflammatory drugs interfere in prostaglandins metabolism, causing ductal constriction. However, many cases of fetal ductal constriction, as well as of persistent neonatal pulmonary artery hypertension, remain without an established etiology, being referred as “idiopathic.” In recent years, a growing body of evidence has shown that herbs, fruits, nuts, and a wide diversity of substances commonly used in daily diets have definitive effects upon the metabolic pathway of inflammation, with consequent inhibition of prostaglandins synthesis. This antiinflammatory action, especially of polyphenols, when ingested during the third trimester of pregnancy, may influence the dynamics of fetal ductus arteriosus flow. The goal of this review is to present these new observations and findings, which may influence dietary orientation during pregnancy. Birth Defects Research (Part C) 99:256–274, 2013. © 2013 Wiley Periodicals, Inc.

show abstract

Premature constriction of the fetal ductus arteriosus following the maternal consumption of camomile herbal tea

Cited by 31 publications

References 6 publications

Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial

Reversal of fetal ductal constriction after maternal restriction of polyphenol-rich foods: an open clinical trial

Response to Galão et al

Prenatal effects of maternal consumption of polyphenol‐rich foods in late pregnancy upon fetal ductus arteriosus

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