1 / 28

ORIENTATION TO WITHDRAWL FOODS WITH MORE OF 30mg/100g

… could their antioxidant and antiinflammatory components interfere with prostaglandin metabolism and thus influence fetal ductus arteriosus dynamics?. FOOD FREQUENCY QUESTION NAIRE FOR QUANTIFICATION OF DAILY INGESTION OF POLIPHENOLS. ORIENTATION TO WITHDRAWL FOODS WITH MORE OF 30mg/100g.

gaye
Download Presentation

ORIENTATION TO WITHDRAWL FOODS WITH MORE OF 30mg/100g

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. … could their antioxidant and antiinflammatory components interfere with prostaglandin metabolism and thus influence fetal ductus arteriosus dynamics?

  2. FOOD FREQUENCY QUESTIONNAIRE FOR QUANTIFICATION OF DAILY INGESTION OF POLIPHENOLS ORIENTATION TO WITHDRAWL FOODS WITH MORE OF 30mg/100g COMPLETE REVERSION IN 96.3% (48/52 FETUSES WITH DUCTAL CONSTRICTION) (3 WEEKS AFTER SUSPENSION OF THE SUBSTANCES)

  3. CONSTRICTION OF DUCTUS ARTERIOSUS Pulsatility Index 2.19 ± 0.43 1.70 ± 0.41 PRE POST P=0.001

  4. Polyphenols FLAVONOIDS FLAVONOLS FLAVONS Catequinas Epicatequinas Teaflavinas FLAVAN - 3 - ONS FLAVONONS ANTOCYANIDINS

  5. ANTIINFLAMMATORY AND ANTIOXIDANT EFFECTS OF COMMON FOODS GREEN TEA BLACK TEA MATE TEA DARK CHOCOLATE RESVERATROL ORANGE JUICE

  6. 3rd TRIMESTER MATERNAL INGESTION • HERBAL TEAS AND OTHER FLAVONOID-RICH FOODS [3-gallate-gallocatechin, quercitin, cacao,…] • GRAPE DERIVATIVES [resveratrol] POLYPHENOLS WITH ANTIINFLAMMATORY ACTIONS DEPENDENT ON INHIBITION OF COX-2 AND PROSTAGLANDINS FETAL DUCTAL CONSTRICTION ?

  7. CONSTRICTION OF DUCTUS ARTERIOSUS

  8. IN NORMAL FETUSES, DUCTAL FLOW DYNAMICS AND RIGHT VENTRICULAR SIZE ARE INFLUENCED BY MATERNAL CONSUMPTION OF POLYPHENOL-RICH FOODS (CASE-CONTROL STUDY)

  9. Warn mothers about this... zielinsky@cardiol.br

  10. CONSTRICTION OF DUCTUS ARTERIOSUS Daily consumption ofpolyphenols 1509.05 mg/day (>perc 75) GA=32 ± 2 wks 2000 (28 - 38 wks) 1000 80.05 mg/day (<perc 25) AT DIAGNOSIS 0 AFTER ORIENTATION P= 0.0001

  11. DOPPLER BEFORE AND AFTER INGESTION OF GREEN TEA (CASES) p < 0.001 SYST VEL p < 0.001 DIASTVEL p =0.003 PI

  12. Heart specimen of a fetal lamb exposed to green tea VD VE RV/LV RATIO RV HYPERTROPHIC AND DILATED

  13. DUCTAL HISTOLOGY IN FETAL LAMB EXPOSED TO GREEN TEA 687.7 um DUCTAL LUMEN DECREASED DUCTAL LUMEN AND INCREASED MEDIAL AVASCULAR ZONE THICKNESS

  14. DUCTAL HISTOLOGY 238.4 AVASCULAR ZONE Case MEAN CONTROLS THICKNESS: 255.3 ± 97.9 AVASCULAR ZONE Control 933.3 MEAN CASES THICKNESS: p < 0.001 746.6 ± 214.6

  15. OBJECTIVE To investigate the interrelationships between fetal ductal flow dynamics, oxidative damage and polyphenol excretion after experimental exposure of PRF in sheep during late pregnancy 15

  16. STUDY SETUP SUFFOLK SHEEP (90-100kg) >120 DAYS GESTATION PRF Control Control PRF N= 2 N= 7 N=10 N=5 14 DAYS BASAL PRF supplementation (basic ingestion + 3100 mg/day Habitual diet (basic polyphenol ingestion) Statistics: Generalized Estimating Equations, post hoc Bonferroni.

  17. OPEN CLINICAL TRIAL n = 72 FETUSES GA > 28 WEEKS 3rd ECHO 2nd ECHO 1st ECHO 2 weeks 2 weeks Nutritional Questionnaire Nutritional Questionnaire SUSPENSION OF POLYPHENOL_RICH FOODS

  18. CONSTRICTION OF DUCTUS ARTERIOSUS Daily consumption ofpolyphenols 1509.05 mg/day (>perc 75) GA=32 ± 2 wks 2000 (28 - 38 wks) 1000 80.05 mg/day (<perc 25) AT DIAGNOSIS 0 AFTER ORIENTATION P= 0.0001

  19. CONSTRICTION OF DUCTUS ARTERIOSUS CONCLUSION OF INTERVENTIONAL STUDY The oriented restriction of maternal ingestion of polyphenol-rich foods in the third trimester is followed by regression of fetal ductal constriction.

  20. IN NORMAL FETUSES, DUCTAL FLOW DYNAMICS AND RIGHT VENTRICULAR SIZE ARE INFLUENCED BY MATERNAL CONSUMPTION OF POLYPHENOL-RICH FOODS (CASE-CONTROL STUDY)

  21. 143 NORMAL FETUSES FROM NORMAL MOTHERS IN THE THIRD SEMESTER OF PREGNANCY 28.4 ± 3.1 wks (23-38 wks) 102FETUSES WITH MATERNAL INGESTION OF POLIPHENOLS (> 75th PERCENTILE, 1089 MG) 41 FETUSES WITHOUT MATERNAL INGESTION OF POLIPHENOLS (< 25th PERCENTILE, 127 MG) FETAL DOPPLER ECHOCARDIOGRAM

  22. FETAL DUCTAL FLOW VELOCITIES AND RV/LV RATIO ACCORDING TO MATERNAL POLYPHENOL CONSUMPTION SYST VEL DIAST VEL P<0.001 P=0.011 0.17 0.96 0.96 0.11 0.61 PERC 75 >PERC 75 <PERC 25 >PERC 75 <PERC 25 RV/LV RATIO 0.96 P<0.001 1.23 0.94 >PERC 75 <PERC 25

  23. Fetal ductal constriction detection in fetal CHD Consider the possibility of mild ductal constriction in any fetal left heart disease (HLHS) with a decreasing CV Profile score (TR, decreasing RV function) Counsel mothers on polyphenol foods early after fetal diagnosis

  24. Use of Maternal Indomethacin and Fetal Ductal Constriction • Indomethacin doses of 25 mg PO BID or TID are effective for tocolysis • Short course of 48 hours is well tolerated • Some types of ductal dependent CHD can have short-course indomethacin tocolysis safely i.e. pulmonary atresia, Tetralogy of Fallot, etc.

  25. Effects of Indomethacin ductal closure in R heart disease e.g. Ebstein and TV dysplasia • Constriction/occlusion of the ductus arteriosus • Theoretical constriction of coronary arteries • Increase in pulmonary vascular resistance Benefits • Prevent or reverse pulmonary valve regurgitation • Decrease tricuspid valve regurgitation • Promote systolic pulmonary arterial flow • Improve systemic flow

  26. Approach to the fetus with CHDand preterm labor • Early identification • Address the cause (i.e. infection, indocin for poly) • Aggressive management of cervical incompetence, Redefine “viability” • Screen for CHF • Consider tocolysis early

  27. Advances in Perinatal Cardiology 10th Fun in the Sun Course Oct.23-26, 2014 St. Petersburg, FL Focus: Fetal Cardiac Treatment Arrhythmia Management See www.allkids.org “Conferences”

More Related