Capacidade antioxidante total da dieta de gestantes assistidas em rede pública de saúde e sua relação com desfechos maternos e neonatais

Abstract

Introduction: This dissertation's phenomenon of interest is the dietary total antioxidant capacity (TAC) and its association between the various nuances of women's health, with emphasis on pregnant women and their newborns and is composed of two scientific articles. Methodology: The first refers to a systematic review with metaanalysis and its search was carried out in the MEDLINE (via PubMed), EMBASE, LILACS and CINAHL databases until February 2024, considering observational studies that evaluated dietary TAC in pregnant women, women of reproductive age and in the pre- and post-menopausal period, with diseases related to women's health. In addition, manuscripts published in English, Portuguese and Spanish with full text available were included and all analyzes were performed using the RevMan 5.4 software. This review was prepared with the document proposed by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines (PRISMA) and registered in the PROSPERO database (ID: CRD42024427784). The second article deals with a cross-sectional study, carried out between 2013/2014, with pregnant women assisted by the public health system. Pregnant women with a single fetus who lived in Maceió and were treated in the public health network were included; and excluded those who had physical changes that could distort the anthropometric assessment and/or neurological problems. Socioeconomic, demographic, clinical, anthropometric, dietary and maternal-fetal outcome data were collected, the latter collected after birth. To calculate and determine dietary TAC, the following methods were analyzed: the ferric reducing capacity of plasma (FRAP) and the oxygen radical absorption capacity (ORAC), including ORAC-total and total phenolics (TP). Pearson's χ2 and Fisher's exact χ2 statistical tests were performed to determine differences in maternal and neonatal outcomes in tertiles (T1, T2 and T3) of dietary TAC adjusted for energy using the residual method, adopting a significance of p<0.05. The project was approved by the Ethics and Research Committee of the Federal University of Alagoas under CAAE no. 18807113.3.0000.5013. Results: In the first article, nineteen studies met the eligibility criteria. These studies had samples ranging from 64 to 3,209 women and evaluated the following clinical conditions: neoplasms (breast, endometrial and ovarian), bacterial vaginosis, menopause, polycystic ovary syndrome (PCOS), preeclampsia (PE), gestational diabetes mellitus (GDM), miscarriage, infertility and serum markers of inflammation and oxidative stress. Of these, twelve observed a significant association between dietary TAC and the outcomes of interest. In relation to the second article, in the adjusted model, the higher risk of gestational obesity in T1 of FRAP and the higher occurrence of vaginal birth in T2 of FRAP remained significant; the higher risk of gestational overweight, prematurity, fewer full-term births and appropriate for gestational age (AGA) in T1 of TP and higher probability of full-term birth in T2 of TP; higher chance of arterial hypertension, low birth weight (LBW), newborn small for gestational age (SGA), large for gestational age (LGA) and less AGA in T1 of ORAC-total, lower risk of premature birth and more than term at T2 of ORACtotal and higher possibility of low gestational weight at T3 of ORAC-total. The foods that most contributed to the consumption of FRAP in this population were coffee (with and without milk), fruits and fruit juices (guava, orange and apple) and couscous. While the biggest influences on TP consumption were couscous, fruits and fruit juices (guava and apple), chocolate and soups (bean and vegetable). The ORAC-total, in turn, had fruits and fruit juices (mango, guava, apple and orange), cereals (rice and couscous) and soups (beans and vegetables) as the most active foods. Conclusions: The thirteen articles involved in the meta-analysis, considered to present similar or possible standardization methodologies, involved neoplasms, PCOS, menopause, PE and GDM. Among these, all produced high epidemiological evidence, showing that TAC of the diet is significantly lower in women with some complication/illness. In the second article, pregnant women who were in the lowest tertile of dietary TAC pregnant women in the lowest tertile of dietary TAC had a higher risk of negative maternal-fetal outcomes, unlike those in the highest tertiles. This provides evidence that dietary consumption of total antioxidants can have beneficial effects on maternal-fetal health and be used in clinical practice to prevent such outcomes.