Prebióticos, probióticos e simbióticos na modulação da glicemia, de biomarcadores inflamatórios e de estresse oxidativo no diabetes mellitus gestacional: uma revisão sistemática

Abstract

Gestational diabetes mellitus (GDM) is characterized by a set of metabolic disorders, resulting from adaptive failures during pregnancy. The scientific literature points out that modulating the intestinal microbiota can optimize treatments and minimize the harmful effects of the disease, through the use of prebiotics, probiotics and synbiotics. These products can improve the signaling of antioxidant and anti-inflammatory pathways, which can mitigate adverse outcomes during pregnancy. Given this, the objective of the study was to identify whether the consumption of prebiotics, probiotics, and synbiotics has effects on glycemia, inflammatory biomarkers and oxidative stress in women with GDM. This is a systematic review, which considered the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instrument for its preparation. The Population, Intervention, Comparison, Outcome (PICO) model was used for the search strategy. A search was carried out in three electronic databases (PMC, Web of Science and Embase), for articles published until October 2023. The screening was carried out by a pair of independent reviewers and in the event of a tie, a third reviewer was consulted. To assess the methodological quality of the included articles, the Cochrane Collaboration risk of bias tool was used. It was possible to observe that the use of synbiotic reduced markers of oxidative stress (Malonaldehyde – MDA), and inflammatory stress (C-reactive protein – CRP), in addition to increasing antioxidant parameters (Total antioxidant capacity – CAT), however, there was no influence in maternal glycemia. While supplementation with probiotics had positive effects on reducing blood glucose (fasting blood glucose - FPG), inflammation (CRP; Tumor necrosis factor - TNF-α; and Interleukin-6 - IL-6), and oxidative stress (MDA; and MDA/CAT ratio). With the use of prebiotics in GDM, it was possible to observe a reduction in inflammation (CRP; IL-6), in glucose parameters (GJ; Glycated Hemoglobin - HbA1c); and also, the increase in antioxidant activity (CAT). Regarding methodological quality, the RCTs were classified as low risk (88.2%; 15/17), undefined risk (5.8%; 1/17) and high risk (11.7%; 2/17). Therefore, it can be concluded that supplementation with prebiotics, probiotics and synbiotics in pregnancies with GDM was safe for pregnant women and fetuses.