Impacto da suplementação materna com ácido fólico no rim dos descendentes na vida adulta

Fernandes, Thayane Ferreira da Costa; Conde, Poliana dos Santos; Brasil, Flavia de Bittencourt; Oliveira, Marcos Roberto de

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev Bras Ginecol Obstet. 45 (4) • 2023 • https://doi.org/10.1055/s-0043-1769001 copiar

Impacto da suplementação materna com ácido fólico no rim dos descendentes na vida adulta

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

A suplementação com ácido fólico (AF) durante a gestação tem sido recomendada pela sociedade médica em todo o mundo, mas alguns estudos têm mostrado que a ingestão de altas quantidades de ácido fólico na dieta pode desencadear danos aos descendentes. Objetivos: Descrever os efeitos da suplementação materna com AF durante a gestação no rim da prole em fases tardias da vida. Fonte de Dados: Trata-se de uma revisão sistemática realizada através da consulta das seguintes bases de dados: Medline, através da Plataforma Pubmed, Lilacs e Scielo. A pesquisa foi realizada utilizando-se as palavras-chave “Ácido Fólico”, “Gestação” e “Rim”. Seleção dos Estudos: Oito estudos foram considerados para esta revisão sistemática. Coleta de Dados: Foram incluídos estudos que abordaram o consumo de ácido fólico durante a gestação e seus efeitos exclusivamente no rim dos descendentes em diferentes fases da vida. Resultados: O consumo gestacional de AF não alterou o volume renal, a taxa de filtração glomerular e a expressão de alguns genes essenciais no rim dos filhotes de mães suplementadas com AF. A associação de AF e selênio na dieta materna foi eficaz na preservação da atividade de enzimas antioxidantes no rim da prole de mães expostas ao álcool. O consumo de AF diminuiu algumas anomalias importantes nos filhotes causadas por drogas teratogênicas, apesar de não ter sido eficiente na prevenção de alguns danos a arquitetura renal. Conclusão: A suplementação com AF não causou toxicicdade renal, exerceu efeito protetor antioxidante e mitigou algumas desordens renais causadas por agressões severas.

Palavras-chave
Ácido fólico; Gestação; Rim; Descendentes; Vida adulta

Author/Year	Sample	Intervention	Follow-up	Settings & participants	Objective	Assessment methods	Results
Lisle et al. (2003)³⁹39 Lisle SJ, Lewis RM, Petry CJ, Ozanne SE, Hales CN, Forhead AJ. Effect of maternal iron restriction during pregnancy on renal morphology in the adult rat offspring. Br J Nutr. 2003;90(01):33–39. Doi: 10.1079/bjn2003881 https://doi.org/10.1079/bjn2003881...	Control (153 mg Fe/kg diet, n 7) or low-Fe (3 mg/kg diet, n 6)	Experimental study	18 months	Offspring rats (n = 28)	Investigated the renal morphology of adult rats born to mothers who were Fe-deficient during pregnancy.	Kidney weight; Glomerular number and size; Systolic blood pressure	Maternal Fe restriction causes hypertension in the adult offspring that may be due, in part, to a deficit in nephron number.
Miliku et al. (2017)⁴⁵45 Miliku K, Mesu A, Franco OH, Hofman A, Steegers EAP, Jaddoe VWV. Maternal and fetal folate, vitamin B12, and homocysteine concentrations and childhood kidney outcomes. Am J Kidney Dis. 2017;69(04):521–530. Doi: 10.1053/j.ajkd.2016.11.014 https://doi.org/10.1053/j.ajkd.2016.11.0...	Folic acid supplement (0.4–0.5 mg)	Population-based prospective cohort study from fetal life onwards	From pregnancy to 6 years of the child	Pregnant women and their (n = 4.226)	Examined the associations of folate, vitamin B12, and homocysteine concentrations during pregnancy with kidney outcomes in school-aged children.	Folate, vitamin B12 and homocysteine blood concentrations measured in early pregnancy and at birth (cord blood).	Folate, vitamin B12 and homocysteine concentrations during fetal life are associated with offspring kidney development.
Ly et al. (2016)⁴⁶46 Ly A, Ishiguro L, Kim D, et al. Maternal folic acid supplementation modulates DNA methylation and gene expression in the rat offspring in a gestation period-dependent and organ-specific manner. J Nutr Biochem. 2016;33:103–110. Doi: 10.1016/j.jnutbio.2016.03.018 https://doi.org/10.1016/j.jnutbio.2016.0...	Folic acid supplement (2 mg and 5mg)	Experimental study	8 weeks	Sprague-Dawley Rats (n = 10)	This study evaluated whether maternal folic acid supplementation might change the offspring's.metabolism.	Brain, liver, kidney and colon of puppies were assessed about folate concentrations, global DNA methylation and expression. of Igf2, Er-α, Gr, Ppar-α e Ppar-γ genes.	Folic aid supplementation at late pregnancy or throughout gestation reduced the expression of Er-α, Gr and Ppar-α genes in the liver.
Ojeda et al. (2012)⁴⁷47 Ojeda ML, Nogales F, Murillo ML, Carreras O. Selenium or selenium plus folic acid-supplemented diets ameliorate renal oxidation in ethanol-exposed pups. Alcohol Clin Exp Res. 2012;36(11): 1863–1872. Doi: 10.1111/j.1530-0277.2012.01788.x https://doi.org/10.1111/j.1530-0277.2012...	(Se) (0.5 ppm) or with Se (0.5 ppm) + folic acid (8 ppm) administered to EtOH-exposed (20% v/v	Experimental study	8 weeks	Winstar rats (n = 6) female (n = 6) male	Diet supplemented with selenium or with Se + folic acid administered to EtOH-exposed dams during gestation and lactation prevents the oxidative EtOH-provoked effects in their offspring's kidneys.	Serum, urine and kidney, Se levels, creatinine clearance, antioxidant enzyme activities and lipid and protein peroxidation in the kidney.	Dietary supplementation improve renal development, Se deposits, and protein content while decreasing lipid and protein oxidation and modifying antioxidant enzymes' activity.
Ojeda et al. (2010)⁴⁸48 Ojeda ML, Jotty K, Nogales F, Murillo ML, Carreras O. Selenium or selenium plus folic acid intake improves the detrimental effects of ethanol on pups’ selenium balance. Food Chem Toxicol. 2010;48 (12):3486–3491	Se (0.5 ppm) or with Se (0.5 ppm) plus folic acid (8 ppm) to ethanol-exposed (20% v/v)	Experimental study	8 weeks	Winstar rats (n = 6) female (n = 6) male	Supplemented diet with Se or with Se plus folic acid to ethanol-exposed dams prevents the ethanol-provoked effects in their offspring's Se deposits.	Selenium levels in the liver, kidney and testes.	Results show that ethanol decreases Se deposits in pups' heart, liver, kidney and testes. However Se levels in both pancreas and serum were increased by ethanol; it also compromised the weight and length of the offspring at the end of lactation.
Król et al. (2011)⁴⁹49 Król E, Krejpcio Z, Chmurzynska A. Folic acid and protein content in maternal diet and postnatal high-fat feeding affect the tissue levels of iron, zinc, and copper in the rat. Biol Trace Elem Res. 2011;144(1-3):885–893. Doi: 10.1007/s12011-011-9048-3 https://doi.org/10.1007/s12011-011-9048-...	(1) normal protein, normal folic acid (FA) diet (0.002-g FA); (2) protein-restricted, normal folic acid diet (0.002-g); (3) protein restricted, folic acid-supplemented diet (0.005 g FA); (4) normal protein, folic acid-supplemented diet (0.005 g FA).	Experimental study	6 weeks	Offspring (n = 48)	The aim of the study is investigate the influence of maternal diet during gestation on Fe, Zn, and Cu levels in the liver and kidney of adult rats.	The levels of Fe, Zn, and Cu in the livers and kidneys; Offspring's tissue mineral levels.	The results of this study show that maternal dietary folic acid and protein intake during pregnancy, as well as the type of postweaning diet, affect Fe, Zn and Cu levels in the offspring.
El-Ashmawy and Bayad (2016)⁵⁰50 El-Ashmawy IM, Bayad AE. Folic acid and grape seed extract prevent azathioprine-induced fetal malformations and renal toxicity in rats. Phytother Res. 2016;30(12):2027–2035. Doi: 10.1002/ptr.5709 https://doi.org/10.1002/ptr.5709...	(1) AZA (25 mg/kg) (2) AZA, simultaneously with grape seed extract at the dose of 75 mg/kg (3) AZA, simultaneously with folic acid at the dose of 5 mg/kg;	Experimental study	4 weeks	Adult Wister rats (n = 40)	Investigate the influence of AZA on the fetal development and renal function and its co-administration with either folic acid (FA) or grape seed extract (GSE).	Kidney histology; Glutathione level (GSH); Lipid per oxidation content as malondialdehyde in the kidney tissue.	Maternal administrations of both FA and GSE protect against AZA-induced fetal malformations. Grape seed extract was more active than FA in potentiating the antioxidative defenses for controlling AZA-induced oxidative renal damages.
Hawkesworth et al. (2013)⁶⁴64 Hawkesworth S, Wagatsuma Y, Kahn AI, et al. Combined food and micronutrient supplements during pregnancy have limited impact on child blood pressure and kidney function in rural Bangladesh. J Nutr. 2013;143(05):728–734. Doi: 10.3945/ jn.112.168518 https://doi.org/10.3945/jn.112.168518...	(1) Fe30F: 30 mg iron and 400 µg of folate (2) Fe60F: 60 mg of iron and 400 µg of folate (3) MMS: Multiple micronutrient supplement	A trial follow-up study	Between November 2001 and October 2003 (recruited early in pregnancy) Between May 2007 and February 2009 when the descendants were 4.5 years old (children born)	Women were recruited early in pregnancy (n = 3.560) children (n = 3.267)	Assess the association between prenatal food and micronutrient supplementation and childhood blood pressure and kidney function. Women received either iron and folate or multiple micronutrient tablets daily.	Blood pressure; Kidney function.	Limited evidence for long-lasting impacts of pregnancy supplementation on offspring markers of kidney function.

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Flavia de Bittencourt Brasil, PhD, Rua Recife, Lotes, 1-7, 28895-532, Jardim Bela Vista, Rio das Ostras, RJ, Brazil (brasil.fb@gmail.com, flaviabrasil@id.uff.br)