Efeito da pré-eclâmpsia nos níveis de citocinas do leite materno
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Data
2017-01-21
Autores
Freitas, Natália Alves de [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Na fisiopatologia da pré-eclâmpsia (PE) há importante participação de mediadores inflamatórios, cujas concentrações encontram-se alteradas tanto na placenta como no sangue materno. Entretanto, o efeito da pré-eclâmpsia nos imunocomponentes do leite materno ainda é pouco conhecido. Objetivo: Investigar se a PE altera os níveis de citocinas no leite materno. Método: Estudo prospectivo longitudinal de corte transversal, envolvendo puérperas cujo parto foi realizado na Maternidade da Faculdade de Medicina de Botucatu – UNESP, em 2014-2016. Critério de inclusão: diagnóstico de PE, gestação única, sorologias negativas, ausência de diabetes e de corioamnionite, sem uso de drogas ilícitas e/ou álcool, recém-nascido sem malformação congênita múltipla. Critério de exclusão: não obtenção da quantidade necessária de colostro, diagnóstico de mastite, uso contínuo de medicamento pela puérpera. Foram estudadas 228 puérperas, divididas em 2 grupos: PE (n=114) e Normotensas (controle, n=114), pareados pela idade gestacional, o grupo PE foi subdividido em PE de início precoce e tardia. O colostro foi coletado entre 24-72 horas pós-nascimento e o leite maduro no final do primeiro mês. Foram dosadas as citocinas (IL-1β, IL-6, IL-8, IL-10, IL-12 e TNF-α) por citometria de fluxo. Teste Qui-quadrado ou Exato de Fisher, teste t Student ou Mann-Whitney, bem como um modelo linear generalizado com distribuição gama foram utilizados para analisar as diferenças entre grupos e as alterações dependentes do tempo. Resultados: A maioria das puérperas teve PE tardia (≥ 34 semanas) e a idade gestacional média foi de 36 semanas. No colostro de mães com PE foram detectados níveis aumentados de IL-1 e IL-6, e menores níveis de IL-12 em comparação ao grupo controle. Alterações ocorreram durante a lactação e menores níveis e IL-6 e IL-8 foram encontrados no leite maduro de mães com PE. A PE de início precoce associou-se a valores aumentados de IL-6 no colostro e no leite maduro. Conclusão: A pré-eclâmpsia está associada com aumento dos níveis de citocinas inflamatórias no colostro e menores níveis de IL-6 e IL-8 no leite maduro. Os níveis de IL-6 no leite materno são maiores na pré-eclâmpsia precoce em comparação à tardia.
Introduction: IInflammatory mediators have an important role In the pathophysiology of preeclampsia (PE), and increased levels of these mediators have been found in the placenta and maternal circulation. However, the effect of preeclampsia on immune-components of breast milk is still unknown. Objective: To investigate whether PE affects breast milk cytokines levels. Method: Prospective longitudinal cross-sectional study involving nursing mothers whith childbirth at Maternity of the Botucatu Medical School - UNESP, during 2014-2016. Inclusion criteria: diagnosis of PE, single gestation, negative serologies, no history of diabetes, chorioamnionitis, drug use or alcohol consumption, and newborn without multiple congenital anomalies. Exclusion criteria: Insufficient volume of colostrum, mastitis, continuous use of medication by the mother. A total of 228 mothers were included and divided into 2 groups: PE (n = 114) and Normotensive (control, n = 114). Groups were matched by gestational age and PE was further divided into early and late PE. Colostrum was collected between 24-72 hours postpartum and mature milk at the end of the first month. IL-1β, IL-6, IL-8, IL-10, IL-12 and TNF-α were measured by flow cytometry. Chi-square or Fisher's Exact test, Student t-test or Mann-Whitney, and a general linear model with Gama distribution were used to analyse diffrences between groups and changes dependet on time. Results: Most preeclamptic women had late onset PE (≥ 34 weeks) and the mean gestational age was 36 weeks. In colostrum of PE mothers the levels of IL-1 and IL-6 were significantly increased, whereas IL-12 was decreased, compared to control group. Changes occured during lactation and lower concentrations of IL-6 and IL-8 were found in mature milk of PE mothers. Early-onset PE was associated with increased IL-6 values in colostrum and mature milk. Conclusion: Preeclampsia was associated with higher levels of pro-nflammatory cytokines in colostrum and lower levels of IL-6 and IL-8 in mature milk. The levels of IL-6 in breast milk are increased in early onset PE.
Introduction: IInflammatory mediators have an important role In the pathophysiology of preeclampsia (PE), and increased levels of these mediators have been found in the placenta and maternal circulation. However, the effect of preeclampsia on immune-components of breast milk is still unknown. Objective: To investigate whether PE affects breast milk cytokines levels. Method: Prospective longitudinal cross-sectional study involving nursing mothers whith childbirth at Maternity of the Botucatu Medical School - UNESP, during 2014-2016. Inclusion criteria: diagnosis of PE, single gestation, negative serologies, no history of diabetes, chorioamnionitis, drug use or alcohol consumption, and newborn without multiple congenital anomalies. Exclusion criteria: Insufficient volume of colostrum, mastitis, continuous use of medication by the mother. A total of 228 mothers were included and divided into 2 groups: PE (n = 114) and Normotensive (control, n = 114). Groups were matched by gestational age and PE was further divided into early and late PE. Colostrum was collected between 24-72 hours postpartum and mature milk at the end of the first month. IL-1β, IL-6, IL-8, IL-10, IL-12 and TNF-α were measured by flow cytometry. Chi-square or Fisher's Exact test, Student t-test or Mann-Whitney, and a general linear model with Gama distribution were used to analyse diffrences between groups and changes dependet on time. Results: Most preeclamptic women had late onset PE (≥ 34 weeks) and the mean gestational age was 36 weeks. In colostrum of PE mothers the levels of IL-1 and IL-6 were significantly increased, whereas IL-12 was decreased, compared to control group. Changes occured during lactation and lower concentrations of IL-6 and IL-8 were found in mature milk of PE mothers. Early-onset PE was associated with increased IL-6 values in colostrum and mature milk. Conclusion: Preeclampsia was associated with higher levels of pro-nflammatory cytokines in colostrum and lower levels of IL-6 and IL-8 in mature milk. The levels of IL-6 in breast milk are increased in early onset PE.
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Palavras-chave
Pré-eclâmpsia, Inflamação, Citocinas, Leite materno, Colostro