Articles - Revista Brasileira de Ginecologia e Obstetrícia

  • Original Article08-07-1999

    The use of sulfonylureas by pregnant diabetic women and fetal malformations

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):393-397

    Abstract

    Original Article

    The use of sulfonylureas by pregnant diabetic women and fetal malformations

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):393-397

    DOI 10.1590/S0100-72031999000700005

    Views90

    Purpose: to evaluate a possible relationship between fetal malformations (FM) and the use of sulfonylureas (SF) by diabetic pregnant women. Methods: we retrospectively studied 35 type 2 diabetic pregnant women followed at the Pathological Prenatal Care Outpatient Clinic of the University Hospital, Faculty of Medicine of Ribeirão Preto, from 1993 to 1995. Twenty-two of these women had been inadvertently using sulfonylureas during the 1st trimester of gestation (SF group). We determined their prevalence of FM and compared it to that observed for pregnant diabetic women who were only on diet or insulin therapy (group C). We also analyzed other variables such as time of disease, age, metabolic control, and prenatal care. Results: there was no significant difference between groups in terms of age range, duration of diabetes, glycemic control, or early start of prenatal care, with the prevalence of FM being similar for the two groups (8.3% in group C and 13.6% in group SF). The malformations observed in group SF were: renal agenesis, pulmonary hypoplasia and ribbon gonads (patient 1); short limbs and abnormally implanted toes (patient 2); cleft palate, low implanted ears, neck webbing and saddle nose (patient 3), and micrognathia, dysplastic ears, imperforate anus, hypospadia, polydactily, ventricular septal defect and atrial septal defect (patient 4) in group C. Conclusions: these data do not allow us to attribute the malformations detected in group SF to the use of sulfonylureas, although not usually described alterations in diabetic embryopathy occurred in this group.

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  • Original Article08-07-1999

    Amnioinfusion during labor with meconium-stained amniotic fluid

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):389-392

    Abstract

    Original Article

    Amnioinfusion during labor with meconium-stained amniotic fluid

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):389-392

    DOI 10.1590/S0100-72031999000700004

    Views96

    Purpose: to report the personal experience with the use of the amnioinfusion technique in patients in labor presenting meconial amniotic fluid, and the incidence of complications, the meconium aspiration syndrome and of cesarean sections. Method: twenty patients at term and in labor with meconial amniotic fluid were evaluated retrospectively, at the delivery ward at two public institutions of Rio Grande do Sul. An initial infusion of 1.000 ml of normal saline solution at room temperature, at an infusion rate of 20-30 ml per minute was initiated and then reduced to 3 ml per minute. The liquid was drained by elevating the cephalic pole. Results: the procedure was feasible when a nasogastric catheter was used. None of the patients presented major complications related to the procedure. None of the neonates presented meconium below their vocal cords. The cesarean section rate was 3/20 (15%). Conclusion: the amnioinfusion is a low-cost and feasible technique that did not show any complication in this study.

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  • Original Article08-07-1999

    Fetal pulse oximetry: relationship between oxygen saturation at second stage of labor and the umbilical artery pH at birth

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):381-384

    Abstract

    Original Article

    Fetal pulse oximetry: relationship between oxygen saturation at second stage of labor and the umbilical artery pH at birth

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):381-384

    DOI 10.1590/S0100-72031999000700003

    Views93

    Purpose: to study the correlation between fetal oxygen saturation measured by pulse oximetry during second stage of labor and umbilical artery pH at birth. Patients and Methods: fetal oxygen saturation (FSpO2) was monitored by pulse oximetry during the second stage of labor in 64 singleton pregnancies at term, with vertex presentation. Umbilical blood was sampled immediately after delivery for subsequent measurement of venous and arterial blood gases and pH. All fetuses maintained FSpO2 > or = 30% through the first stage of labor, until the start of second stage. Results: the mean FSpO2 at the second stage of labor correlated significantly with umbilical artery pH at birth (n = 64, r = 0.79, p <0.001). There was no significant corre-lation between FSpO2 at the second stage of labor and umbilical artery oxygen saturation at birth. Conclusion: fetal oxygen saturation measured by pulse oximetry during second stage of labor has a good correlation with umbilical artery pH at birth.

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  • Original Article08-07-1999

    Reverse blood flow in ductus venosus: new perspective in detection of chromosomal abnormalities

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):371-376

    Abstract

    Original Article

    Reverse blood flow in ductus venosus: new perspective in detection of chromosomal abnormalities

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):371-376

    DOI 10.1590/S0100-72031999000700002

    Views145

    Purpose: to evaluate the possible value of pulsed and color Doppler of ductus venosus blood flow in the screening for chromosomal abnormalities at 10-14 weeks of gestation. Methods: the ductus venosus flow velocity waveforms and the nuchal translucency (NT) thickness were obtained immediately before the chorionic villus sample in 26 pregnancies. We employed the following criteria for the suspicion of chromosomal defects: reverse or absent flow during atrial contraction and NT greater or equal to 3 mm. We calculated the sensitivity, the specificity, the negative and positive predictive value for each of the above items. Results: there were 9 chromosomal abnormalities (3 cases of trisomy 21, 2 cases of trisomy 13, 1 case of trisomy 9, 1 case of trisomy 22, 1 triploidy and 1 monosomy X). Abnormal ductus venosus flow was observed in all cases (sensitivity of 100%). In the normal fetuses (17 cases) only 1 had abnormal flow (specificity of 94%). Concerning NT, the sensitivity and the specificity were 88% and 76%, respectively. Conclusion: our preliminary results suggest that the presence of chromosomal abnormalities may be strongly suspected when an increased NT thickness is associated with an absent or reverse flow in the ductus venosus. We speculated that both methods are valid in the screening of chromosomal defects.

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  • 08-07-1999

    As sociedades científicas, sua proliferação e a ética

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):370-370

    Abstract

    As sociedades científicas, sua proliferação e a ética

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(7):370-370

    DOI 10.1590/S0100-72031999000700001

    Views71
    As Sociedades Científicas, sua Proliferação e a Ética […]
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  • 08-07-1999

    Avaliação dos padrões vasculares uterino e placentário no primeiro trimestre das gestações normal e patológica

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):302-302

    Abstract

    Avaliação dos padrões vasculares uterino e placentário no primeiro trimestre das gestações normal e patológica

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):302-302

    DOI 10.1590/S0100-72031999000500012

    Views63
    Avaliação dos Padrões Vasculares Uterino e Placentário no Primeiro Trimestre das Gestações Normal e Patológica […]
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  • 08-07-1999

    Dopplervelocimetria das artérias uterinas, arqueadas e espiraladas no prognóstico de receptividade endometrail de mulheres em ciclos estimulados para fertilização in vitro

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):302-302

    Abstract

    Dopplervelocimetria das artérias uterinas, arqueadas e espiraladas no prognóstico de receptividade endometrail de mulheres em ciclos estimulados para fertilização in vitro

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):302-302

    DOI 10.1590/S0100-72031999000500013

    Views55
    Dopplervelocimetria das Artérias Uterinas, Arqueadas e Espiraladas no Prognóstico de Receptividade Endometrail de Mulheres em Ciclos Estimulados para Fertilização In Vitro […]
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  • 08-07-1999

    Estudo anatomoclínico do carcinoma ductal invasivo da mama em pacientes axila-negativas associado à identificação dos receptores de estrogênio

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):301-301

    Abstract

    Estudo anatomoclínico do carcinoma ductal invasivo da mama em pacientes axila-negativas associado à identificação dos receptores de estrogênio

    Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(5):301-301

    DOI 10.1590/S0100-72031999000500010

    Views64
    Estudo Anatomoclínico do Carcinoma Ductal Invasivo da Mama em Pacientes Axila-Negativas Associado à Identificação dos Receptores de Estrogênio. […]
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  • Original Article09-06-2022

    Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings?

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):838-844

    Abstract

    Original Article

    Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings?

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(9):838-844

    DOI 10.1055/s-0042-1751061

    Views373

    Abstract

    Objective

    The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital.

    Methods

    A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological).

    Results

    A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency.

    Conclusion

    The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

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  • Review Article02-24-2022

    Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):409-424

    Abstract

    Review Article

    Deficiency and Insufficiency of Vitamin D in Women of Childbearing Age: A Systematic Review and Meta-analysis

    Revista Brasileira de Ginecologia e Obstetrícia. 2022;44(4):409-424

    DOI 10.1055/s-0042-1742409

    Views337

    Abstract

    Objective

    To estimate the prevalence of inadequate vitamin D level and its associated factors for women of childbearing age in Brazil.

    Methods

    A systematic reviewwas conducted (last updatedMay 2020).Meta-analyses were performed using the inverse-variance for fixed models with summary proportion calculation by Freeman-Tukey double arcsine. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies.

    Results

    Our review identified 31 studies, comprising 4,006 participants. All the studies had at least one weakness, mainly due to the use of convenience sampling and small sample size. The overall prevalence of vitamin D deficiency, insufficiency, and both deficiency and insufficiency were 35% (confidence interval, 95%CI: 34-37%), 42% (95%CI: 41-44%), and 72% (95%CI: 71-74%), respectively.

    Conclusion

    Although the magnitude of the prevalence of inadequate levels of vitamin D is uncertain, the evidence suggests that presence of vitamin D deficiency or insufficiency in women of reproductive age can cause moderate to severe problems.

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  • Review Article10-18-2021

    Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature

    Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569

    Abstract

    Review Article

    Placental Findings in Preterm and Term Preeclampsia: An Integrative Review of the Literature

    Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(7):560-569

    DOI 10.1055/s-0041-1730292

    Views272

    Abstract

    Introduction

    Preeclampsia (PE) is a pregnancy complication associated with increased maternal and perinatal morbidity and mortality. The disease presents with recent onset hypertension (after 20 weeks of gestation) and proteinuria, and can progress to multiple organ dysfunction, with worse outcomes among early onset preeclampsia (EOP) cases (<34 weeks). The placenta is considered the root cause of PE; it represents the interface between the mother and the fetus, and acts as a macromembrane between the two circulations, due to its villous and vascular structures. Therefore, in pathological conditions, macroscopic and microscopic evaluation can provide clinically useful information that can confirm diagnosis and enlighten about outcomes and future therapeutic benefit.

    Objective

    To perform an integrative review of the literature on pathological placental findings associated to preeclampsia (comparing EOP and late onset preeclampsia [LOP]) and its impacts on clinical manifestations.

    Results:

    Cases of EOP presented worse maternal and perinatal outcomes, and pathophysiological and anatomopathological findings were different between EOP and LOP placentas, with less placental perfusion, greater placental pathological changes with less villous volume (villous hypoplasia), greater amount of trophoblastic debris, syncytial nodules, microcalcification, villous infarcts, decidual arteriolopathy in EOP placentas when compared with LOP placentas. Clinically, the use of low doses of aspirin has been shown to be effective in preventing PE, as well asmagnesium sulfate in preventing seizures in cases of severe features.

    Conclusion

    The anatomopathological characteristics between EOP and LOP are significantly different, with large morphological changes in cases of EOP, such as

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  • Review Article05-01-2018

    Recommendations for the Use of Testosterone in Male Transgender*

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(5):275-280

    Abstract

    Review Article

    Recommendations for the Use of Testosterone in Male Transgender*

    Revista Brasileira de Ginecologia e Obstetrícia. 2018;40(5):275-280

    DOI 10.1055/s-0038-1657788

    Views333

    Abstract

    Gender incongruence is defined as a condition in which an individual self-identifies and desires to have physical characteristics and social roles that connote the opposite biological sex. Gender dysphoria is when an individual displays the anxiety and/or depression disorders that result from the incongruity between the gender identity and the biological sex. The gender affirmation process must be performed by a multidisciplinary team. The main goal of the hormone treatment is to start the development of male physical characteristics by means of testosterone administration that may be offered to transgender men who are 18 years old or over. The use of testosterone is usually well tolerated and improves the quality of life. However, there is still lack of evidence regarding the effects and risks of the long-term use of this hormone. Many different pharmacological formulations have been used in the transsexualization process. The most commonly used formulation is the intramuscular testosterone esters in a short-term release injection, followed by testosterone cypionate or testosterone enanthate. In the majority of testosterone therapy protocols, the male physical characteristics can be seen in almost all users after 6 months of therapy, and themaximum virilization effects are usually achieved after 3 to 5 years of regular use of the hormone. To minimize risks, plasmatic testosterone levels should be kept within male physiological ranges (300 to 1,000 ng/dl) during hormonal treatment. It is recommended that transgender men under androgen therapy be monitored every 3 months during the 1st year of treatment and then, every 6 to 12 months.

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  • Original Article12-21-2020

    The Influence of Preeclampsia, Advanced Maternal Age and Maternal Obesity in Neonatal Outcomes Among Women with Gestational Diabetes

    Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):607-613

    Abstract

    Original Article

    The Influence of Preeclampsia, Advanced Maternal Age and Maternal Obesity in Neonatal Outcomes Among Women with Gestational Diabetes

    Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):607-613

    DOI 10.1055/s-0040-1710300

    Views342

    Abstract

    Objective

    The present study aims to analyze adverse fetal or neonatal outcomes in women with gestational diabetes, including fetal death, preterm deliveries, birthweight, neonatal morbidity and mortality, as well as the synergic effect of concomitant pregnancy risk factors and poor obstetric outcomes, as advanced maternal age, maternal obesity and pre-eclampsia in their worsening.

    Methods

    The present cohort retrospective study included all pregnant women with gestational diabetes, with surveillance and childbirth at the Hospital da Senhora da Oliveira during the years of 2017 and 2018. The data were collected from the medical electronic records registered in health informatic programs Sclinico and Obscare, and statistical simple and multivariate analysis was done using IBM SPSS Statistics.

    Results

    The study participants included 301 pregnant women that contributed to 7.36% of the total institution childbirths of the same years, in a total of 300 live births. It was analyzed the influence of pre-eclampsia coexistence in neonatal morbidity (p = 0.004), in the occurrence of newborns of low and very low birthweight (p < 0.01) and in preterm deliveries (p < 0.01). The influence of maternal obesity (p = 0.270; p = 0.992; p = 0.684) and of advanced maternal age in these 3 outcomes was also analyzed (p = 0,806; p = 0.879; p = 0.985).Using a multivariate analysis, the only models with statistic significance to predict the three neonatal outcomes included only pre-eclampsia (p = 0.04; p < 0.01; p < 0.01).

    Conclusion

    Only coexistence of pre-eclampsia showed an association with adverse neonatal outcomes (neonatal morbidity, newborns of low and very low birthweight and preterm deliveries) and can be used as a predictor of them in women with gestational diabetes.

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  • Original Article03-01-2016

    Assessment of the Effects of Tribulus Terrestris on Sexual Function of Menopausal Women

    Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):140-146

    Abstract

    Original Article

    Assessment of the Effects of Tribulus Terrestris on Sexual Function of Menopausal Women

    Revista Brasileira de Ginecologia e Obstetrícia. 2016;38(3):140-146

    DOI 10.1055/s-0036-1571472

    Views333

    Objective

    The aim of this study was to study the effects of Tribulus terrestris on sexual function in menopausal women.

    Methods

    This was a prospective, randomized, double-blind, placebo-controlled clinical trial that included 60 postmenopausal women with sexual dysfunction. The women were divided into two groups, placebo group and Tribulus group, and evaluated by using the Sexual Quotient-female version (SQ-F) and Female Intervention Efficacy Index (FIEI) questionnaires.

    Results

    There was no significant difference between the groups in age, age at menopause, civil status, race, and religion. In the evaluation with the SQ-F questionnaire, there were significant differences between the placebo (7.6±3.2) and Tribulus (10.2±3.2) groups in the domains of desire and sexual interest (p d” 0.001), foreplay (3.3±1.5 versus 4.2±1.0) (p d” 0.01), arousal and harmonious interaction with the partner (5.7±2.1 versus 7.2±2.6) (p d” 0.01), and comfort in sexual intercourse (6.5±2.4 versus 8.0±1.9) (p d” 0.01). There was no significant difference between the placebo and Tribulus groups in the domains of orgasm and sexual satisfaction (p = 0.28). In the FIEI questionnaire, there was a significant improvement (p < 0.001) in the domains of vaginal lubrication during coitus and/or foreplay (20 versus 83.3%), sensation in the genitalia during sexual intercourse or other stimuli (16.7 versus 76.7%), sensation in the genital region (20 versus 70%), sexual intercourse and/or other sexual stimulations (13.3 versus 43.3%), and the ability to reach orgasm (20% versus 73.3%). There was no significant difference in adverse effects between the two groups.

    Conclusions

    After 90 days of treatment, at the doses used, we found Tribulus terrestris to be effective in treating sexual problems among menopausal women.

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    Assessment of the Effects of Tribulus Terrestris on Sexual Function of Menopausal Women
  • Review Article12-21-2020

    Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):659-668

    Abstract

    Review Article

    Clinical Procedures for the Prevention of Preeclampsia in Pregnant Women: A Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2020;42(10):659-668

    DOI 10.1055/s-0040-1714135

    Views334

    Abstract

    Objective

    To identify the most effective procedures recommended for the prevention of preeclampsia.

    Data Sources

    A systematic review was performed in the following databases: Pubmed/MEDLINE, CINAHL, Web of Science, Cochrane and LILACS via the Virtual Health Library (VHL). A manual search was also performed to find additional references. The risk of bias, the quality of the evidence, and the classification of the strength of the recommendations were evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

    Selection of Studies

    In the initial search in the databases, the total number of articles retrieved was 351, and 2 were retrieved through the manual search; after duplicate articles were removed, 333 citations remained. After a thorough review of the titles and abstracts, 315 references were excluded. Accordingly, 18 articles were maintained for selection of the complete text (phase 2). This process led to the exclusion of 6 studies. In total, 12 articles were selected for data extraction and qualitative synthesis.

    Data Collection

    The articles selected for the study were analyzed, and we inserted the synthesis of the evidence in the online software GRADEpro Guideline Development Tool (GDT) (McMaster University and Evidence Prime Inc. All right reserved. McMaster University, Hamilton, Ontário, Canada); thus, it was possible to develop a table of evidence, with the quality of the evidence and the classification of the strength of the recommendations.

    Data Synthesis

    In total, seven studies recommended the individual use of aspirin, or aspirin combined with calcium, heparin or dipyridamole. The use of calcium alone or in combination with phytonutrients was also highlighted. All of the studies were with women at a high risk of developing preeclampsia.

    Conclusion

    According to the studies evaluated, the administration of aspirin is still the best procedure to be used in the clinical practice to prevent preeclampsia.

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  • Review Article12-17-2021

    Association of the Maternal Folic Acid Supplementation with the Autism Spectrum Disorder: A Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):775-781

    Abstract

    Review Article

    Association of the Maternal Folic Acid Supplementation with the Autism Spectrum Disorder: A Systematic Review

    Revista Brasileira de Ginecologia e Obstetrícia. 2021;43(10):775-781

    DOI 10.1055/s-0041-1736298

    Views327

    Abstract

    Objective

    To analyze the scientific production regarding maternal folic acid (FA) supplementation and its relationship with autistic spectrum disorder (ASD).

    Data Sources

    We performed unrestricted electronic searches in the BIREME virtual bank, Virtual Health Library (VHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed) databases.

    Selection of Studies

    For sample selection, articles that met the proposed objectives were included, published in English, Spanish and Portuguese, the use of Health Sciences Descriptors (DeCS): autistic OR autism AND autism spectrum disorder AND folic acid, AND, with the use of the Medical Subject Headings (MeSH): autistic OR autism AND autistic spectrum disorder AND folic acid.

    Data Collection

    Data extraction was performed by the reviewers with a preestablished data collection formulary.

    Data Synthesis

    The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) was used based on a checklist with 27 items and a 4-step flowchart.

    Results

    A total of 384 articles was found by the search strategies, of which 17 were eligible following the pre-established criteria. The main findings of the present review point to maternal FA supplementation in the pre-conception period and beginning of pregnancy as a protective effect in relation to ASD, which should be indicated in this period as prevention to the problem.

    Conclusion

    According to the research analyzed, more studies are necessary to know its effects on pregnancy, since the consumption of excessive FA may not be innocuous.

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