RESUMO
The aim of this study was to present the implications of the use of herbs during pregnancy, pointing out those that should be avoided during this condition because of their abortifacient and/or teratogenic potential. We carried out searches in the databases ScienceDirect, Scielo and Google Scholar, adopting as criteria for inclusion: book chapters and/or complete articles (with abstract), available in English, Portuguese or Spanish, published from 1996 to in 2011. After a pre-selection of 83 articles, 49 bibliographies were used in the manufacturing end of the article, where 25 were from the Scielo database, 18 from ScienceDirect and 6 from Google Scholar. From the articles studied, we identified the four most commonly used plants as emmenagogue/abortifacient agents by patients of the Department of Prenatal SUS: senne, arruda, boldo and buchinha-do-norte or cabacinha. Thus, we conclude that people often adhere to the maxim "if it's natural, it does no harm" in their rational use of natural products, without the right guidance, believing that these products are safe to use. This usage is even more worrisome among the elderly, pregnant women and children. Regarding the safety of these products, some information and reliable data are scarce or contradictory.
Este trabalho busca as implicações atuais sobre o uso de plantas medicinais durante a gravidez, alertando sobre aquelas que devem ser evitadas nesse período por serem potencialmente abortivas e/ou teratogênicas. Para tanto, foram realizadas buscas nas bases de dados Sciencedirect, Scielo e Google scholar, adotando-se como critérios de inclusão capítulos de livros e/ou artigos completos (com abstract) e disponíveis, em português, inglês ou espanhol, publicados de 1996 a 2011. Após uma pré-seleção de 83 artigos, 49 bibliografias foram utilizadas na confecção final do artigo, sendo 25 provenientes da base de dados Scielo, 18 do Sciencedirect e 06 do Google scholar. A partir dos artigos estudados, identificaram-se as quatro plantas mais utilizadas como emenagogas/abortivas por pacientes do Serviço de Pré-Natal do SUS: senne, arruda, boldo e buchinha-do-norte ou cabacinha. Assim, é possível concluir que, muitas vezes, a população se utiliza da máxima "se é natural, não faz mal" para fazer uso irracional de produtos naturais, sem a correta orientação, acreditando que esses produtos sejam incapazes de provocar qualquer dano. Esse uso é ainda mais preocupante quando realizado por idosos, gestantes e crianças. Em relação à segurança do uso desses produtos, algumas informações e dados confiáveis ainda são escassos ou contraditórios.
Assuntos
Plantas Medicinais/toxicidade , Gravidez , Produtos Biológicos/análise , Indutores da Menstruação/análiseRESUMO
Intároducción:el síndrome de ovario poliquístico (SOP) se caracteriza por anovulación crónica e hiperandrogenismo y en nuestro medio afecta el 12% de las mujeres. No existen dudas de la función que cumple la metformina en pacientes con SOP, obesidad e insulinorresistencia (IR), sin embargo, al no conocer íntegramente su mecanismo de acción, no estamos en condiciones de predecir cual es su rol en el grupo de no obesas, no IR. Se trata del 80% de nuestras pacientes con diagnóstico de PCO que solo presentan oligoamenorrea-anovulación y ovarios ecográficamente poliquísticos. Objetivo: investigar la efectividad de la metformina en la restauración de los ciclos menstruales y la ovulación, así como también en el logro del embarazo en mujeres con SOPQ no obesas, no IR, y reportar la evolución de los embarazos con metformina. Materiales y métodos: se realizó un trabajo prospectivo, desde julio de 2005 a marzo de 2007, en 59 pacientes con diagnóstico de SOP, según los criterios del Consenso de Rotterdam, todas con deseo de fertilidad, oligomenorreicas-anovuladoras, no obesas, no IR (mediana del peso: 60kg, mediana de talla:165 cm, BMI 22,8 de mediana. Indice HOMA:143 de mediana) El estudio se dividió en 3 etapas. En la primera etapa se utilizó metformina en dosis crecientes hasta la dosis de 1700mg/día, durante 6 meses. En la segunda, se sumó citrato de clomifeno, 50 mg/día entre el 5º y 9º días. La tercera etapa la constituyó el seguimiento de embarazos con el uso de metformina. Resultados: se observó un franco cambio en el ritmo menstrual y en la ovulación, con eumenorrea en un 72% de los casos post-metformina y dosaje de progesterona dentro de rango ovulatorio en el día 21 del ciclo. La tasa de embarazo global fue del 52,5% (31/59), de los que el 74% fue solo con metformina, más un 25,8% con el agregado de citrato de clomifeno. El 58% de embarazos (18/31) ocurrió en los 2 primeros meses. De los 31 embarazos, se logró seguimiento completo de 24, ... (AU)
Assuntos
Feminino , Gravidez , Humanos , Metformina/uso terapêutico , Síndrome do Ovário Policístico/terapia , Menstruação , Clomifeno/uso terapêutico , Indutores da Menstruação/uso terapêutico , Ovulação , Gravidez , Fármacos para a Fertilidade Feminina/uso terapêuticoRESUMO
Intároducción:el síndrome de ovario poliquístico (SOP) se caracteriza por anovulación crónica e hiperandrogenismo y en nuestro medio afecta el 12% de las mujeres. No existen dudas de la función que cumple la metformina en pacientes con SOP, obesidad e insulinorresistencia (IR), sin embargo, al no conocer íntegramente su mecanismo de acción, no estamos en condiciones de predecir cual es su rol en el grupo de no obesas, no IR. Se trata del 80% de nuestras pacientes con diagnóstico de PCO que solo presentan oligoamenorrea-anovulación y ovarios ecográficamente poliquísticos. Objetivo: investigar la efectividad de la metformina en la restauración de los ciclos menstruales y la ovulación, así como también en el logro del embarazo en mujeres con SOPQ no obesas, no IR, y reportar la evolución de los embarazos con metformina. Materiales y métodos: se realizó un trabajo prospectivo, desde julio de 2005 a marzo de 2007, en 59 pacientes con diagnóstico de SOP, según los criterios del Consenso de Rotterdam, todas con deseo de fertilidad, oligomenorreicas-anovuladoras, no obesas, no IR (mediana del peso: 60kg, mediana de talla:165 cm, BMI 22,8 de mediana. Indice HOMA:143 de mediana) El estudio se dividió en 3 etapas. En la primera etapa se utilizó metformina en dosis crecientes hasta la dosis de 1700mg/día, durante 6 meses. En la segunda, se sumó citrato de clomifeno, 50 mg/día entre el 5º y 9º días. La tercera etapa la constituyó el seguimiento de embarazos con el uso de metformina. Resultados: se observó un franco cambio en el ritmo menstrual y en la ovulación, con eumenorrea en un 72% de los casos post-metformina y dosaje de progesterona dentro de rango ovulatorio en el día 21 del ciclo. La tasa de embarazo global fue del 52,5% (31/59), de los que el 74% fue solo con metformina, más un 25,8% con el agregado de citrato de clomifeno. El 58% de embarazos (18/31) ocurrió en los 2 primeros meses. De los 31 embarazos, se logró seguimiento completo de 24, ...
Assuntos
Feminino , Gravidez , Humanos , Clomifeno/uso terapêutico , Menstruação , Metformina/uso terapêutico , Síndrome do Ovário Policístico/terapia , Fármacos para a Fertilidade Feminina/uso terapêutico , Gravidez , Indutores da Menstruação/uso terapêutico , OvulaçãoRESUMO
O emprego de plantas para indução da menstruação e do aborto é amplamente difundido, e há uma grande diversidade de espécies vegetais utilizadas. Este trabalho revisa a literatura sobre o uso popular de plantas como emenagogas e abortivas, visando a contribuir com a divulgação de informações etnofolclóricas e dados experimentais a respeito das espécies vegetais mais utilizadas. Foram apresentados os dados sobre carrapichinho (Acanthospermum hispidum), cipó mil homens (Aristolochia triangularis), losna (Arthemisia absinthium), erva de santa maria(Chenopodium ambrosioides), buchinha do norte (Luffa operculata), pariparoba (Piper sp.) e arruda (Ruta graveolens). A ação das plantas deve-se à presença de substâncias estrogênicas, citotóxicas e/ou que estimulem a contratilidade uterina. Se o aborto não ocorrer, anomalias ou malformações podem ser produzidas. O uso de plantas para indução do aborto é comum, apesar dos riscos de intoxicação. Essa conduta deveria ser desestimulada por programas de saúde comunitária, com esclarecimento sobre os riscos à saúde da mulher e do feto e com acesso a métodos contraceptivos. Por outro lado, os produtos de origem vegetal devem ser considerados pela indústria farmacêutica como importante fonte na busca de agentes interceptivos e de medicamentos para o tratamento das desordens menstruais
Assuntos
Abortivos , Indutores da Menstruação , Plantas Medicinais/efeitos adversosRESUMO
Despite its prohibition, illegal abortion is widely practiced in Brazil, with important adverse health consequences. This report aims to document the prevalence and correlates of the unsuccessful use of drugs to "induce menstrual flow" in a cohort of pregnant Brazilian women. In a cross-sectional study, 6,102 pregnant women between gestation weeks 21 and 28 were interviewed in prenatal clinics of the Brazilian National Health Care System from April 1991 to November 1995. When asked "In order to know if you were pregnant, did you take any medication to induce menstrual flow", 874 (14.4%) responded "yes." The most frequently used drugs were herbal teas (41%), estrogens and/or progestogens (30%), and misoprostol (16%). As demonstrated through logistic regression analysis, independent correlates of such use were unplanned pregnancy (odds ratio [OR] 4.3), low educational attainment (OR 3.3), absence of a husband or partner (OR 1.8), number of children (one or more) (OR 1.5), a history of a previous induced abortion (OR 1.4), and use of oral contraceptives at the time (OR 1.4). Misoprostol use occurred in 2.2% of pregnancies, and showed a very strong association with an unplanned pregnancy (OR 16.0), absence of a husband or partner (OR 3.5), and a history of a previous induced abortion (OR 2.2). It was not associated with a history of menstrual irregularity. In contradistinction, the use of medroxyprogesterone was strongly associated with previous menstrual irregularity (OR = 5.0). The use of drugs and teas, many of which are unknown in terms of fetal risk, in early pregnancy to induce menstrual flow is quite common in women in the Brazilian National Health System. Although the objective of such drug use appears to be varied, analysis of the clinical correlates of use suggest attempted abortion to be the principal aim.
PIP: In countries such as Brazil, where abortion is prohibited, a range of drugs are used to induce menstruation. The present study investigated the prevalence and clinical correlates of unsuccessful use of drugs given to pregnant women to start menstrual flow. Enrolled were 6102 pregnant women at gestational weeks 21-28 presenting to the prenatal clinics of the Brazilian National Health Care System in 1991-95. 874 women (14.4%) responded affirmatively to the question, "In order to know if you were pregnant, did you take any medication to induce menstrual flow?" The frequency varied from 6-22% among the seven cities included in the study. The most commonly used drugs were herbal teas (41%), estrogens and/or progestogens (30%), and misoprostol (16%). Significant independent predictors of such medication use included unplanned pregnancy (odds ratio (OR), 4.3), low educational attainment (OR, 3.3), absence of husband or male partner (OR, 1.8), 1 or more living children (OR, 1.5), previous induced abortion (OR, 1.4), and current use of oral contraception (OR, 1.4). Herbal tea and misoprostol use were more strongly associated with unplanned pregnancy than medroxyprogesterone acetate; however, most drug use reported for menstrual induction appeared to be intended to avoid a possible pregnancy. Of concern is the effect of these medications and herbs on fetuses in cases where an abortion attempt is unsuccessful.
Assuntos
Indutores da Menstruação , Abortivos não Esteroides , Aborto Criminoso , Aborto Induzido , Adulto , Bebidas , Brasil , Escolaridade , Estrogênios , Características da Família , Feminino , Humanos , Modelos Logísticos , Estado Civil , Misoprostol , Gravidez , Gravidez não Desejada , ProgestinasRESUMO
The effectiveness of a sequential regimen consisting of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles was assessed in 10 surgically sterilized volunteers who were followed for one pretreatment and three treated cycles. Hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and an endometrial biopsy taken on day 22-25 of the third treatment cycle were used to monitor the effects of treatment. During treatment, 24 monophasic (no sustained progesterone rise above 12 nmol/l) and six biphasic cycles were recorded. Nine follicular ruptures were detected echographically in these 30 treated cycles, five of which occurred in monophasic cycles. All follicular ruptures occurred on days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were recorded. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.
PIP: This study investigated the efficacy of mifepristone, 10 mg/day for 15 days, followed by nomegestrol acetate (NOMA), 5 mg/day for the next 13 days, for inhibiting ovulation and maintaining regular bleeding cycles in 10 surgically sterilized volunteers. To monitor the effects of treatment, hormonal determinations in blood and urine, ovarian ultrasonography, bleeding records in all cycles and endometrial biopsy were taken on day 22-25 of the third treatment cycle. About 24 monophasic and 6 biphasic cycles were recorded during treatment. About 9 follicular ruptures were echographically detected in these 30 cycles, 5 of which occurred in monophasic cycle. All follicular ruptures occurred in days 1-7 of NOMA treatment. Echographic and endocrine features of ovulatory cycles were both present in only four treated cycles (13.3%). Development of a secretory endometrium was achieved in all cases, but it was always irregular. Regular withdrawal bleeding occurred in all subjects and no adverse reactions were observed. The ovarian and endometrial effects of this regimen justify testing its contraceptive effectiveness in phase 2 clinical trials.
Assuntos
Anticoncepcionais Orais Combinados/administração & dosagem , Megestrol , Indutores da Menstruação/administração & dosagem , Mifepristona/administração & dosagem , Norpregnadienos/administração & dosagem , Ovulação/efeitos dos fármacos , Adulto , Estradiol/sangue , Feminino , Humanos , Hormônio Luteinizante/urina , Progesterona/sangue , Congêneres da Progesterona/administração & dosagem , Esterilização ReprodutivaRESUMO
Abortion is not condoned in Jamaica. Its meaning is linked to the meanings of kinship and parenthood, which are expressed through procreation and involve altruism and the assumption of responsibility for the well-being of others. Abortion subverts these ideals but indigenous methods for it are known and are secretly used. The inconsistencies between abortion talk and abortion practice are examined, and the structural functions of abortion (and of its culturally constructed, ideological meaning) are discussed. The distinction--and the overlap--between abortion as such and menstrual regulation is explored. The use of the culturally constructed 'witchcraft baby' syndrome to justify abortion is also investigated. Traditional abortion techniques follow from (and can illuminate) general health practices, which focus on inducing the ejection of 'blockages' and toxins, and from ethnophysiological beliefs about procreation and reproductive health, which easily allow for menstrual delays not caused by conception. The latter understanding and the similarity between abortifacients, emmenagogues and general purgatives allows women flexibility in interpreting the meanings of their missed periods and the physical effects of the remedy.
Assuntos
Aborto Induzido , Medicina Tradicional , População Rural , Aborto Criminoso , Feminino , Humanos , Recém-Nascido , Jamaica , Indutores da Menstruação , Gravidez , Valores Sociais , BruxariaRESUMO
The effect of androstenedione on luteal progesterone production was studied during luteolysis preceding parturition as well as that induced by the antiprogestin RU486 in late pregnant rats. Luteal cells from animals on days 19, 20 or 21 of pregnancy and incubated with 10 microM androstenedione increased progesterone production by 99, 136, and 277%, respectively. The animals receiving androstenedione (10 mg/rat s.c.) on day 19 of pregnancy showed an increase in serum progesterone levels, a decline in luteal 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) activity and an increase in corpus luteum weight without modifying 20 alpha-hydroxysteroid dehydrogenase (20 alpha-HSD) activity on day 21 of pregnancy. Androstenedione and testosterone but not dihydrotestosterone were able to prevent the decrease in serum progesterone concentration and corpus luteum weight observed 58 h after treatment with RU486 (2 mg/kg) on day 18 of pregnancy. However, the three androgens studied inhibited the luteal 3 beta-HSD activity but 20 alpha-HSD activity was not affected, when compared with animals receiving RU486 alone. The co-administration of androstenedione with the aromatase inhibitor 4-hydroxyandrostenedione or with the specific antioestrogen ICI 164,384 did not modify the effects induced by androstenedione in RU486-treated rats, indicating that the action of androstenedione on progesterone production and secretion at the time of luteolysis seems to occur through an androgenic mechanism and is not mediated by previous conversion of the androgens to oestrogens. In all experiments the high luteal 20 alpha-HSD activity, that characterizes a luteolytic process, was not modified by androgens. Androstenedione administered to adrenalectomized rats was also able to prevent the decrease in serum progesterone concentration observed in spontaneous or RU486-induced luteolysis. The administration of androstenedione to RU486-treated rats induced a decrease in luteal progesterone content concomitant with an increase in serum progesterone levels. These studies demonstrate that androgens during luteolysis, are able to stimulate luteal progesterone secretion, prevent the loss in corpora lutea weight and enhance the decrease in 3 beta-HSD activity, without affecting the increase in 20 alpha-HSD activity.
Assuntos
Androstenodiona/farmacologia , Corpo Lúteo/metabolismo , Luteólise/metabolismo , Mifepristona/farmacologia , Prenhez , Progesterona/biossíntese , 17-Hidroxiesteroide Desidrogenases/metabolismo , 20-Hidroxiesteroide Desidrogenases/metabolismo , 20-alfa-Hidroxiesteroide Desidrogenase , Adrenalectomia , Androstenodiona/análogos & derivados , Androstenodiona/metabolismo , Animais , Inibidores da Aromatase , Células Cultivadas , Corpo Lúteo/citologia , Corpo Lúteo/efeitos dos fármacos , Di-Hidrotestosterona/farmacologia , Estradiol/análogos & derivados , Estradiol/farmacologia , Feminino , Antagonistas de Hormônios/farmacologia , Luteolíticos/farmacologia , Indutores da Menstruação/farmacologia , Tamanho do Órgão/efeitos dos fármacos , Alcamidas Poli-Insaturadas , Gravidez , Progesterona/sangue , Ratos , Ratos Wistar , Testosterona/farmacologiaRESUMO
Individuals of Spanish and Mexican descent in New Mexico have used a number of plants as emmenagogues and abortifacients. Of the plants used, cotton root bark (Gossypium sp.), inmortal ((Asclepias capricornu Woodson), poleo chino (Hedeoma oblongifolia (Gray) Heller), rue Ruta graveolens L.), wormseed (Chenopodium ambrosioides L.), and three species of Artemesia seem to be used most widely. Of these, the cotton root bark, when used as an abortifacient, seems to exhibit the lowest toxicity. Rue is notable because of its use independently within different cultures, but may exhibit toxic side effects when used as an abortifacient. Seven other plants are outlined on the basis of anecdotal and folkloric reports. Investigations are underway to look at use effectiveness, side effects, impact on fertility, and acceptance among cultures of the Southwestern United States.
PIP: Spanish and Mexican descendents in New Mexico have used plants as emmenagogues and abortifacients to bring on their periods if pregnancy is suspected. The absence of menses in a woman must be treated as a disease because menses is believed to be the removal of bad blood. The most widely used plants are cotton root bark (Gossypium sp.), inmortal (Asclepias capricornu Woodson), wormseed (Chenopodium ambrosioides L.), poleo chino (Hedeoma oblongifolia), rue (Ruta graveolens L.), and 3 species of Aremesia. The cotton root bark, when used as an abortifacient, exhibits the lowest toxicity. Rue is used independently within different cultures but may exhibit toxic side effects when used as an abortifacient. The plants are used by 3 principal practitioners: 1) curanderos (healers), who tend to specialize in the care of certain diseases; 2) herbalists, who use many of the materials used in traditional medicine; and 3) brujos, who are sorcerers and witches. Other plants used are osha, chuchupate-lovage; ponso or tanse-tansy; poleo-spearmint or pennyroyal mint; amolillo-wild licorice; dormilon-tall cone flower; malva; and, lanten-plantain. The least toxic abortifacients are species of Gossypium, Ruta, Ligusticum, Asclepias, and Rudbeckia.