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Interciência & Sociedade9 A IMPORTÂNCIA DO ÁCIDO FÓLICO NA REDUÇÃO DOS DEFEI- TOS DO TUBO NEURAL DURANTE A GESTAÇÃO 2/,9(,5$��Adriana Cristina1 )DFXOGDGH�0XQLFLSDO�³3URI��)UDQFR�0RQWRUR´��)03)0�� GUL�F�FE#KRWPDLO�FRP 5(**,2//,��Márcia Regina� )DFXOGDGH�0XQLFLSDO�³3URI��)UDQFR�0RQWRUR´��)03)0�� PUUHJJLROOL#WHUUD�FRP�EU 5,%(,52�, Karina Rosa� )DFXOGDGH�0XQLFLSDO�³3URI��)UDQFR�0RQWRUR´��)03)0� .DULQD�URVD#JPDLO�FRP RESUMO: Introdução:�$�GH¿FLrQFLD�GH�iFLGR�IyOLFR�p�R�SULQFLSDO�IDWRU�GH�ULVFR�UHODFLRQDGR�DRV�GHIHLWRV� GR�WXER�QHXUDO��$�IRUWL¿FDomR�GH�DOLPHQWRV�FRP�iFLGR�IyOLFR�p�XPD�LQWHUYHQomR�LQGLVSHQViYHO�QD�SUH� YHQomR�GHVWD�DOWHUDomR�QR�IHWR��Objetivo:�5HDOL]DU�XPD�UHYLVmR�ELEOLRJUi¿FD�GHVWDFDQGR�R�HIHLWR�GH�DOL� PHQWRV�IRUWL¿FDGRV�FRP�iFLGR�IyOLFR�H�GD�VXSOHPHQWDomR�GH�IRODWR�QD�SUHYDOrQFLD�GRV�GHIHLWRV�GR�WXER� neural. Metodologia:�/HYDQWDPHQWR�ELEOLRJUi¿FR�GH�DUWLJRV�UHODFLRQDGRV�jV�QHFHVVLGDGHV�HVSHFt¿FDV� de nutrientes durante a gestação. Considerações:�$�VXSOHPHQWDomR�RUDO�GH�IRODWR�SHULFRQFHSFLRQDO�H� GXUDQWH�R�SULPHLUR�WULPHVWUH�GH�JUDYLGH]�GLPLQXt�R�ULVFR�GH�RFRUUrQFLD�GRV�GHIHLWRV�GR�WXER�QHXUDO�HP� FHUFD�GH����D������HQTXDQWR�TXH�RV�DOLPHQWRV�IRUWL¿FDGRV�GHPRQVWUDP�HIHLWR�VLJQL¿FDWLYR�QD�SUHYDOrQ� FLD�GH�GHIHLWRV�GR�WXER�QHXUDO��YDULDQGR�GH����D������ PALAVRAS – CHAVES: $OLPHQWRV�IRUWL¿FDGRV��6XSOHPHQWDomR�GH�)RODWR�QD�JHVWDomR��'HIHLWR�GR�7XER� Neural. ABSTRACT: Introduction:�7KH�GH¿FLHQF\�RI�IROLF�DFLG�LV�WKH�PDLQ�IDFWRU�RI�ULVN�UHODWHG�WR�WKH�GHIHFWV�LQ� WKH�QHXUDO�WXEH��7KH�HQULFKPHQW�RI�IRRG�ZLWK�IROLF�DFLG�LV�DQ�LQGLVSHQVDEOH�LQWHUIHUHQFH�IRU�WKH�SUHYHQWLRQ� RI�WKLV�IHWDO�DOWHUDWLRQ��Objective:�0DNH�D�ELEOLRJUDSKLFDO�UHYLVLRQ�KLJKOLJKWLQJ�WKH�HIIHFW�RI�HQULFKHG�IRRG� ZLWK�IROLF�DFLG�DQG�WKH�VXSSOHPHQW�RI�IRODWH�LQ�WKH�SUHGRPLQDQFH�RI�GHIHFWV�RI�FORVXUH�LQ�WKH�QHXUDO�WXEH�� Methodology:�%LEOLRJUDSKLFDO�VXUYH\�RI�DUWLFOHV�UHODWHG�WR�WKH�VSHFL¿F�QHHGV�RI�QRXULVKLQJ�GXULQJ�WKH� SUHJQDQF\��Considerations:�7KH�XVH�RI�RUDO�VXSSOHPHQWDWLRQV�RI� IRODWH�SHULFRQFHSWLRQDO�DQG�GXULQJ� WKH�¿UVW�WKUHH�PRQWKV�RI�SUHJQDQF\�GLPLQLVKHV�WKH�ULVN�RI�RFFXUUHQFH�RI�WKH�GHIHFWV�LQ�WKH�QHXUDO�WXEH�LQ� DERXW����WR�������ZKLOH�WKH�HQULFKHG�IRRG�VKRZV�D�YDULDEOH�SURWHFWRU�HIIHFW�RI�VLJQL¿FDQFH�LQ�WKH�SUHYD- OHQFH�RI�GHIHFWV�LQ�WKH�QHXUDO�WXEH��YDU\LQJ�IURP����WR������ KEYWORDS:�(QULFKHG�IRRG��6XSSOHPHQWDWLRQ�RI�)RODWH�LQ�WKH�*HVWDWLRQ��'HIHFWV�LQ�WKH�1HXUDO�7XEH. 1. INTRODUÇÃO $� JUDYLGH]� SURYRFD� PXGDQoDV� ¿� VLROyJLFDV� QR� RUJDQLVPR� TXH� FDXVDP� D� necessidade aumentada de nutrientes es� VHQFLDLV�� 2� DSRUWH� HQHUJpWLFR� LQDGHTXDGR� GD�JHVWDQWH�� VHMD�HP� WHUPRV�GH�PDFUR�RX� PLFURQXWULHQWHV��SRGH�LQGX]LU�D�XPD�FRQFRU� rência nutricional entre a mãe e o feto, limi� WDQGR�D�GLVSRQLELOLGDGH�HQHUJpWLFD�QHFHVVi� ULD�DR�DGHTXDGR�FUHVFLPHQWR�IHWDO��0(//2� HW�DO���������� 2�HVWDGR�QXWULFLRQDO�PDWHUQR�p�LQ� GLFDGRU�GH�VD~GH�H�TXDOLGDGH�GH�YLGD�WDQWR� SDUD�D�PXOKHU�TXDQWR�SDUD�R�FUHVFLPHQWR�GR� VHX� ¿OKR��2� SHVR� GR� EHEr� DR� QDVFLPHQWR� p�XP�LPSRUWDQWH� LQGLFDGRU�GR�HVWDGR�QXWUL� FLRQDO�GD�PmH�GXUDQWH�D�JHVWDomR��XPD�YH]� TXH��D�~QLFD�IRQWH�GH�QXWULHQWHV�GR�FRQFHS� WR�p�FRPSRVWD�SHODV�UHVHUYDV�QXWULFLRQDLV�H� LQJHVWmR� DOLPHQWDU� PDWHUQD� �0(/2� HW� DO��� ������� $� GLHWD�� QR� SULPHLUR� WULPHVWUH� GD� JHVWDomR�� p� PXLWR� LPSRUWDQWH� SDUD� R� GH� VHQYROYLPHQWR�H�GLIHUHQFLDomR�GRV�GLYHUVRV� yUJmRV�IHWDLV��-i�QRV�WULPHVWUHV�VXEVHTXHQ� Interciência & Sociedade10 WHV��D�GLHWD�HVWi�PDLV�HQYROYLGD�FRP�D�RWLPL� ]DomR�GR�FUHVFLPHQWR�H�GR�GHVHQYROYLPHQ� WR�FHUHEUDO�GR�IHWR��5,)$6�6&+,0$1�HW�DO��� ������ O sucesso de uma gestação sem FRPSOLFDo}HV�HVWi�UHODFLRQDGR�D�XPD�GLHWD� balanceada e equilibrada, contendo todos RV� QXWULHQWHV� QHFHVViULRV� �HQHUJLD�� SURWHt� QDV��FDUERLGUDWRV�� OLStGHRV��YLWDPLQDV�$��'�� (��&��SLULGR[LQD��FREDODPLQD�� WLDPLQD�� ULER� ÀDYLQD��QLDFLQD��FiOFLR��IyVIRUR��]LQFR��IHUUR�� iFLGR�IyOLFR��SDUD�D�VD~GH�GD�PXOKHU�GXUDQ� WH�D�JUDYLGH]��D�VD~GH�GR�FRQFHSWR��R�EHP� �HVWDU�PDWHUQR��SRVVLELOLWDQGR�D�QXWULomR�GR� UHFpP�QDVFLGR��H�SURWHomR�FRQWUD�R�GHVHQ� YROYLPHQWR� GH� PiV� IRUPDo}HV� FRQJrQLWDV� H� GRHQoDV� FU{QLFDV� GXUDQWH� D� YLGD� DGXOWD� �/8&<.�H�)8580272��������� $V� JHVWDQWHV� HVWmR� SUHGLVSRVWDV� HVSHFLDOPHQWH�D�GHVHQYROYHU�GH¿FLrQFLD�GH� iFLGR�IyOLFR��GHYLGR�DR�DXPHQWR�GD�QHFHV� VLGDGH�GHVVH�QXWULHQWH�SDUD�R�FUHVFLPHQWR� IHWDO�H�WHFLGRV�PDWHUQRV��R�TXH�SRGH�GHVHQ� FDGHDU�PRGL¿FDo}HV�QD�VtQWHVH�GH�'1$�H� DOWHUDo}HV� FURPRVV{PLFDV� �0(==202� HW� DO��� �������8PD�GLHWD� QRUPDO� QmR�p� FDSD]� GH�VXSULU�DV�QHFHVVLGDGHV�GH�iFLGR�IyOLFR�GD� JHVWDQWH�H�GR� IHWR�GXUDQWH�R�SHUtRGR�JHV� WDFLRQDO�� GHYLGR� DR� DXPHQWR� GD� GHPDQGD� GHVVD�YLWDPLQD��VHQGR�QHFHVViULR�R�XVR�GH� VXSOHPHQWDomR� GH� IRODWR� �6$1726� H� 3(� 5(,5$�������� 2�REMHWLYR�GHVWH�HVWXGR�IRL�UHDOL]DU� XPD�UHYLVmR�ELEOLRJUi¿FD�GHVWDFDQGR�R�HIHL� WR�GH�DOLPHQWRV�IRUWL¿FDGRV�FRP�iFLGR�IyOLFR� H� VXSOHPHQWDomR� GH� IRODWR� QD� SUHYDOrQFLD� de defeitos de fechamento do tubo neural. 2. METODOLOGIA 8PD�H[WHQVD� UHYLVmR�GH� OLWHUDWXUD� SHUPLWLX�DQDOLVDU�RV�HVWXGRV�FLHQWt¿FRV� UH� ODFLRQDGRV�DRV�REMHWLYRV�GHVWH�WUDEDOKR�GH� PDQHLUD�VLVWHPiWLFD�H�DPSOD� 2� OHYDQWDPHQWR� GD� SHVTXLVD� IRL� UHDOL]DGR� DWUDYpV� GD� ELEOLRWHFD� YLUWXDO� HP� VD~GH��DWUDYpV�GRV�EDQFRV�GH�GDGRV�FRPR� 6FLHOR��6FLHQWL¿F�(OHFWURQLF�/LEUDU\�2QOLQH��� %'(1)��%DVH�GH�'DGRV�%LEOLRJUi¿FRV�(V- SHFLDOL]DGRV� QD� ÈUHD� GH� (QIHUPDJHP� QR� %UDVLO���%96�06��%LEOLRWHFD�9LUWXDO�HP�6D~- GH�0LQLVWpULR�GD�6D~GH���DPERV�GD�iUHD�GD� VD~GH�UHODFLRQDGRV�jV�QHFHVVLGDGHV�HVSH� Ft¿FDV� GH� QXWULHQWHV� GXUDQWH� D� JHVWDomR�� Essas bases de dados foram selecionadas GHYLGR�jV�PHVPDV�SRVVXtUHP�SXEOLFDo}HV� de ordem nacional e internacional. A escolha dos artigos foi obtida DWUDYpV�GH�SDODYUDV�FKDYHV�FRPR�� ³6XSOH� mentação de Folato na gestação, Alimentos IRUWL¿FDGRV�H�'HIHLWR�GR�7XER�1HXUDO´� )RUDP�DQDOLVDGDV�SDUD�D�SHVTXLVD� ELEOLRJUi¿FD��YLQWH�H�XPD�SXEOLFDo}HV�FLHQ� Wt¿FDV�� VHQGR� GH]HVVHLV� QDFLRQDLV� H� FLQFR� internacionais. 3. DEFEITOS DO FECHAMENTO DO TUBO NEURAL (DFTN) 2�WXER�QHXUDO�p�XPD�HVWUXWXUD�SUH� FXUVRUD�GR�FpUHEUR�H�GD�PHGXOD�HVSLQKDO�GR� IHWR��2�IHFKDPHQWR�GR�WXER�QHXUDO��SULPyU� GLR�GR�VLVWHPD�QHUYRVR�FHQWUDO��RFRUUH�HP� TXDWUR�RX�FLQFR�ORFDLV��HP�P~OWLSORV�SRQWRV� VLPXOWkQHRV�H�GH�IRUPD�ELGLUHFLRQDO�QDV�SUL� PHLUDV�TXDWUR�VHPDQDV�DSyV�D�FRQFHSomR�� 4XDQGR�HVVH�WXER�QmR�FRQVHJXH�FRPSOHWDU� D�QHXUXODomR�RX�HQYROWyULRV��RFRUUH�R�GHIHL� to de fechamento, sendo uma malformação RFRUULGD�QD�IDVH�LQLFLDO�GR�GHVHQYROYLPHQWR� IHWDO��TXH�WHP�D�VXD�PRUIRORJLD�GHSHQGHQWH� GR�WLSR�GH�IDOKD�H�GR�ORFDO�DIHWDGR��RULJLQDQ� do doenças que causam morte ou seqüelas JUDYHV�QRV�UHFpP�QDVFLGRV��$*8,$5�HW�DO��� ������� $� LQFLGrQFLD�GRV�')71�p�HP�Pp� GLD�GH���������QDVFLGRV�YLYRV��'HVWDFDQGR� DLQGD�� TXH� ���� GDV� PXOKHUHV� FRP� ¿OKRV� DIHWDGRV� SRU�')71�QmR� DSUHVHQWDP�DQWH� FHGHQWHV�SHVVRDLV�RX�IDPLOLDUHV��&21&(,� d2�������� $V� JHVWDo}HV� FRP� FRPSOLFDo}HV� como defeito de fechamento de tubo neural, UHVXOWDP�HP�DERUWRV��H�TXDQGR�QDVFLGRV�YL� YRV��PRUUHP�SRXFDV�KRUDV�RX�SRXFRV�GLDV� DSyV�R�SDUWR�� RX�DLQGD� UHVXOWDP�HP� OHVmR� QHUYRVD� SHUPDQHQWH�� FDXVDQGR� SDUDOLVLDV� HP�QtYHLV�GLYHUVRV�GRV�PHPEURV�LQIHULRUHV�� EH[LJD��LQWHVWLQR��FRPSURPHWLPHQWR�ItVLFR�H� GL¿FXOGDGH� GH� DSUHQGL]DJHP� �0(==202� HW�DO��������� 'H�DFRUGR�FRP�0HOR�H�5LR�������� PXOKHUHV� FXMRV� IHWRV� RX� UHFpP�QDVFLGRV� DSUHVHQWDP� GHIHLWRV� GR� WXER� QHXUDO� SUHFL� VDP� VHU� QRUWHDGDV� TXDQWR� j� SRVVLELOLGDGH� GR� ULVFR�GH� UHFRUUrQFLD�QDV�SUy[LPDV�JHV� ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� Interciência & Sociedade11 WDo}HV�� VHQGR� QHFHVViULR�PDQWHU� D� VXSOH� PHQWDomR� FRQWtQXD� GH� IRODWR� GLDULDPHQWH�� QR�SHUtRGR�SHULFRQFHSFLRQDO��DWp�D����VH� mana da gestação. As causas dos defeitos do tuboQHXUDO�QmR�VmR�FRPSOHWDPHQWH�FRQKHFLGDV�� PDV�DV�HYLGrQFLDV�LQGLFDP�TXH��SHOR�PHQRV� HP�SDUWH��VH�GHYHP�D�REHVLGDGH�PDWHUQD��D� SUREOHPDV�QXWULFLRQDLV��D�DJHQWHV�DPELHQ� WDLV��D�FDXVDV�JHQpWLFDV��DR�XVR�GH�GURJDV� e ao uso de certos medicamentos, como os DQWLFRQYXOVLYDQWHV�� H�j�QXWULomR�GH¿FLHQWH�� HVSHFLDOPHQWH�HP�iFLGR�IyOLFR�VHQGR�FRQVL� GHUDGR�R�SULQFLSDO�IDWRU�GH�ULVFR�UHODFLRQDGR� DRV�GHIHLWRV�GR�WXER�QHXUDO��6$1726�H�3(� 5(,5$�������� 0H]]RPR� HW� DO��� ������� UHODWDUDP� HP� XP� HVWXGR� GH� FDVR�FRQWUROH� GH� EDVH� SRSXODFLRQDO� HP� 3HORWDV�� 5LR� *UDQGH� GR� 6XO��QR�%UDVLO��D�RFRUUrQFLD�GH��������QDV� FLPHQWRV�GXUDQWH�R�SHUtRGR�GH���GH�MDQHLUR� GH������j����GH�GH]HPEUR�GH�������VHQGR� TXH�GHVWH� WRWDO������ UHFpP�QDVFLGRV�DSUH� VHQWDUDP�VH�PDOIRUPDGRV����������'HVWHV�� ��� ����� WLYHUDP� GLDJQyVWLFR� GH� DQHQFHID� OLD��'RV�����UHFpP�QDVFLGRV�PDOIRUPDGRV�� ����DSUHVHQWDYDP�GHIHLWRV�GR�WXER�QHXUDO�� (VWHV�GDGRV�GHPRQVWUDP�XPD�SUHYDOrQFLD� LPSRUWDQWH�� HVWLPDGD� HP� ��PLO�� VHQGR� QH� FHVViULD�PDLRU� DWHQomR� DRV� FXLGDGRV� SUH� YHQWLYRV�GHVVDV�PDOIRUPDo}HV� 3HUDOWD� ������� GHVFUHYH� TXH� RV� (VWDGRV�8QLGRV�SRVVXL�XP�JDVWR�DQXDO�HP� WRUQR�GH�����PLOK}HV�GH�GyODUHV�FRP�RV�SD� FLHQWHV�FRP�')71�� ���� &RQVHTXrQFLDV� GRV� HIHLWRV� GH� IHFKD� mento do tubo neural (VWXGRV�WrP�LQGLFDGR�TXH�D�GH¿FL� rQFLD�GH�iFLGR�IyOLFR�SRGH�GHVHQFDGHDU�GH� IHLWRV�QR�WXER�QHXUDO�H�YiULDV�FRPSOLFDo}HV� QD�JHVWDomR��7$085$�������� As consequências mais frequen� WHV� FDXVDGDV� SHOR� IHFKDPHQWR� LQFRPSOHWR� GR�WXER�QHXUDO�VmR�D�DQHQFHIDOLD��)LJXUD����� RFDVLRQDGD�TXDQGR�D�H[WUHPLGDGH�VXSHULRU� do tubo neural não se fecha, resultando na DXVrQFLD�GR�FpUHEUR��H�D�HVSLQKD�Et¿GD��)L� JXUD�����RFRUULGD�TXDQGR�D�H[WUHPLGDGH�LQ� ferior do tubo neural não se fecha, causan� GR�GDQRV�PHGXODUHV�VLJQL¿FDWLYRV�� Figura 1 : $QHQFHIDOLD��$GDSWDGR�GH��KWWS���ZZZ�EUDVLOLDFDWROLFD�FRP������$FHVVR�HP�����RXW Figura 2:�(VSLQKD�%t¿GD��)RQWH���KWWS���ZZZ�HVSLQKDEL¿GD�FRP�!�$FHVVR�HP�����RXW������ ,QWHUFLrQFLD� �6RFLHGDGH��,661���������������9RO�����1��������� Interciência & Sociedade12 �����*UXSR�GH�ULVFR�SDUD�R�GHIHLWR�GR�IHFKD� mento do tubo neural (P�XP�HVWXGR�UHFHQWH��IRL�LGHQWL¿� FDGR�TXH�XPD�HP�FDGD�VHWH�SHVVRDV�SRGH� SRUWDU�XPD�PXWDomR�JHQpWLFD�TXH�IDYRUHFH� XPD�GH¿FLrQFLD�GH�iFLGR�IyOLFR��PHVPR�TXH� a alimentação contenha a quantidade reco� PHQGDGD�GH�iFLGR�IyOLFR�QDWXUDO��(VWDV�SHV� VRDV�WrP�SUREOHPDV�SDUD�SURFHVVDU�D�IRUPD� GD�YLWDPLQD�TXH�VH�HQFRQWUD�QDWXUDOPHQWH� QRV�DOLPHQWRV��FRPSURPHWHQGR�DVVLP�D�DE� VRUomR��GLPLQXLQGR�RV�QtYHLV�GH�iFLGR�IyOLFR� no sangue. Desta forma as mulheres que SRVVXHP�HVWD�PXWDomR�JHQpWLFD�FRQWrP�XP� risco maior de gerar um feto com defeito de WXER�QHXUDO��6$1726�H�3(5(,5$�������� De acordo com Souza e Machado ��������p�FRQVLGHUDGR�JUXSR�GH� ULVFR� WRGD� PXOKHU�JUiYLGD�H�HP�LGDGH�UHSURGXWLYD�TXH� QmR�ID]HP�R�XVR�GD�VXSOHPHQWDomR�GH�IR� lato corretamente durante a gestação, ou DLQGD��WRGDV�DTXHODV�TXH�SRVVXHP�DOLPHQ� WDomR�GH¿FLHQWH�HP�iFLGR�IyOLFR�� �����ÈFLGR�IyOLFR 'H� DFRUGR� FRP� 1DVVHU� �������� R� iFLGR�IyOLFR�p�D�IRUPD�VLQWpWLFD�GR�IRODWR��OR� FDOL]DGR�HP�VXSOHPHQWRV�YLWDPtQLFRV�H�DOL� PHQWRV� IRUWL¿FDGRV�� H� WHP�PDLRU� ELRGLVSR� QLELOLGDGH�QD� IRUPD�VLQWpWLFD�TXH�QD� IRUPD� QDWXUDO�� e� WDPEpP� FRQVLGHUDGR� XP� WHUPR� JHQpULFR� SDUD� RV� FRPSRVWRV� TXH� WrP� DWL� YLGDGH�YLWDPtQLFD�SDUHFLGD�D�GR�iFLGR�SWH� URLOJOXWkPLFR�VHQGR�D�IRUPD�GH�YLWDPLQD�QD� turalmente encontrada nos alimentos. 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