ABC | Volume 112, Nº5, May 2019

Guideline Brazilian Fetal Cardiology Guidelines – 2019 Arq Bras Cardiol. 2019; 112(5):600-648 potential anti-inflammatory actions (corticosteroids, 108 aspirin, 107 dipyrone, 105,110 fluoxetine, 109,126 paroxitine, sertraline, 109,111 isoxsuprine, 107 and naphazoline), 107 their use interruption may be considered (Class of recommendation: IIa; level of evidence: C). In cases in which there is no reversal of ductal constriction and its consequences after initiation of treatment, preterm delivery may be considered, provided that fetal pulmonary maturity has been established (Class of recommendation: IIb; level of evidence: C). 6.5.2. Recommendations for Ductal Constriction Prevention In order to prevent fetal ductal constriction, pregnant women should be recommended not to use NSAID during the third trimester of gestation, regardless of the route of administration (Class of recommendation: I; level of evidence: A). It is also considered to recommend that they avoid using other medications with possible anti-inflammatory effects (corticosteroids, 108 Table 6.2 – Recommendations for polyphenol-rich foods restriction after 28 weeks gestation for ductal constriction treatment Restricted foods Alternatives options Raw beets: consume no more than 2 tablespoons/day Cooked beets or carrots Lettuce: consume no more than 10 medium-sized leaves/day It is ideal to consume less Red/purple plums, unpeeled: consume no more than 1 small unit/day Pineapples, pears, and peeled red apples Blackberries/mulberries: consume no more than 1/2 cup/day Pineapples, acerolas, and limes Red apples, unpeeled: do not eat the peel Green apples or peeled red apples Oranges/orange juice: do not consume Pineapples, acerolas, limes, and tangerines* Papaya: consume no more than 1 slice/day (formosa variety) Guavas, acerolas, limes, and tangerines* Strawberries: consume no more than 2 larges units/day Pineapple, acerolas, limes, and tangerines* Red/purple/pink grapes/grape juice: do not consume White grapes, pears, and peeled apples Green tea: do not consume Fruit teas (teabags) Black tea: do not consume Fruit teas (teabags) Boldo tea: do not consume Fruit teas (teabags) Coffee: do not consume --- Yerba mate: do not consume --- Dark/milk/bittersweet chocolate: do not consume White chocolate Cocoa powder: do not consume Olive oil: do not consume Canola oil Green herbs: consume no more than 12 teaspoons/day Other natural spices * Consume in moderation. When consuming a restricted food, consume no more than once daily, and do not exceed the quantities described in the table. Source: Adapted from Arnt et al. 127 aspirin, 107 dipyrone, fluoxetine, 109,126 paroxetine, sertraline, 109,111 isoxsuprine, 107 and naphazoline) 107 (Class of recommendation: IIa; level of evidence: C). It is sufficient to recommend moderate maternal polyphenol-rich foods consumption during the third trimester of gestation, i.e., below the 75 th percentile of consumption, 76 or limiting consumption of foods with concentrations above 30 mg per 100 g, in accordance with the food pyramid shown in Figure 6.1. Reduced daily consumption of polyphenols below 1,089 mg (75 th percentile) maintains an acceptable diet for nutritional needs during this period of gestation (Class of recommendation: IIa; level of evidence: C). Figures 6.2 and 6.3, respectively, show recommendations for treatment and prevention of fetal ductal constriction. 7. Fetal Cardiac Arrhythmias: Diagnosis and Treatment Screening programs for detecting prenatal cardiac abnormalities developed over the past 3 decades, 623