Relação entre o uso de dipirona durante o período gestacional e transtorno de déficit de atenção e hiperatividade em crianças
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Tipo
TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Doelinger, Bernardo Gomes
Santos, Yanka Dickow dos
Santos, Yanka Dickow dos
Orientador
Ribas, Mauricio Marcondes
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INTRODUÇÃO: A dipirona (metamizol) é um fármaco amplamente utilizado no Brasil, tanto por conta dos seus efeitos antipiréticos quanto analgésicos. Além disso, a automedicação no país é uma realidade e é um grande desafio para a saúde, principalmente em gestantes.O paracetamol e a dipirona são os analgésicos mais seguros disponíveis no mercado, com preferência para utilização, nas gestantes, antes do terceiro trimestre de gravidez. Os medicamentos podem possuir efeitos teratogênicos e sua utilização na gestação deve ser especialmente avaliada. O paracetamol (acetaminofeno) é da mesma classe da dipirona (analgésicos não opióides) e também é amplamente consumido pelos brasileiros. Diversos estudos já evidenciaram uma significativa relação entre a utilização do paracetamol no período gestacional e a incidência de TDAH na prole. Ademais, os dois medicamentos têm um mecanismo de ação com diversas semelhanças, entre elas a atuação no sistema Substância Cinzenta Periaquedutal, que ativa a via antinociceptiva descendente, atuam também no sistema endocanabinoide, assim como na inibição da síntese de prostaglandinas mediadas pela COX. Apesar de haver diversos estudos relacionando o paracetamol com TDAH em crianças, a dipirona é escassa nas pesquisas acerca do tema. O TDAH acomete cerca de 5% das crianças mundialmente, sendo no brasil uma prevalência de aproximadamente 6,7%. É um transtorno multifatorial e heterogêneo, sua severidade e sintomas estão relacionados a fatores genéticos, com múltiplos genes acometidos, neurobiológicos, ambientais e sociais. OBJETIVO: Busca-se por meio deste estudo avaliar a associação entre a exposição pré-natal de Dipirona e o risco de TDAH na prole. METODOLOGIA: A pesquisa foi realizada por meio de um estudo de caso-controle, observacional e quantitativo envolvendo mães de pacientes diagnosticados entre 4 a 12 anos com Transtorno de Hiperatividade e Déficit de Atenção e Hiperatividade. Estes pacientes estiveram em acompanhamento no ambulatório de pediatria e neuropediatria do Hospital Evangélico Mackenzie do Paraná. A pesquisa foi realizada com 56 participantes, com e sem diagnóstico de TDAH, sendo N1=28, com mães com filhos portadores de TDAH e N2=28, com mães em que os filhos não são portadores de TDAH. A coleta de dados foi por meio de questionário impresso, que foi respondido pela mãe do paciente no ambulatório de pediatria e neuropediatria do HUEM, em sala reservada. RESULTADOS: Das participantes, 80,4% não usaram dipirona durante a gestação, e 19,6% utilizaram, devido à prescrição recomendada para tratamento de dor no Brasil. No entanto, não houve associação significativa entre o uso de dipirona e a presença de TDAH nos filhos. Mais mães usaram paracetamol (60,7%) do que dipirona (19,6%). A maior parte usou medicamentos conforme prescrição médica, embora a automedicação de dipirona tenha sido mais frequente entre mães com filhos diagnosticados com TDAH. CONCLUSÃO: Não foi encontrada uma relação direta entre o uso de dipirona durante a gestação e o desenvolvimento de TDAH na prole. A prescrição médica é predominante, mas a automedicação ainda é presente, especialmente com a dipirona entre mães com filhos com TDAH. Mais estudos são necessários para um entendimento completo dos efeitos da dipirona durante a gravidez.
INTRODUCTION: Dipyrone (metamizole) is a drug widely used in Brazil, both because of its antipyretic and analgesic effects. Furthermore, self-medication in the country is a reality and is a major health challenge, especially for pregnant women. Paracetamol and dipyrone are the safest analgesics available on the market, with preference for use in pregnant women before the third trimester of pregnancy. pregnancy. Medications may have teratogenic effects and their use during pregnancy must be especially evaluated. Paracetamol (acetaminophen) is from the same class as dipyrone (non-opioid analgesics) and is also widely consumed by Brazilians. Several studies have already shown a significant relationship between the use of paracetamol during pregnancy and the incidence of ADHD in the offspring. Furthermore, the two medications have a mechanism of action with several similarities, including acting on the Periaqueductal Gray Substance system, which activates the descending antinociceptive pathway, and also acting on the endocannabinoid system, as well as inhibiting the synthesis of prostaglandins mediated by COX. Although there are several studies linking paracetamol with ADHD in children, dipyrone is scarce in research on the topic. ADHD affects around 5% of children worldwide, with a prevalence of approximately 6.7% in Brazil. It is a multifactorial and heterogeneous disorder, its severity and symptoms are related to genetic factors, with multiple affected genes, neurobiological, environmental and social. OBJECTIVE: This study aimed to assess the association between prenatal exposure to dipyrone and the risk of ADHD in offspring. METHODS: A case-control, observational, and quantitative study was conducted involving mothers of diagnosed ADHD patients aged 4-12 years from the Evangelical Mackenzie Hospital of Paraná. Data was collected through printed questionnaires answered by the mothers. The sample consisted of 56 participants, 28 with ADHD-diagnosed children (N1) and 28 without (N2). RESULTS: Among the participants, 80.4% did not use dipyrone during pregnancy, whereas 19.6% did, primarily for pain management. However, no significant association between dipyrone use and ADHD presence in offspring was found. Paracetamol was more frequently used (60.7%) than dipyrone (19.6%). Most medication use followed medical prescriptions, but self-medication with dipyrone was more frequent among mothers of ADHD-diagnosed children. CONCLUSION: No direct relationship between prenatal dipyrone exposure and ADHD development in offspring was identified. While prescription medication dominates, self-medication, particularly with dipyrone among mothers of ADHD children, persists. Further research is needed to understand dipyrone's effects during pregnancy fully.
INTRODUCTION: Dipyrone (metamizole) is a drug widely used in Brazil, both because of its antipyretic and analgesic effects. Furthermore, self-medication in the country is a reality and is a major health challenge, especially for pregnant women. Paracetamol and dipyrone are the safest analgesics available on the market, with preference for use in pregnant women before the third trimester of pregnancy. pregnancy. Medications may have teratogenic effects and their use during pregnancy must be especially evaluated. Paracetamol (acetaminophen) is from the same class as dipyrone (non-opioid analgesics) and is also widely consumed by Brazilians. Several studies have already shown a significant relationship between the use of paracetamol during pregnancy and the incidence of ADHD in the offspring. Furthermore, the two medications have a mechanism of action with several similarities, including acting on the Periaqueductal Gray Substance system, which activates the descending antinociceptive pathway, and also acting on the endocannabinoid system, as well as inhibiting the synthesis of prostaglandins mediated by COX. Although there are several studies linking paracetamol with ADHD in children, dipyrone is scarce in research on the topic. ADHD affects around 5% of children worldwide, with a prevalence of approximately 6.7% in Brazil. It is a multifactorial and heterogeneous disorder, its severity and symptoms are related to genetic factors, with multiple affected genes, neurobiological, environmental and social. OBJECTIVE: This study aimed to assess the association between prenatal exposure to dipyrone and the risk of ADHD in offspring. METHODS: A case-control, observational, and quantitative study was conducted involving mothers of diagnosed ADHD patients aged 4-12 years from the Evangelical Mackenzie Hospital of Paraná. Data was collected through printed questionnaires answered by the mothers. The sample consisted of 56 participants, 28 with ADHD-diagnosed children (N1) and 28 without (N2). RESULTS: Among the participants, 80.4% did not use dipyrone during pregnancy, whereas 19.6% did, primarily for pain management. However, no significant association between dipyrone use and ADHD presence in offspring was found. Paracetamol was more frequently used (60.7%) than dipyrone (19.6%). Most medication use followed medical prescriptions, but self-medication with dipyrone was more frequent among mothers of ADHD-diagnosed children. CONCLUSION: No direct relationship between prenatal dipyrone exposure and ADHD development in offspring was identified. While prescription medication dominates, self-medication, particularly with dipyrone among mothers of ADHD children, persists. Further research is needed to understand dipyrone's effects during pregnancy fully.
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Palavras-chave
TDAH , crianças , dipirona , gestação , ADHD , children , dipyrone , pregnancy