Relação entre o selênio e a fertilidade feminina: Uma revisão sistemática

Lima, Luiz Gustavo; Santos, André Amaro Mamédio dos; Gueiber, Tiago Daniel; Gomes, Ricardo Zanetti; Martins, Camila Marinelli; Chaikoski, Andrielle Cristina

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Brasil

Español English

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Sumário

Review Article • Rev Bras Ginecol Obstet. 44 (07) • Jul 2022 • https://doi.org/10.1055/s-0042-1744288 copiar

Relação entre o selênio e a fertilidade feminina: Uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Analisar a influência do selênio na fertilidade feminina.

Fonte dos dadosUma busca foi realizada nas seguintes bases de dados: MEDLINE, Web of Science, Scopus, SciELO, LILACS, MDPI, ScienceDirect e Europe PMC. Os descritores selecionados foram “selenium” AND “female” AND “fertility”. O intervalo de busca foi de 1996 a 2021.

Seleção dos estudosA avaliação ocorreu de maneira independente por dois revisores, sendo que um terceiro corroborou a eleição dos artigos em casos de divergência. Os estudos foram selecionados através da leitura do título e resumo, e aqueles que contemplaram os critérios de elegibilidade foram lidos na íntegra.

Coleta dos dadosOs seguintes dados foram extraídos: autor, ano de publicação, país, tipo de estudo, objetivo, método, tamanho da amostra, tempo de acompanhamento, média de idade das pacientes, critérios de inclusão e exclusão, concentração de selênio sérico e capilar. Os dados foram organizados em ordem cronológica de publicação do estudo.

Síntese dos dadosForam identificados 3.800 artigos e incluídos 7 estudos na revisão sistemática. Os resultados indicaram correlação positiva entre o nível de selênio sérico e a concentração de antioxidantes no fluido folicular; diminuição dos níveis de anticorpos antitireoidianos; produção de oócitos, e número de folículos.

Conclusão

A suplementação de selênio é promissora em mulheres com deficiência do micronutriente, a fim de promover melhora na eficiência reprodutiva e prevenir danos na gravidez. Salientou-se a necessidade de realização de mais estudos sobre o tema.

Palavras-chave
selênio; fármacos para a fertilidade feminina; reprodução

Author/Year of publication	Country	Type of study	Mean age (years)	Sample size	Study aim	Methodological quality
Kim et al. (2018)²⁹29 Kim K, Wactawski-Wende J, Michels KA. , Schliep KC, Plowden TC, Chaljub EN, Mumford SL. Dietary minerals, reproductive hormone levels and sporadic anovulation: associations in healthy women with regular menstrual cycles. Br J Nutr 2018; 120 (01) 81-89 DOI: 10.1017/S0007114518000818. https://doi.org/10.1017/S000711451800081...	United States	Prospective cohort	18–44¹	259	To investigate the association between 10 minerals and reproduction hormones	Moderate quality *
Dickerson et al. (2011)³⁰30 Dickerson EH, Sathyapalan T, Knight R. , Maguiness SM, Killick SR, Robinson J, Atkin SL. Endocrine disruptor & nutritional effects of heavy metals in ovarian hyperstimulation. J Assist Reprod Genet 2011; 28 (12) 1223-1228 DOI: 10.1007/s10815-011-9652-3. https://doi.org/10.1007/s10815-011-9652-...	United Kingdom	Prospective cohort	32.7	30	To assess the exposure to mercury, zinc, and selenium in the gonadal response in IVF	Moderate quality *
Singh et al. (2013)³¹31 Singh AK, Chattopadhyay R, Chakravarty B, Chaudhury K. Markers of oxidative stress in follicular fluid of women with endometriosis and tubal infertility undergoing IVF. Reprod Toxicol 2013; 42: 116-124 DOI: 10.1016/j.reprotox.2013.08.005. https://doi.org/10.1016/j.reprotox.2013....	India	Prospective Cohort	32.1	340	To evaluate the relation between oxidative stress and elements of the follicular fluid in women subjected to IVF	High quality *
Ambroziak et al. (2017)³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	Poland	Prospective Cohort	29.6	74	To determine whether selenium is associated to the AITD during pregnancy	High quality *
Lozano et al. (2020)³³33 Lozano M, Murcia M, Soler-Blasco R. , Iñiguez C, Irizar A, Lertxundi A, et al. Prenatal Se concentrations and anthropometry at birth in the INMA study (Spain). Environ Res 2020; 181: 108943 DOI: 10.1016/j.envres.2019.108943. https://doi.org/10.1016/j.envres.2019.10...	Spain	Prospective Cohort	30.7	1,249	To investigate the association between maternal selenium serum levels and their babies' anthropometry	High quality*
Thomas et al. (2013)³⁴34 Thomas VV, Knight R, Haswell SJ, Lindow SW, van der Spuy ZM. Maternal hair selenium levels as a possible long-term nutritional indicator of recurrent pregnancy loss. BMC Womens Health 2013; 13: 40 DOI: 10.1186/1472-6874-13-40. https://doi.org/10.1186/1472-6874-13-40...	South Africa	Case-control	32.75	48	To evaluate whether selenium deficiency is found in women with RPL	Moderate quality *
Mantovani et al. (2019)³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	Italy	Randomized clinical trial	31.9	45	To investigate whether selenium supplementation has a protective effect on thyroid during and after pregnancy	High quality **

Study	Design	Selection	Comparability	Outcome	Total
Kim et al. (2018)²⁹29 Kim K, Wactawski-Wende J, Michels KA. , Schliep KC, Plowden TC, Chaljub EN, Mumford SL. Dietary minerals, reproductive hormone levels and sporadic anovulation: associations in healthy women with regular menstrual cycles. Br J Nutr 2018; 120 (01) 81-89 DOI: 10.1017/S0007114518000818. https://doi.org/10.1017/S000711451800081...	Prospective cohort	4	1	1	6
Dickerson et al. (2011)³⁰30 Dickerson EH, Sathyapalan T, Knight R. , Maguiness SM, Killick SR, Robinson J, Atkin SL. Endocrine disruptor & nutritional effects of heavy metals in ovarian hyperstimulation. J Assist Reprod Genet 2011; 28 (12) 1223-1228 DOI: 10.1007/s10815-011-9652-3. https://doi.org/10.1007/s10815-011-9652-...	Prospective cohort	3	1	3	7
Singh et al. (2013)³¹31 Singh AK, Chattopadhyay R, Chakravarty B, Chaudhury K. Markers of oxidative stress in follicular fluid of women with endometriosis and tubal infertility undergoing IVF. Reprod Toxicol 2013; 42: 116-124 DOI: 10.1016/j.reprotox.2013.08.005. https://doi.org/10.1016/j.reprotox.2013....	Prospective cohort	4	2	3	9
Ambroziak et al. (2017)³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	Prospective cohort	4	2	3	9
Lozano et al. (2020)³³33 Lozano M, Murcia M, Soler-Blasco R. , Iñiguez C, Irizar A, Lertxundi A, et al. Prenatal Se concentrations and anthropometry at birth in the INMA study (Spain). Environ Res 2020; 181: 108943 DOI: 10.1016/j.envres.2019.108943. https://doi.org/10.1016/j.envres.2019.10...	Prospective cohort	4	2	3	9
Thomas et al. (2013)³⁴34 Thomas VV, Knight R, Haswell SJ, Lindow SW, van der Spuy ZM. Maternal hair selenium levels as a possible long-term nutritional indicator of recurrent pregnancy loss. BMC Womens Health 2013; 13: 40 DOI: 10.1186/1472-6874-13-40. https://doi.org/10.1186/1472-6874-13-40...	Case-control	4	2	2	8

Study	PEDro scale criteria
Study	2	3	4	5	6	7	8	9	10	11
Mantovani et al. (2019)³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	Y	N	Y	N	N	N	Y	Y	Y	Y

Pregnancy trimester	Mean serum Se concentration (μg/L)	SD
1st trimester
Healthy pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	64.60	14.60
Healthy pregnant women³³33 Lozano M, Murcia M, Soler-Blasco R. , Iñiguez C, Irizar A, Lertxundi A, et al. Prenatal Se concentrations and anthropometry at birth in the INMA study (Spain). Environ Res 2020; 181: 108943 DOI: 10.1016/j.envres.2019.108943. https://doi.org/10.1016/j.envres.2019.10...	79.57	9.64
AITD pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	66.60	12.60
Placebo pregnant women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	70.26	29.06
Supplemented pregnant women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	70.09	30.95
2nd trimester
Healthy pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	57.80	14.00
AITD pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	59.00	9.90
Placebo pregnant women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	56.24	19.48
Supplemented pregnant women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	91.53	25.49
3rd trimester
Healthy pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	48.40	11.30
AITD pregnant women³²32 Ambroziak U, Hybsier S, Shahnazaryan U. , Krasnodębska-Kiljańska M, Rijntjes E, Bartoszewicz Z, et al. Severe selenium deficits in pregnant women irrespective of autoimmune thyroid disease in an area with marginal selenium intake. J Trace Elem Med Biol 2017; 44: 186-191 DOI: 10.1016/j.jtemb.2017.08.005. https://doi.org/10.1016/j.jtemb.2017.08....	52.20	11.60
6 months postpartum
Placebo women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	71.80	18.83
Supplemented women³⁵35 Mantovani G, Isidori AM, Moretti C. , Di Dato C, Greco E, Ciolli P, et al. Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the “SERENA study”, a randomized, double-blind, placebo-controlled trial. Endocrine 2019; 66 (03) 542-550 DOI: 10.1007/s12020-019-01958-1. https://doi.org/10.1007/s12020-019-01958...	93.54	23.53

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[1] Address for correspondence Luiz Gustavo Lima, Medical Student, Av. General Carlos Cavalcanti, 4748, 84030900, Uvaranas, Ponta Grossa, PR, Brazil (e-mail: luizlima742@gmail.com).