Espécies da flora da Amazônia oriental maranhense como alternativa e/ou complemento terapêutico para infertilidade feminina: a etnofarmacologia como ferramenta para a bioprospecção e a farmacovigilância em fitoterapia

Abstract

Infertility constitutes a significant global public health problem, affecting approximately 17.5% of the population and impacting physical, emotional, and social well-being. In Brazil, the prevalence of infertility among women of reproductive age is estimated at 10 to 15%, suggesting the importance of expanding access to specialized therapies and public policies for equitable care. Given the limitations and high costs of conventional treatments, especially assisted reproductive techniques, there is a growing popular interest in the use of plant species; a traditional practice recognized as a potential source for therapeutic purposes, but which can trigger adverse events due to irrational use. In this context, this research aims to conduct an ethnopharmacological study to identify plant species associated with female infertility in São Luís, Maranhão, followed by a systematic review of the most representative plant species in the ethnopharmacological research and to propose educational actions in Pharmacovigilance in Phytotherapy. The first chapter is an observational, cross-sectional analytical study with data collected through structured and semi structured interviews using a questionnaire containing 26 questions focused on characterizing the plant species used and/or known in popular culture for the treatment of female infertility. The study included 389 interviewees, of whom only 208 had knowledge of/used plants for infertility. Forty-one plant species used in popular culture were identified, with Himatanthus drasticus (janaúba) being the most frequently cited (34.2%), exhibiting high ethnobotanical indices (IVs=143, FRC=0.6875, UCs=1.375). Although 88.94% reported no adverse events, the documentary analysis revealed toxic risks in species such as Aloe vera (dermatitis) and Stryphnodendron adstringens (abortive effects), highlighting gaps in scientific validation for this purpose. The second chapter comprises a synthesized review of data from preclinical studies evaluating the efficacy and toxicity of extracts, fractions, and isolated substances from the latex of Himatanthus drasticus (Mart.) Plumel. The 10 preclinical (in vitro/in vivo) studies confirmed the promising profile of H. drasticus latex, with low toxicity at the tested doses (low risk of bias according to ROBINS-I), with anti-inflammatory, healing, and antidiabetic actions. The third chapter addresses pharmacovigilance actions represented by a comic strip of the plant species that were highlighted in response to the toxicity of the species inventoried in the ethnopharmacological research. It is concluded that the integration of traditional knowledge, scientific validation, and regulation is essential to ensure the rational and safe use of medicinal plants as a therapeutic resource in female infertility, especially among populations with greater social vulnerability.