By Breanne Kallonen
August 5, 2016
Pregnancy is a time to optimize health, glow and be overjoyed.
These positive pregnancy emotions are often crushed with the diagnosis of an all to common condition called preeclampsia.
It is alarming that the rates of preeclampsia in the United States have increased by 25% in the last two decades. Preeclampsia is a third trimester concern that is defined by the presence of hypertension & proteinuria (protein in the urine) or other signs & symptoms of end-organ dysfunction (e.g. seizures, pulmonary edema, etc.) This condition affects anywhere between 5-8% of women and often arises suddenly in the late 2nd or 3rd trimester and the concern with preeclampsia is it may decrease blood flow to the placenta and/or lead to placental abruption.
Typical signs and symptoms include severe headaches that won’t resolve with pain medications, sudden weight gain (greater then 2-5 lbs/week), changes in vision (blurry vision, flashes or spots), severe right upper quadrant stomach pain or vomiting, and chest pain or shortness of breath.
Preeclampsia is always diligently screened for in primary care because it is the leading cause of maternal death worldwide. Thus if you experience any of the above symptoms please contact your primary care provider and proceed to the nearest emergency department.
Risk factors for developing preeclampsia include; first pregnancy, teenage or over age 40, carrying multiples, being overweight, previous preeclampsia diagnosis, and diagnosis with high blood pressure, diabetes or kidney disease. What is the best medicine? Prevention, as always.
Many of the risk factors for preeclampsia are what we call “modifiable” risk factors. Unlike age and first pregnancy, which are non-modifiable, modifiable risk factors, we can alter. Ideally, prior to conception a couple should evaluate my “What you need to know before becoming pregnant” checklist.
Being overweight, inactivity, having high blood pressure or type 2 diabetes are all contributing factors to preeclampsia we can work on to ensure you have a healthy and normal pregnancy.
Pregnancy is a time where “hindsight” is not good enough. You and your partner are giving each other the gift of a lifetime…A family. Your family deserves the highest quality of care and that care which begins with YOU.
What to do about preeclampsia?
Most conventional as well as naturopathic treatment approaches to preeclampsia do not have good research. Strategies to prevent preeclampsia have been studied extensively over the past 20 years and NO intervention to date has been proved unequivocally effective.
The only definitive “cure” for this condition is in fact the delivery of the placenta. The latest Task Force Report “Hypertension in Pregnancy” (November 14, 2013) reviewed the current literature and reported evidence based recommendations for prevention and treatment or preeclampsia. This report concluded daily low-dose aspirin was beneficial to help prevent preeclampsia but only in very high-risk women.
Likewise, the use of magnesium sulfate for is helpful but only if there is progression to severe preeclampsia. It also concluded that calcium supplements have a moderate benefit but only in women with a nutritional deficiency of calcium. The evidence also strongly advises against supplementing with antioxidants vitamin C and E as there is no reduced risk of preeclampsia development or improvement in maternal or fetal death outcomes.
A review of all the trials that studied sodium restriction found no significant benefits. With regards to diuretics it was found they do no reduce the incidence of preeclampsia. Depending on the gestational age and blood pressure level anti-hypertension mediations and or time delivery may be advised.
What about the Brewer’s Diet?
The Brewer’s diet was created by Gail Sforza Brewer and Thomas Brewer M.D. in 1983. It emphases high protein, high/unlimited salt (sodium), high calcium and high calorie intake. After review of the latest Task Force Report “Hypertension in Pregnancy” is it obvious the flaws in this diet. There is no evidence to support the benefit of calcium supplementation in a population receiving adequate amounts such as the United States. Next while I agree sodium intake does matter, suggesting unlimited amounts is not advisable.
The current American Heart Association recommendation is roughly around 2000mg/day of sodium. Considering that 80% of sodium intake comes in the form of processed foods I would suggest removing all processed food from the diet. Another major issue I have with this diet is the ratio of whole grains to vegetables. This diet emphasizes protein which is great but in my opinion the servings of fruits and vegetables should be greater then the whole grains. Fruits and vegetables provide antioxidants, vitamins and minerals as well as are a source of fiber. According to the diet the 5 whole grain choices could look like 5 slices of bread or 5 pancakes which from a caloric standpoint is not close to ideal.
What is the Ideal Diet?
Instead of a “diet” I focus on positive lifestyle changes. Nutrition is not just a phase or temporary “quick-fix” it needs to be a lifelong habit or routine. The ideal diet for preeclampsia impacts the modifiable risk factors discussed above such as obesity, diabetes and high blood pressure.
The only diet with health come evidence is the Mediterranean diet. Most impressively the current evidence is supportive that the Mediterranean diet reduces ALL CAUSE MORTALITY (reduces your total overall risk of death). This diet emphasizes fruit & vegetables, nuts & seeds, legumes lean protein sources, healthy fats and daily physical activity.
A Free Guide to the Mediterranean Diet can be found here. Note: One component of the Mediterranean diet that is not advisable during pregnancy is the consumption of red wine.
In conclusion, there is no way to 100% prevent preeclampsia but there is lots you can do to positively modify your risk factors and make monumental changes to your overall health. Ensuring a healthy weight, blood pressure and blood sugar prior to conception, is highly advisable.
The time is NOW to take control of your health. In ways we are just beginning to understand your health at conception dramatically impacts the health of your unborn child and that of future generations to come.
References:
“American Heart Association – Building Healthier Lives, Free Of Cardiovascular Diseases And Stroke.”. Heart.org. N.p., 2016. Web. 20 July 2016.
“Task Force Report “Hypertension In Pregnancy””. American College of Obstetricians and Gynecologists (2013): 1-89. Web. http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Hypertension-in-Pregnancy
Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin No. 33. American College of Obstetricians and Gynecologists. 2002.
Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hyper- tension during pregnancy. Cochrane Database of Systema- tic Reviews 2007, Issue 1. Art. No.: CD002252. DOI: 10.1002/14651858. CD002252.pub2.
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Cerdeira AS, Karumanchi SA. Biomarkers in preeclampsia. In: Edelstein CL, editor. Biomarkers of kidney disease. 1st ed. Amsterdam ; Boston: Academic Press/Elsevier; 2011. p. 385–426.
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Hakim J, Senterman MK, Hakim AM. Preeclampsia is a biomarker for vascular disease in both mother and child: the need for a medical alert system. Int J Pediatr 2013:953150.
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