Let's talk about pre-e

[Contented73]

Situation: first time mom, developed pre-e and was induced at 39 weeks. What can she do the second time around to prevent it, avoid induction, and avoid the hospital alltogether? I always hear people say that there is so much you can do, and that midwives work so hard to help prevent, etc. etc. -- but then when I look into it, the only practical advice I find is to eat lots of protein. She was already eating around 70 grams of protein a day. Is there certain types of protein? What about other diet modifications? Any special supplements she could take? Would love any advice that I can pass on to this mom. Thanks!

[onlyboys]

From reading Holistic Midwifery lately, I don't think it's the protein that does it. It's the protein plus enough calories. Also not restricting salt is a big one too. And in Spiritual Midwifery there were very very few cases of pre-e, maybe only one or something, and that is though to be attributable to the veggie diet that is common there. There's the Brewer's Diet, which isn't just about protein, it's about eating lots of other things, too. www.blueribbonbaby.org is a good website for the Brewer diet.

Did she have true pre-e? Or just PIH?

[Paige, CPM]

I had pre-e and am a homebirth midwife (the first one in my practice to get it in over 6 years of practice).

I ate lots of protien (90gm p/d +/-), and ate healthy too...but I still blew up like an elephant at 33 wks, then bad bp, then progressive kidney involvment...bought me 3 inductions starting at 35 wks...the final one taking.

My diet wasn't perfect, I had lots of dairy, some baked goods and ice cream...but mostly organic fruits, veggies and natural meats.

Next pregnancy I am going to be super viligant about what goes into my body and be even more active (this pregnancy I had knee problems which curtailed my activity). I will do herbal drinks that support my liver and kidneys...dandelion root, nettles...etc... And keep my fingers crossed!

Good luck with your client!

[pamamidwife]

I think it's nearly impossible to just suddenly get pre-e at 39 weeks. without any other signs/symptoms prior?

I honestly think that a rising bp is considered normal at the end of pregnancy - and it gets lumped into "pre-e". In fact, I wonder how much of pre-e is pre-e and not just preg-induced hypertension, some of which is normal.

[riomidwife]

Originally Posted by pamamidwife

I think it's nearly impossible to just suddenly get pre-e at 39 weeks. without any other signs/symptoms prior?

I honestly think that a rising bp is considered normal at the end of pregnancy - and it gets lumped into "pre-e". In fact, I wonder how much of pre-e is pre-e and not just preg-induced hypertension, some of which is normal.

I agree. Preeclamspia is not something that just "develops" at term, thought it may only be diagnosed then. It is a sydrome that begins with implantation. While full blown pre-e is a very dangerous disorder, I think a lot of women get scared into believing they have something more serious, like pre-e, when in reality they may just have plain old uncomplicated gestational hypertension, like pamamidwife is suggesting.

I also don't think there is much to do in the way of prevention, at least from what available evidence suggests. having researched the topic for a two years, the only strong evidence was calcium supplementation for calcium-deficient women (not common here in the US). There is some evidence though that suggests that OVER nutrition (excess calories and harmful fats) may be just as much of a factor as insufficient calories and protein.

As Paige testified though , sometimes a woman has a near perfect diet and still develops Preeclampsia, so I don't think we should be making mamas feel like there is something they can "do", or could have done, to avoid it

[pamamidwife]

Originally Posted by elriomidwife

As Paige testified though , sometimes a woman has a near perfect diet and still develops Preeclampsia, so don't think we would be making mamas feel like there is something they can "do", or could have done, to avoid it

This is so true. It's one issue that I take with other homebirth midwives who swear that by taking in 100 grams or more of protein/day that pre-e will be prevented.

I'm interested, though, in the studies that have been done on Magnesium and it's effects on not only pre-e but also preterm labor and PIH. Anyone?

[riomidwife]

I stopped actively pursuing the research about two years ago, and at that point I hadn't come across much about magnesium. Don't know about more current lit.

[pamamidwife]

Originally Posted by elriomidwife

I stopped actively pursuing the research about two years ago, and at that point I hadn't come across much about magnesium. Don't know about more current lit.

Well, IMO, if there was something solid that actually showed a huge reduction in pre-e, you can bet the docs would be on it.

[SublimeBirthGirl]

Originally Posted by pamamidwife

Well, IMO, if there was something solid that actually showed a huge reduction in pre-e, you can bet the docs would be on it.

I have seen some pretty convincing evidence that 75+ grams of protein a day reduces the risk of pre-e. And I don't believe *at all* that doctors would be all over something that reduces the risk unless it was a pill or a procedure. MANY illnesses can be prevented, cured, or improved with diet and exercise but that means little to medical types IME.

[Reha]

Originally Posted by SublimeBirthGirl

I have seen some pretty convincing evidence that 75+ grams of protein a day reduces the risk of pre-e.

I would be very curious to see it.

[pamamidwife]

Originally Posted by Lennon

I would be very curious to see it.

I would agree. Even the most comprehensive and respected research collection, the Cochrane Database, shows otherwise. I don't buy Brewer's "research" as his sample size and his collection methods very crude and not up to par with what is considered solid evidence.

I know there are rumblings about anecdotal stuff - but how do we know this to be true? There are women out there that have blood pressure issues late in preg that seem to resolve with increased protein. But overall, I do not think that increased protein prevents pre-e. It could possibly help *some* women turn around a contracted blood volume that was starting to show some signs of pre-e (like late second trimester, early third trimester), but not to overall reduce the signs of pre-e.

I would venture to say that many American women get a good amount of protein. Although it's not likely quality protein, if we look at the Standard American Diet, flooded with dairy and meats, we're probably pretty close to 75 grams.

Overall, pre-e's etiology is unknown and its treatment is even worse (having the baby).

IMO, you can bet your butt that if there was something simple like protein or a supplement that would magically get rid of pre-e, docs would be all over it. Seriously. It's one of the major fears and reasons for maternal death, fetal death and litigation. Somehow I don't think those three things would warrant them ignoring a cure or prevention for pre-e. I'm as suspicious of allopathic medicine as the next MDC mama, but this is serious stuff.

[SublimeBirthGirl]

Here's an interesting theory (I love any theory that encourages chocolate consupmtion! lol)

http://www.news.harvard.edu/gazette/.../01-cocoa.html

I'll post if i find the protein stuff-it's not all Brewer. Does anyone know of any issues with the Harvard study on protein and pre-e? It found significantly lower rates of pre-e in the 75+g a day group. I don't have it in front of me though, and can't remember the details/design.

My thoughts on this are that it makes sense that protein requirements are higher during pregnancy, and maybe it makes a difference with pre-e and maybe it doesn't, but it doesn't hurt to increase protein intake to 75 g or more during pregnancy.

[JustJamie]

I'm in the camp that says there currently is no way to prevent pre-e.

I was diagnosed with it at 30 weeks, though I was displaying symptoms as early as 16 weeks.

I have hypoglycemia, which was diagnosed when I was 17; as a result, I have a highly monitored diet, including insane amounts of protein. I was also active-duty army, and therefore HIGHLY active. By the time my daughter was delivered (c-section following induction) my BP was at 190/???, my platelet count was nearly zero, I had huge amounts of swelling, and had gained 75 pounds over the course of the pregnancy, despite my highly monitored diet (which included no sugar.) and high activity.

Sure, recommend and suggest to your clients that changing their diets *might* reduce their risk of pre-e, but don't sell it as a cure-all; that could cause them to ignore the symptoms of a real problem.

[SublimeBirthGirl]

I can't imagine anyone tells their students/clients that protein cures pre-e in every case. I don't think even Dr. Brewer claimed that. Hard to imagine one of my students, mostly first time moms, ignoring the symptoms of pre-e because they're eating a lot of protein. I don't see that happening.

Your case on its own, Jamie, doesn't prove that increased protein doesn't reduce the risk of pre-e. It's like a vegetarian with a healthy, low-fat diet having high cholesterol. Sometimes there's a genetic predisposition that can't be overcome, but it doesn't mean that a low-fat, healthy diet doesn't decrease the risk of high cholesterol.

[SublimeBirthGirl]

This one gave me a chuckle.

http://cat.inist.fr/?aModele=afficheN&cpsidt=1340021

Study by a hard-up husband, perhaps?

[SublimeBirthGirl]

Another thing that is interesting is that one of the risk factors for pre-e is poverty. That seems to indicate that in *some women* at least, there is some sort of environmental influence.

Sorry to keep serial posting-I'm doing some research and keep coming across interesting tidbits.

[JustJamie]

Originally Posted by SublimeBirthGirl

I can't imagine anyone tells their students/clients that protein cures pre-e in every case. I don't think even Dr. Brewer claimed that. Hard to imagine one of my students, mostly first time moms, ignoring the symptoms of pre-e because they're eating a lot of protein. I don't see that happening.

Your case on its own, Jamie, doesn't prove that increased protein doesn't reduce the risk of pre-e. It's like a vegetarian with a healthy, low-fat diet having high cholesterol. Sometimes there's a genetic predisposition that can't be overcome, but it doesn't mean that a low-fat, healthy diet doesn't decrease the risk of high cholesterol.

Genetic disposition? No one else in my family has ever had pre-e or pregnancy induced hypertension...including extended family, aunts, cousins, etc. Yes, my issues were discussed at great length by all of my family members.

I certainly understand that anecdotes do not = data, but I think it would be foolish of you as a birth professional to not see the risk you run of having patients mis-interpret certain ways of phrasing advice.

"Eating 75g of protein can reduce your risk of pre-e" becomes "If I eat enough protein, it won't happen to me." "Some pregnancy-induced hypertension is normal" becomes "My consistently high blood pressure is not worrisome even though it's accompanied by extreme swelling and excessive weight gain"

[Sharlla]

I didn't get pre e with my second (I was induced at 36.5 weeks with my first) I did a lover carb diet with my second one in hopes to not gain 90 lbs like I did with my first.

[onlyboys]

Originally Posted by JustJamie

I certainly understand that anecdotes do not = data, but I think it would be foolish of you as a birth professional to not see the risk you run of having patients mis-interpret certain ways of phrasing advice.

"Eating 75g of protein can reduce your risk of pre-e" becomes "If I eat enough protein, it won't happen to me." "Some pregnancy-induced hypertension is normal" becomes "My consistently high blood pressure is not worrisome even though it's accompanied by extreme swelling and excessive weight gain"

Yes, I agree with you. When something like pre-e has happened it seems that clients automatically flash back to "what did I do? how could I have prevented this?" instead of forward thinking. It's greatly concerning.

Brewer did claim that his diet made pre-e statistically zero.

“… If we argue 1.0% MTLP (toxemia) with the Brewer Diet … that’s still one per hundred, ten per thousand, ten thousand per million. I am saying zero, 0, zip, NONE per million ….”

~Dr. Tom Brewer

I hesitate to suggest anything that might do anything completely. There's always the exception. And, I still assert that protein without adequate calories still won't help. Perhaps women who are so very careful with their protein are neglecting other aspects of their diet. Or, perhaps there are things at work that we cannot understand.

[SublimeBirthGirl]

There are definitely many things about pregnancy and birth we don't understand, pre-e being just one of them.

My classes are thorough and detailed, and I'm not concerned that my teaching skills are so terrible and my students lack critical thinking skills to the extent that they'd think a possible reduction of risk = no chance. If that's the case, why bother to teach anything? It could always get misinterpreted. Maybe I shouldn't teach them ways to reduce the risk of ending up with a c-section, because then they'll think there's no chance they'll need one and in a real emergency they'll all die. Of course that's not going to happen. We give them the information we have, including warning signs and symptoms of various things, and they couple their own knowledge with that of their HCPs to make the best decisions for themselves. They're not stupid.