a question about pre-eclampsia for the midwives

[bellymama]

do you guys think that its something that can be prevented? i have read a bit about diets to prevent it....i had it at the very end of my pregnancy and it prevented me from birthing at home, and i ended up with a c/s at the hospital...i really really really want to have a homebirth next time, so i want to do everything i can to make sure i don't get preeclampsia.
what are your thoughts?


ETA: one more question...if you have had pre-eclampsia...does that mean you will get it again for sure? do you guys know of any resources i can look at to learn more about it? i feel like i am really ignorant on the topic, and i want to be informed.

[MidwifeErika]

No, just because you had it once does not at all mean you will get it again. It is something that is most common in first pregnancies or first pregnancy with new partner. Usually if a mom gets it again, it is also less severe than the first time and occurs later.

Prevention of pre-eclampsia I feel a bit mixed on. I do not think 100% of cases can be prevented with diet and herbs and what-not, but I do think that a body that is well nourished is better able to handle anything that comes its way. I think you have nothing to loose by eating the absolute best foods you can and treating your body well during pregnancy.

[Alison Cole]

I'm with the pp that probably not all cases of PE can be prevented with diet. However, midwife and author Anne Frye presents a pretty compelling case for how symptoms of PE could be related to a diet low in protein, calories, salt and fluids.

To summarize: Our blood volume expands in pregnancy by quite a bit. To hold enough fluid in our blood to make this expansion happen, our bodies need to have enough protein so that our livers can make albumin (blood protein) and enough salt, so that water stays in our blood-stream rather than seeping out of the blood into the tissues. If you remember the concept of osmosis from high school science classes, you know that water flows toward areas where there's a higher concentration of dissolved stuff in the water (i.e. if there's more salt and albumin in the blood than there is dissolved stuff in the tissues, blood holds the water, but if not, water seeps into the tissues). When water seeps into the tissues, you get pathological swelling, the blood volume dips, and the pregnant body acts like a hemorrhage has occurred: kidneys release a hormone that constricts the blood vessels, leading to high blood pressure, in an attempt to keep the contracted blood volume doing all the same work that ought to be being done by more blood. When the blood becomes super concentrated, the kidneys have a hard time filtering it effectively, and you end up with protein in the urine. Thus, you get the symptoms that constitute the PE diagnosis: swelling, high BP, protein in the urine.

That said, I know that there are women do everything they can (lots of calories, 100g protein daily, a gallon of water daily, salt-to-taste) and still develop PE. Clearly, those people have something going on that is different from the physiologic low-blood-volume thing described above, though their symptoms may be the same. I also NEVER think that the physiologic understanding of PE should lead us to a blame-the-mom mentality about this disease -- that is not what I'm advocating for at all. BUT, if I had a history of PE, I'd be all over my protein, calories, salt and fluids the next time around, just to see if I could ward it off. Hope that helps, and if it's totally unclear what I'm talking about, let me know and I'll try to clarify.

Good luck, mama. Hopefully, this pg will progress without incident, and you won't even need to be able to make sense of my long-winded reply to your question.

[nashvillemidwife]

I responded to your post in the homebirth thread. Having had it before means you are increased risk of having it again, but certainly not destined.

As far as prevention, our most current understanding is that the path to preeclampsia is determined at implantation and is caused by an anomaly in the way the tiny capillaries of the placenta spiral and wrap themselves around the mother's blood vessels in the uterine wall. The very latest research (published only weeks ago) claim that the underlying cause may actually be related to viral exposures. We don't know enough about the disease to know if you can do anything before you are pregnant to prevent this from happening, but if this explanation is true then the stage is already set from implantation.

However, preeclampsia does present in varying degrees of severity, and I do believe that a diet high in protein, high water intake, and moderate exercise can stave it off.

The water intake recommendation that makes the most sense to me is to drink as many ounces of water daily as matches half your body weight in pounds. I.e., if you weigh 150 pounds, you should be drinking 75 ounces daily. Therefore at least half a gallon would be appropriate for most women, entire gallon would only become appropriate as you approach 250 pounds.

[mwherbs]

do I think it can be prevented. Maybe depends on what might be done in the timeline- before pregnancy- best chance to try and reduce "risk factors" also you may be able to mitigate how much PE is expressed

but before I take off on that whole bit- I would like talk about cause- it seems that it starts at implantation - it has to do with how the maternal and fetal circulation interplay- shallow or deeply - if the uterine spiral arteries have enough NO to relax and intertwine close enough to the placental bed, if there is enough antibody give and take between fetal and maternal cells-
so diseases that effect micro-circulation - like diabetes (type 1 or 2 ) will increase the chances of PE- high bp will also change microcirculation, exposure to oxidative stress, autoimmune diseases, sperm health... I think that some of these things can be changed before pregnancy and to a lesser extent during pregnancy that may reduce the risk of PE becoming an overt disease state.

I see that nashvillemidwife and I posted at almost the same time- so you get a double dose of cause--

dietary changes before pregnancy may be able to help during pregnancy as well but should be done before SS even peek out if possible- lots of green veggies, fruits and protein foods whole grains but really sugars and grains should be a very small part of the diet , foods rich in essential fatty acids, no transfats, cut out the deep fried foods, daily exercise , B vitamin and folate supplements. Maybe some herbal prep for pregnancy. reduce exposure to toxins - look at your and DP work and exposures.
as far as water goes depends on where you live- here in AZ a gallon a day of water is appropriate but we have quite a bit of evaporative loss- but we do have to have more than water it is an elecrolyte game here so hydration but not sodas more like soup,tea, juices and water

[maxmama]

Originally Posted by Alison Cole

I'm with the pp that probably not all cases of PE can be prevented with diet. However, midwife and author Anne Frye presents a pretty compelling case for how symptoms of PE could be related to a diet low in protein, calories, salt and fluids.

To summarize: Our blood volume expands in pregnancy by quite a bit. To hold enough fluid in our blood to make this expansion happen, our bodies need to have enough protein so that our livers can make albumin (blood protein) and enough salt, so that water stays in our blood-stream rather than seeping out of the blood into the tissues. If you remember the concept of osmosis from high school science classes, you know that water flows toward areas where there's a higher concentration of dissolved stuff in the water (i.e. if there's more salt and albumin in the blood than there is dissolved stuff in the tissues, blood holds the water, but if not, water seeps into the tissues). When water seeps into the tissues, you get pathological swelling, the blood volume dips, and the pregnant body acts like a hemorrhage has occurred: kidneys release a hormone that constricts the blood vessels, leading to high blood pressure, in an attempt to keep the contracted blood volume doing all the same work that ought to be being done by more blood. When the blood becomes super concentrated, the kidneys have a hard time filtering it effectively, and you end up with protein in the urine. Thus, you get the symptoms that constitute the PE diagnosis: swelling, high BP, protein in the urine.

That said, I know that there are women do everything they can (lots of calories, 100g protein daily, a gallon of water daily, salt-to-taste) and still develop PE. Clearly, those people have something going on that is different from the physiologic low-blood-volume thing described above, though their symptoms may be the same. I also NEVER think that the physiologic understanding of PE should lead us to a blame-the-mom mentality about this disease -- that is not what I'm advocating for at all. BUT, if I had a history of PE, I'd be all over my protein, calories, salt and fluids the next time around, just to see if I could ward it off. Hope that helps, and if it's totally unclear what I'm talking about, let me know and I'll try to clarify.

Good luck, mama. Hopefully, this pg will progress without incident, and you won't even need to be able to make sense of my long-winded reply to your question.

I had early-onset (20 weeks) PIH (not pre-eclampsia, though it became pre-e at 35 weeks). I followed the Brewer diet. It didn't work. In fact, except for Brewer's original work 30 years ago, there's no evidence that diet-based interventions work, no matter how compelling the theory is.

Despite HELLP syndrome and severe pre-e in my first pregnancy (they are separate but related entities), I did not develop it in a subsequent one. Was it my atenolol and lasix? Was it that I was a multip? Who knows? But I surely didn't follow the BRewer diet that time around.

[bellymama]

thanks! lots of stuff for me to mull over. thanks for taking the time to post!

[mwherbs]

as for something to read you can download(pdf) the booklet or read it online archived-- this is the national working group report on BP in pregnancy includes PE as well as other forms of hypertension

http://www.nhlbi.nih.gov/health/prof...p/hbp_preg.htm

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also here is an illustration of uterine spiral arteries
http://www.sgul.ac.uk/depts/immunolo...roph/troph.htm

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and here is an interesting bit written and illustrated by a biologist
http://pharyngula.org/index/weblog/c..._preeclampsia/

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and here is an example of something that can be done

1: Am J Obstet Gynecol. 2008 Jan;198(1):45.e1-7.

Folic acid supplementation in early second trimester and the risk of
preeclampsia.

Wen SW, Chen XK, Rodger M, White RR, Yang Q, Smith GN, Sigal RJ, Perkins SL, Walker MC.

OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada. [e-mail]

OBJECTIVE: The objective of the study was to evaluate the association between folic acid supplementation in early second trimester and the risk of developing preeclampsia. STUDY DESIGN: We carried out a prospective cohort study between October 2002-December 2005. We recruited women who had their prenatal care visit (12-20 weeks' gestation) at the Ottawa Hospital and Kingston General Hospital.All charts for participants with a diagnosis of preeclampsia were audited and blindly adjudicated by 4 study investigators to validate the diagnosis. RESULTS: A total of 2951 pregnant women were included in the final analysis. Supplementation of multivitamins containing folic acid was associated with increased serum folate (on average 10.51 micromol/L), decreased plasma homocysteine (on average 0.39 micromol/L), and reduced risk of preeclampsia (adjusted odds ratio, 0.37; 95% confidence interval, 0.18-0.75).
CONCLUSION: Supplementation of multivitamins containing folic acid in the second trimester is associated with reduced risk of preeclampsia.


PMID: 18166303 [PubMed - indexed for MEDLINE]

[bellymama]

Thanks!!!!