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September 14, 2007

Comments

katherine

Now THAT's just way beyond interesting. When I have time I'm going to have to read some of those links. In the meantime, I think I'm gonna go eat some flax seed. :)

Kat

Isn't it! I think if doctors had the time to carefully review nutrition at visits, we wouldn't have so many "complications" but in six minutes, which is I seem to recall the average time spent with an OB (no time to look up at the moment) there isn't time to do that.

frumiousb

A very long response, apologies.

There as a study some years back which suggested that anti-oxidants may be beneficial against pree. Millions of women and thousands of doctors started to advise taking them. Follow-up studies, however, found that they actually made the pree *worse*, and lowered birth weights.

And let's not forget the received "wisdom" of the high protein diets, which appear to do no good at all for preventing pree and which may actually lead to hyperactivity in babies.

I think, in fairness, you have to realize from that Orgyn article that the results regarding the elongated n-3 fatty acids are not statistically significant. This may be a promising area of further research, but is very very far from conclusive. It is certainly not a ringing endorsement for eating more fish.

"They write: “In conclusion, results from the present study do not support the premise that maternal intake of calcium or vitamins C and E during pregnancy can prevent hypertensive disorders of pregnancy, although they do suggest a potential benefit for elongated n-3 fatty acids in preventing pre-eclampsia.” However, the results on the elongated n-3 fatty acids are not statistically significant. Further studies are warranted to investigate a possible role for dietary intervention in preventing gestational hypertension or pre-eclampsia, the researchers suggest."

Anyone considering making changes to their diet to try to reduce the risk of pree should check out the research section of the forums at the Preeclampsia Foundation. I'm not picking on you in particular, but as a woman who had early-onset preeclampsia and who lost her child in the process, I'm a little bit jaded by all the new discoveries (none of which has proven to make a whits worth of difference, at least so far). I am also conscious of the guilt which most women feel when they get preeclampsia, particularly if their baby dies or they suffer from the results of their prematurity. So far, diet has not been proven to have significant impact-- and the last thing that we need is feeling guilty for how we may or may not have eaten during our pregnancies. Preeclampia is a very complex disease, and may well have multiple roots. We really know very little at all about how to address prevention and cure.

Kat

My heart goes out to you. My parents lost their first child and I have seen the tremendous grief that comes with losing a child.

My point was that midwives have had a lot of success with working with the diet of clients who have the symptoms of preelampsia and I made an observation, based on the articles in ORGYN.com, that the research might be catching up with what midwives have long observed. Anne Frye in Holistic Midwifery Volume I, pg. 193-194 writes "Probably least understood is the relationship between maternal nutrition, blood volume expansion and the increased demand on the liver. Understanding this process is critical to understanding healthy pregnancy....a number physicians (Pinard, Dodge, Frost, Mitchell, Thompkins, Wiehl, Ross, Hamlin and others) have proven this nutritional link in their clinical practices. Unfortunately, their work has been largely ignored. The most recent of theses researchers is Tom Brewer, a general practitioner who worked extensiely with poor pregnant women. He has articulated this process and its link to metabolic toxemia." Anne Frye believes that while the scientific community espouses that the causes of toxemia are not known, the link to nutrition is there and the research should further explore this link. You are right, there is much more work to be done!

Re guilt, I think there is way too much guilt with pregnancy, birth, breast-feeding etc. The reality is that we do the best we can do at the time. I was supposed to have miscarried my second child. Fenimore was as healthy as can be but I had severe unexplained hemorrhaging. If my second pregnancy had ended, would I have beaten myself up about working too hard (which I was), stressing to much (which I was) probably, but it would not have been useful.
Thank you so much for sharing your comments!

cjorp

Agreeing with frumiousb here, because (as another obsessively-researching preeclampsia survivor) I have never seen any published evidence supporting the idea that nutrition is the problem in preeclampsia.

I have, however, seen studies showing no difference in intake of nutrients between populations that do, and that don't, develop preeclampsia. If diet is so important, why doesn't it show up as a problem in studies?

The vitamin D study doesn't necessarily suggest poor dietary intake of vitamin D, and since we know that preeclampsia is associated with autoimmune conditions that can lower levels of vitamin D, I bet it's correlation rather than causation. In many of these autoimmune conditions, increasing intake of vitamin D doesn't change blood levels of it.

The omega-3 stuff isn't statistically significant, which means it's likely that if there is an effect, it is a very small one.

Brewer's data is 40 years old, was never published in a peer-reviewed journal, and has never been replicated. If he's the most recent to publish on the theory that diet affects preeclampsia rates, that means this line of inquiry was abandoned 40 years ago, back before we accepted continental drift as a working theory. Sure, lots of midwives say they have seen results, but where are their publications?

I would be very interested in any peer-reviewed studies showing an reduction in preeclampsia rates from changing diet or supplementing nutrients. My email address is active. Thank you.

Kat

I think Ronnie Falcao's site, http://www.gentlebirth.org/archives/pih.html, has a lot of good information on pre-eclampsia from a midwifery point of view. Unfortunately midwives tend to be too busy catching babies to do research but this is changing. My belief in the importance of diet and pre-eclampsia, for the majority of cases, comes from hearing midwives discuss this at meet-ups and conferences, particularly MANA's conference (the Midwives Alliance of North America). I would highly recommend getting in touch with local experienced Certified Professional Midwives in your area. That said, I have also heard midwives say that sometimes pre-eclampsia seems unexplained and uncontrollable, but in the majority of cases, diet has a big impact (and several physicians, mentioned in the above comment, have found this to be true as well). I think Midwives who attend home births are going to be more aggressive about supporting excellent diet throughout pregnancy because pre-eclampsia means no home birth. But you are right, we definitely need to do more research! Maybe MANA and the ACNM (American College of Nurse Midwives) could get together and do a study on this!

cjorp

But those physicians were all practicing more than 40 years ago, if as you say Brewer is the most recent of them. Anecdotally they may have thought that diet had an impact, but when solid studies were conducted that was refuted.

Brewer says preeclampsia is caused by insufficient dietary protein to grow a baby, which leads to albumin loss from the bloodstream, leading to swelling and increased blood pressure. Wouldn't you agree then that restricting protein ought to increase preeclampsia rates?

But Cochrane says this:
"In three trials involving 384 women, energy/protein restriction of pregnant women who were overweight or exhibited high weight gain significantly reduced weekly maternal weight gain and mean birth weight but had no effect on pregnancy-induced hypertension or pre-eclampsia."

And when they encouraged women to improve their protein intake:

"In two trials involving 1076 women, high-protein supplementation was associated with a small, nonsignificant increase in maternal weight gain but a nonsignificant reduction in mean birthweight, a significantly increased risk of SGA birth, and a nonsignificantly increased risk of neonatal death."

But again, no effect on preeclampsia rates.

You can find that study in the Cochrane database. It's titled "Energy and protein intake in pregnancy."

Here's another quote from a paper published for peer-review in the American Journal of Obstetrics and Gynecology:

"After adjustment for baseline risks, none of the 28 nutritional factors analyzed were significantly related to either preeclampsia or pregnancy-associated hypertension."

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11262466&query_hl=7&itool=pubmed_DocSum

It sure seems to me that if nutrition were related, there would be some intriguing studies out by now linking preeclampsia and nutrition. I hope the midwifery community will provide one; it would certainly please all the women with a history of preeclampsia to think that there was something they could do to have better odds next time.

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