Preeclampsia is a prenatal and postpartum condition that is hallmarked by gestational hypertension and the presence of protein in the urine. It occurs in approximately 5-8% of pregnant women and can be life-threatening. Women who have had preeclampsia with a previous pregnancy are at a higher risk of developing it again.
The symptoms of preeclampsia can be varied and confusing. Edema (specifically pitting in the ankles), sudden weight gain, headaches or vision changes are all common complaints amongst patients with this condition, but presentation varies on the underlying cause.
Research has shown that nutritional deficiencies may play a role. [1] There have been several studies linking different nutritional deficiencies with an increased risk of developing gestational hypertension and preeclampsia. In this article I will address the individual nutrients linked in these studies, as well as nutritional principles to get you started.
NUTRIENT DEFICIENCIES ASSOCIATED WITH AN INCREASED RISK OF PREECLAMPSIA
Magnesium: Magnesium is essential for the proper development of the placenta from mid first trimester on. We see significantly lower levels of magnesium in preeclamptic patients. [2] Not only is Magnesium necessary for many of the other nutrients, like Calcium, Sodium and Potassium, to function properly, it is also necessary for the hormone receptors to accept certain hormones. Without proper levels of Magnesium, sodium and calcium build up in the blood causing increased blood pressure and increasing the risk of preeclampsia. Magnesium is a natural muscle relaxant, and deficiency can cause tightening of the blood vessels. The demand for magnesium grows exponentially from 28 weeks of gestation through childbirth.
Calcium: Calcium supplementation in pregnancies at a higher risk for preeclampsia has been shown to reduce the risk of hypertension and preeclampsia [3] as well as reduce the maternal mortality risk due to preeclampsia. Calcium supplementation help prevent dysfunction in the placenta by affecting Nitric Oxide Pathways. [4] Calcium also interplays with a other nutrients associated with an increased risk of preeclampsia, Vitamin D/K/Magnesium.
Zinc: Zinc is an important mineral for hormone development and immune support. It is one of the most essential minerals for pregnancy. Deficiencies are associated with an increased risk of miscarriage, birth defects, and stillbirths. Too much copper or iron can deplete zinc (there is a tricky balance), it is also necessary for proper B6 absorption. Zinc is the catalyst for the millions of enzymatic reactions that are occurring as your baby develops. It is also necessary in protein synthesis (protein is what your oxytocin is going to be made from). Zinc plays a role in the formation of red blood cells, and deficiency can lead to anemia. All things associated with preeclampsia. A 2015 study found lower zinc levels in preeclamptic mothers. [5]
Manganese: A new study, published in 2020, may possibly be bridging the gap among manganese deficiency, oxidative stress, and preeclampsia risk. This study was led by researchers at Johns Hopkins Bloomberg School of Public Health. The analysis found significantly lower levels of manganese in early pregnancy increased the likelihood of the development of both gestational hypertension and preeclampsia. [6] This is the first paper linking manganese to preeclampsia. Manganese makes up a very important enzyme called superoxide dismutase that helps to reduce inflammation in the placenta.
Vitamin D: Vitamin D is a hormone. It is formed from cholesterol in the diet which interacts with the UVB rays to create Vitamin D. It is a fat soluble vitamin in the diet, and there MUST be a fat present for absorption. We do know that Vitamin D plays a significant role in the regulation of the hormones of our body. The role of Vitamin D in hypertension is still not fully understood, but we know there is a connection between low Vitamin D preeclampsia. There is an interesting correlation between winter pregnancies (lack of sunlight) and preeclampsia rates. Vitamin D is necessary in the formation of several enzymes produced by the placenta, which are missing in preeclampsia. Vitamin D is necessary for Calcium and Phosphorus to function. Supplementing with Vitamin D is associated with a decrease in preeclampsia risk. [7] Vitamin D and K work together, and in combination with Calcium, Magnesium and Potassium. Without vitamin K, these nutrients cannot work together correctly.
COQ10: A 2003 study found a marked decrease in CoQ10 in women with preeclampsia. [8] The theory is that increasing oxidative stress “consumes” the CoQ10, decreasing mitochondrial function. Interestingly, this difference is more prominent in women living at altitude than women living at sea level, [9] and with age.
Folate/B12: Homocysteine is a byproduct of the methionine cycle. This is cycle is the “methylation” cycle and is dependent on folate and B12. [10] Homocysteine increases cardiovascular inflammation, and the decrease in proper methylation affects the stability of the placental cells and their function.
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HOW TO PREVENT PREECLAMPSIA WITH DIET
The idea that diet influences the onset of hypertension and preeclampsia is a huge component of the functional medicine approach to chronic disease. Bear in mind that the development of the blood vessels between the placenta and the uterus begin early in gestation. In prevention, it is important to begin proper nutrition prior to conception. This doesn’t mean that it cannot develop later, or that severity in symptoms cannot be prevented during gestation. The placenta is growing for several months, as your baby develops, and at any point proper nutrition can be used to grow these blood vessels properly, create healthy blood flow, and relax tense blood vessels and stabilize placental function, all to lower hypertension and preeclampsia risk.
Here are my top guidelines for preventing preeclampsia through diet.
REDUCE PRESERVATIVE SODIUM: Research shows that once you have come into a hypertensive state, you are more sensitive to sodium and will react stronger than you would out of the hypertensive state. Typically, because there is an imbalance in the sodium levels in the cells and out of the cells (in the blood). This imbalance causes a strain on the blood vessels and increases blood pressure. Preservative sodium is different than sea salt sodium, or table salt. This synthetic form of sodium is more difficult for Magnesium to transport and becomes built up in the blood more quickly. Learn to read the labels. Synthetic preservative sodium is found in most packaged products.
REDUCE EXCESSIVE AND ADDED SUGARS: In a natural and balanced diet, our body needs sugars. Fructose is a fuel for the brain, and Glucose is a fuel for every cell in our body. But in excess, or not properly balance, these fuels become toxins. In our society, we consume excessive amounts or processed and packaged foods that are full of refined flours and sugars, and typically lead very sedentary lives. These inactive lives and diets rich in unused fuels causes excessive weight gain, hormone disruptions, and internal damage. Stick to natural sweeteners, such as honey, maple syrup, and fruits and fruit juices when needing to sweeten a recipe. If you are craving sugar, it could mean that you are not consuming enough vitamins and minerals, or you are not balancing with enough fat. When your cells are malnourished, you will crave sugar.
LEARN TO LOVE FAT: Many nutritional fats work as anti-inflammatories in the body. Without a proper level of good fats in our bodies, our hormones cannot function (Our hormones are made from fats!), our brain slows down (over 60% fat), our nerves become hypersensitive to stimuli, and our cells become weak. During pregnancy fats and cholesterols are even more important. They are the building blocks of the hormones that sustain pregnancy.
TASTE THE RAINBOW, AND I DON’T MEAN SKITTLES: What I mean is embrace the rainbow of colors found in fruits and vegetables. Foods that are rich in color are also rich in nutrition. They are also higher in antioxidants. Greens, Reds, Yellows, Blues, Purples, all of these colors are associated with nutrients and antioxidants.
SPICE IT UP: Use herbs to flavor your meals. There is such an amazing array of herbs out there that not only add vibrancy to our meals, but are packed with nutrients, antioxidants, and anti-inflammatory phytochemicals. Garlic, Ginger, Turmeric, Parsley, Cilantro, Oregano, Lemongrass, Curry, Fennel, Dill, Mint, the possibilities are endless. Stimulate your body and your brain with these intense flavors, not added sugar. Many of these herbs are also important sources of pregnancy important nutrients (parsley – Vitamin K), others are specifically known to help treat hypertension (Basil, Cinnamon, Garlic, Ginger, Parsley, Dandelion)
CHOOSE QUALITY NOT QUANTITY: The adage of eating for two is a misnomer. The baby growing inside you, at the most, needs 300 extra calories a day at its biggest. What we do need is more nutrients that sustain the health of your body…not calories. Excessive meals are hard on the system and put strain on the body. Often those consuming poor diets, or nutrient deficient diets, find themselves craving more food, even though they are eating large amounts of calories (well over what they need). This is because the foods they are consuming are nutrient deplete but high in carbohydrates and sugars, and the cells are actually STARVING for nutrition. Choose nutrient dense foods and smaller amounts over large amounts of poor-quality foods. You’ll be surprised at how much your food cravings and excessive hunger go away when your cells are getting the correct amount of nutrients.
STAY HYDRATED: Water makes up the majority of our body (80+%). It is a cooling, and lubricating mechanism. When we are deficient the body can heat up and dry out, causing friction and inflammation. Dehydration also causes an increase in pain perception, and reduction in blood flow to the brain. Over time, chronic dehydration can affect the neurotransmitters of the brain. Even mild dehydration can affect your mood, causing mood swings and depression. During pregnancy, your body is making and filtering amniotic fluid, which is a combination of water Vitamin C, E, and other electrolytes. You need to consume enough for your needs, the amniotic fluid, and your developing baby. The old adage of eating for two, should really be drinking for two, which would be more accurate. A little drink to absorbing more and peeing less…. add fruit, lemon, trace minerals, etc.…to your water. Tap water is lacking in naturally occurring minerals, they are removed during filtering, and processing. Traditional peoples didn’t carry around and fill 32 oz water bottles 2-4x per day…they didn’t have to, the water they drank was more nutritional with little bits of soil and debris which aided in absorption.
Sarah Thompson founded Sacred Vessel Acupuncture in 2012, after years of working alongside western medicine physicians. Sarah has dedicated her practice to those with complicated conditions, and those seeking to improve their health. She brings over 20 years of experience working directly with medical doctors in the fields of Pain Management, Obstetrics & Gynecology, and advanced studies in both Acupuncture and Functional Medicine.
Want to know more? Pick up her new book, Functional Maternity – Using Functional Medicine and Nutrition to Improve Pregnancy and Childbirth Outcomes.
Citations
1. Grum T, Hintsa S, Hagos G. Dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia: a case control study. BMC Res Notes. 2018;11(1):683. Published 2018 Oct 1. doi:10.1186/s13104-018-3793-8
2. Kharb S, Goel K, Bhardwaj J, Nanda S. Role of magnesium in preeclampsia. Biomed Biotechnol Res J 2018;2:178-80
3. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochran Database Syst Rev. 2014;6. doi:10.1002/14651858.CD001059
4. DeSousa J, Tong M, Wei J, Chamley L, Stone P, Chen Q. The anti-inflammatory effect of calcium for preventing endothelial cell activation in preeclampsia. J Hum Hypertens. 2016;30(5):303-308. doi:10.1038/jhh.2015.73
5. Ma Y, Shen X, Zhang D. The Relationship between Serum Zinc Level and Preeclampsia: A Meta-Analysis. Nutrients. 2015;7(9):7806-7820. Published 2015 Sep 15. doi:10.3390/nu7095366
6. Liu T, Hivert MF, Rifas-Shiman SL, et al. Prospective Association Between Manganese in Early Pregnancy and the Risk of Preeclampsia. Epidemiology. 2020;31(5):677–680. doi:10.1097/ EDE.0000000000001227
7. Fogacci S, Fogacci F, Banach M, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr. 2020;39(6):1742-1752. doi:10.1016/j.clnu.2019.08.015
8. Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet. 2009;105(1):43–45. doi:10.1016/j.ijgo.2008.11.033
9. Teran E, Chedraui P, Racines-Orbe M, et al. Coenzyme Q10 levels in women with preeclampsia living at different altitudes. Biofactors. 2008;32(1–4):185–190. doi:10.1002/biof.5520320122
10. Mujawar SA, Patil VW, Daver RG. Study of serum homocysteine, folic Acid and vitamin b(12) in patients with preeclampsia. Indian J Clin Biochem. 2011;26(3):257-260. doi:10.1007/s12291-011-0109-3