Proper Nutrition May Minimize the Risk of Preeclampsia

Abstract

This paper examines three studies conducted between 2009 and 2013, investigating the potential link between nutritional intake and increased risk of preeclampsia. These studies focus on the dietary behaviors during pregnancy that have been speculated to either trigger or minimize the risk of developing the condition. This was often accomplished by tracking the personal eating habits of a sample number of women during gestation. Dantas et al. (2013) found a connection between obesity and increased risk, while Brantsæter et al. (2009) found that a diet high in vegetables, vegetable oils, and fruits helped decrease the risk. These findings were complicated by an investigation of trans fats and their effect on preeclampsia, which resulted in a lack of correlation. However, this study, carried out by Chavarro, Halldorsson, Leth, Bysted, and Olsen (2011), posed limitations as it was conducted in Denmark, where there are government regulations on the sale of foods containing trans fats. Thus, the results of this study reflect a limited intake range.

Introduction

Preeclampsia is a condition seen only in pregnant women and is the leading cause of maternal and intrauterine mortalities and morbidities worldwide. In women, seizures, pulmonary edema, and blood clotting are among the by-products of preeclampsia. The baby is in danger of growth restrictions, prematurity, and if the mother is deemed to be at too much risk of serious complications or fatality, the pregnancy may be interrupted. While some women may continue to experience the symptoms post-partum, the only current cure for preeclampsia is delivery. This can be a dangerous endeavor depending on the gestational age of the baby. Extremely serious cases can result in the death of both mother and child. The often sudden and unpredictable nature of the condition makes it all the more important that pregnant women take any measures possible to minimize the risk of being diagnosed with pre-eclampsia.

Women in developing countries have the greatest vulnerability. For those who are not exposed to high amounts of processed foods or trans fats (if applicable), this vulnerability is likely due to a lack of sufficient healthcare. In developed nations, evidence suggests that the absence of healthy, affordable food plays a role in elevated risk. Many studies have also noted socioeconomic status as a factor, providing clues as to which demographics may or may not have access to proper nutrition. Studies suggest that expecting mothers who adhere to a diet composed heavily of fruits, vegetables, and healthy oils have a reduced chance of developing this life-threatening condition, while those who eat mostly processed foods, sweets, and sodium-rich foods are at greater risk.

Literature Review

In the past, studies have shown an increased risk of preeclampsia in women who consume foods with higher energy densities, added sugar, and polyunsaturated fatty acids. With this information in mind, Brantsæter et al. (2009) conducted a study in which they extracted four separate eating patterns from the diets of 23,423 expecting Norwegian mothers. The patterns fell under the following categories: vegetables, processed foods, potatoes and fish, and cake and sweets. Each participant received scores in all four categories, reflecting which dietary patterns they tended to naturally follow and how often. The results of this study corroborated those of its predecessors. Those who developed preeclampsia generally had lower vegetable scores and higher processed food scores, while those who experienced healthier pregnancies scored just the opposite (Brantsæter et al. 2009).

Additional data collected from the study showed that women with higher vegetable scores typically possessed a number of other advantages: higher levels of education, lower BMIs, and fewer of them were smokers (Brantsæter et al. 2009). The discrepancies in education are particularly interesting, as this also ties in with socio-economic status. Processed foods are widely available in most developed countries and among the most affordable for those living on a low income. Moreover, those with access to quality educational resources are often those who can afford it or can afford to live in areas that provide it. This suggests that those with higher incomes have a nutritional advantage for two reasons: they have the money to afford higher quality, whole foods, and access to an education that will likely address and promote good health and nutrition habits. The failure of institutions to address and promote these habits, as well as an individual’s lack of access to information regarding these habits, may also account for the higher number of smokers among those with high processed food scores.

The relationship between BMI, higher intake of processed foods, and increased risk of preeclampsia is also one that supports the theory of nutrition as a modifiable factor in one’s chances of developing the condition. Dantas et al. (2013) studied the occurrence of preeclampsia among a population of northeastern Brazilian women, where it is the principal cause of maternal mortality – a statistic that is credited to an “increasing prevalence of obesity” throughout the country (Dantas et al. 2013). The risk was confirmed to be higher among women with more bodyweight. Additionally, a follow-up with those who experienced preeclampsia during their pregnancies revealed that half of the group had gone on to develop chronic hypertension (Dantas et al. 2013).

Like Brantsæter et al. (2009), Dantas et al. (2013) confirmed that socio-economics play a role in preeclampsia risk. Of the population studied, 44% had either completed an average of 3 years of schooling or had received no schooling at all. Half of the region’s female population was illiterate (Dantas et al. 2013). This, in conjunction with the increased urbanization of Brazil, may indicate that the pervasiveness of obesity is the result of an inability to make informed dietary choices in the midst of an expanding variety and availability of food (Dantas et al. 2013). Of the diet patterns outlined in Brantsæter et al. (2009), those that resulted in increased risk of preeclampsia (sweets, soft drinks, salty snacks, processed foods, etc.) are also synonymous with poor nutrition and weight gain.

With the knowledge that diet is a possible controllable factor in the probability of pregnant women developing preeclampsia, Chavarro, Halldorsson, Leth, Bysted, and Olsen (2011) conducted a study to explore the potential role of trans fat consumption in particular. Trans fats are commonly found in foods such as processed, frozen, and fast foods, as well as sweets, and butter substitutes. The ubiquity of trans fats within foods that are linked to higher incidents of preeclampsia, makes a seemingly strong case for conducting an extensive investigation of its potential contribution to increased risk. Furthermore, previously published studies reported a well-founded relationship between the two (Chavarro, Halldorsson, Leth, Bysted, and Olsen 2011). However, after Chavarro, Halldorsson, Leth, Bysted, and Olsen (2011) tracked the diets of 67,186 pregnant Danish women between 1998 and 2003, they concluded that there is actually no connection between trans fat consumption and preeclampsia.

It is important though, to note the limitations of this study, as there is a greater amount of research in this field supporting contradictory theories. To start, food frequency questionnaires were assessed only at week 25 of gestation, as previous studies indicate that the onset of preeclampsia predominantly happens close to term (Chavarro, Halldorsson, Leth, Bysted, and Olsen 2011). At the same time, Chavarro, Halldorsson, Leth, Bysted, and Olsen (2011) do not fail to recognize that preeclampsia is “defined by onset of hypertension and proteinuria after gestation week 20.” This brings up the possibility that some of the participants could have developed preeclampsia prior to their second trimester and diet assessment.

The study also suggested that, in general, an individual’s dietary habits do not vary drastically from the first trimester to the second, rendering it unnecessary to collect food frequency information for both (Chavarro, Halldorsson, Leth, Bysted, and Olsen 2011). This argument in and of itself may warrant further exploration. During pregnancy, the first trimester and the end of the third trimester are both categorized by particularly unpredictable hormone fluctuations. It has been considered that these severe oscillations are the cause of surprising food cravings, a popularly acknowledged side effect of pregnancy. The possibility of pregnant women displaying erratic variations in diet was dismissed from this study, as was the subjectivity of dietary preferences altogether.

The most important limitation of this study to take into account is the fact that it was conducted in Denmark, a country with both a flourishing economy and government regulations on trans fats. Lowered socio-economic status, and exposure to high quantities of processed foods, most likely containing trans fats, both had major impacts on the results of the studies published by Brantsæter et al. (2009) and Dantas et al. (2013). Of those who participated in the study conducted in Brazil, 14% developed preeclampsia. The sample of Norwegian women studied by Brantsæter et al. (2009) yielded an occurrence rate of 5.4%. These numbers, in consideration with the data provided about the respective populations under scrutiny, already convey an alarming discrepancy in preeclampsia risk between those living on a low income and high exposure to cheap, unhealthy foods, and those who can afford healthier foods and access to the education promoting these choices. In accordance with these patterns, less than 3% of Danish participants developed preeclampsia.

Conclusions

While the results of these studies when taken individually fall short of pinpointing the exact role of nutrition in the prevention of preeclampsia, together they form a reasonably clear narrative. The consideration of socio-economic factors and their influence on the accessibility of nutritious foods provides this narrative with a logical and consistent backdrop on which to digest the chain reaction of information. Obesity introduces a significant risk of preeclampsia in pregnant women. Those living on a low income, or in developing countries, are more likely to consume foods with higher trans fat content in the form of processed foods and/or cooking fats (Chavarro, Halldorsson, Leth, Bysted, and Olsen 2011). Women who adhere to a diet heavy in sugars and processed foods tend to have more body fat than those who gravitate toward fruits and vegetables, putting them at greater risk. What this means is that the dietary choices that a woman makes during pregnancy may be one of the elusive modifiable factors affecting the chances of developing preeclampsia. It is suggested that those who have access to affordable, nutritious foods make healthy choices about food to minimize the risk.

It is important though, to not stop at merely synthesizing this information on an individual level. It may not be enough to simply advise expecting mothers to “eat right.” The important role that both income and location play in a woman’s ability to access the type of nutrition recommended by these studies, makes preeclampsia risk management a big-picture issue. The amount of preeclampsia related deaths and complications that continue to occur around the world suggest that it is something that should not be taken lightly, especially within vulnerable communities. Designing effective strategies for targeting these communities, informing them of the connection between nutrition and preeclampsia, and finding ways to make the right choices more available may require further study.

References

Brantsæter, A. L., Haugen, M., Samuelsen, S. O., Torjusen, H., Trogstad, L., Alexander, J., et al. (2009). A Dietary Pattern Characterized by High Intake of Vegetables, Fruits, and Vegetable Oils Is Associated with Reduced Risk of Preeclampsia in Nulliparous Norwegian Women. The Journal of Nutrition, 139, 1162-1168.

Chavarro, M J. E., Halldorsson, PhD, T. I., PhD, T. L., PhD, A. B., & Olsen, MD, PhD, S. F. (2011). A prospective study of trans fat intake and risk of preeclampsia in Denmark. European Journal of Clinical Nutrition, 65, 944-951.

Dantas, E. M., Pereira, F. V., Queiroz, J. W., Dantas, D. L., Monteiro, G. R., Duggal, P., et al. (2013). Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population. BMC Pregnancy and Childbirth, 13. Retrieved October 12, 2013, from http://www.biomedcentral.com/1471-2393/13/159