Friday, January 22, 2010
Gestational Hypertension Prevention
Since having suffered from it in a previous pregnancy puts me at higher risk for developing it again I've been putting together some info to help try and prevent it or at least keep it better under control this time around and thought I would share it. I'm sorry I have not been keeping sources, as I am just using this for my own personal use. But this would help at least as a jumping off point for others.
Remember to do your own research and discuss your care with your prenatal care provider.
Possible prevention of Gestational Hypertenstion & Preclampsia
Vitamin D3 (not D2), dose: 2000 - 4000 iu
it appears that vitamin D contributes to improving pregnancy outcomes, such as decreasing the risk of pre-eclampsia, and improving length of gestation, birth weight, and infant bone mineralization. It also appears that sufficient vitamin D in early life may decrease the risk of health problems later in life such as schizophrenia, brain tumors, asthma, multiple sclerosis, and autoimmune diseases such as type 1 diabetes.
Evidence is accumulating that a much higher intake than the current dietary reference intake of 200 IU/day to 400 IU/day (5 µg/day to 10 µg/day) is necessary. A number of studies have suggested the need for higher vitamin D intakes during pregnancy. A dose of 4000 IU/day maintained vitamin D sufficiency in the mother and also raised vitamin D in breast milk to the point at which there was no further need of infant supplementation (evidence level II-1). Doses of this magnitude appeared safe. Even experimental doses of up to 10,000 IU/day for five months in pregnancy did not elevate levels into the toxic range.
(side note get tris D3- in a study of children two to eight years of age, Roth et al found that few of the children with intakes of 1.3 µg/kg/day (eg, 20 µg/day [800 IU/day] in a two-year-old) reached adequate levels of 25(OH)D of greater than 75 nmol/L. Data suggested that doses of up to 2.5 µg/kg/day of total vitamin D intake may be optimal. Further studies are needed to see whether the increase in vitamin D requirement with weight is linear or whether a better denominator would be either BMI or body surface area.)
Calcium, dose: 1500- 2000 mg per day
A meta-analysis (statistical review) of 11 studies of calcium supplementation in pregnancy, involving a total of more than 6,000 women, found that calcium slightly reduced the risk of pre-eclampsia and hypertension, particularly in two groups of women: those at high risk for hypertension and/or those with low calcium intakes.
However, by far the largest single study in the meta-analysis found no benefits. In this double-blind study, researchers gave either 2 g of calcium or placebo daily to 4,589 women from weeks 13 to 21 of their pregnancy onward. In the end, researchers found no significant decreases in rates of hypertension or pre-eclampsia—not even when they looked specifically at women whose daily calcium consumption mirrored that of women in developing countries.
The meta-analysis included this negative study in its calculations, but still found that calcium seemed to be helpful.
In a subsequent double-blind, placebo-controlled study published in 2006 and conducted by the World Health Organization, calcium supplements (1.5 g per day) were tried in 8,325 pregnant women whose calcium intake was inadequate. Calcium failed to reduce the incidence of pre-eclampsia. However, it did appear to reduce the severity of pre-eclampsia episodes.
The bottom line: Calcium might be of some benefit for those pregnant women who are at high risk for hypertension or deficient in calcium. However, for well-nourished, low-risk women, effects are likely to be minimal or nil.
Antioxidants, beta-carotene; C & E, Dose: C 1gram per day& E 400iu per day
levels in the blood of women with GH appear to be reduced in some, but not all, preliminary studies. No studies have yet been conducted evaluating the effects of antioxidant supplementation on the incidence or severity of GH.
Women with preeclampsia have been found to be depleted in antioxidants. Some but not all studies have reported deficiencies in vitamin C, vitamin E, and beta-carotene in preeclampsia patients. In a double-blind trial, supplementation of vitamin C (one gram per day) and vitamin E (400 IU per day) reduced the incidence of preeclampsia by 76% in women at high risk. However, for those already suffering from this condition, supplementation with these same vitamins has led to only insignificant effects.
Omega-3 fatty acid (from fish oil), dose: 2g?
Increased consumption of fish was associated with reduced risk of GH in one preliminary study. In one study, the incidence of hypertension during pregnancy was significantly higher in women from communities with lower consumption of fish and lower in women from communities with high fish consumption.
Magnesium, dose: 165 - 365 mg per day
Magnesium deficiency has also been implicated as a possible cause of GH. Dietary intake of magnesium is below recommended levels for many women during pregnancy. Magnesium supplementation has been reported to reduce the incidence of GH in preliminary and many double-blind trials.4 In addition to preventing GH, magnesium supplementation has also been reported to reduce the severity of established GH in one study. Amounts used in studies on GH range from 165 to 365 mg of supplemental magnesium per day.
Zinc, dose: 20 mg per day
reported to reduce the incidence of GH in one double-blind trial studying a group of low-income Hispanic pregnant women who were not zinc deficient.
A marginal zinc deficiency has been reported in some women with preeclampsia. The common practice of prescribing iron and folic acid supplements to pregnant women can lead to reduced zinc absorption.76 Trials studying the relationship between zinc supplementation and preeclampsia incidence have produced conflicting results. In one double-blind trial, the incidence of preeclampsia was significantly lower in women receiving a multivitamin-mineral supplement, which provided 20 mg of zinc per day, than in women who received the same supplement without zinc. However, in another double-blind trial, a higher incidence of preeclampsia was reported in pregnant women given 20 mg of zinc per day than was reported in women given a placebo. In yet another trial, zinc supplementation failed to prevent preeclampsia. Therefore, current evidence does not sufficiently support the use of zinc as a way to protect against preeclampsia.
B6 & Folic Acid, dose: 5mg 2x per day & 5mg per day
In one preliminary trial, women with a previous pregnancy complicated by preeclampsia and high homocysteine supplemented with 5 mg of folic acid and 250 mg of vitamin B6 per day, successfully lowering homocysteine levels. In another trial studying the effect of vitamin B6 on preeclampsia incidence, supplementation with 5 mg of vitamin B6 twice per day significantly reduced the incidence of preeclampsia. Women in that study were not, however, evaluated for homocysteine levels. In fact, no studies have yet determined whether lowering elevated homocysteine reduces the incidence or severity of preeclampsia. Nevertheless, despite a lack of proof that elevated homocysteine levels cause preeclampsia, many doctors believe that pregnant women with elevated homocysteine should attempt to reduce those levels to normal.
B2 (roboflavin), dose: 1.6 mg daily allowance
Women who are deficient in vitamin B2 (riboflavin) are more likely to develop preeclampsia than women with normal vitamin B2 levels. These results were observed in a developing country, where vitamin B2 deficiencies are more common than in the United States. Nevertheless, insufficient vitamin B2 may contribute to the abnormalities underlying the disease process.
Dietary source: The highest concentrations of Vitamin B2 (riboflavin) are found in liver and yeast. More common dietary sources for Vitamin B2 (riboflavin) include milk, lean meat, eggs, and dark green vegetables. Vitamin B2 (riboflavin) is also available in good quantities in legumes, fish, and grains.
Acetylsalicylic Acid, dose: 0.5mg/kg/day
women rated in Doppler velocimetry waveform analysis to be at high risk of pre-eclampsia, low-dose acetylsalicyclic acid reduces the incidence of pregnancy-induced hypertension and especially proteinuric pre-eclampsia.
For women with preeclampsia, obstetricians and midwives often recommend bed rest and lying on the left side; this position helps reduce edema and lower blood pressure by increasing urinary output. However, a review of clinical trials concluded that bed rest can significantly worsen pregnancy-induced hypertension. To the contrary of bed rest routine low stress exercise has been shown to be beneficial.
Women with preeclampsia have been shown to have elevated blood levels of homocysteine. Research indicates elevated homocysteine occurs prior to the onset of preeclampsia Elevated homocysteine damages the lining of blood vessels, which can lead to the preeclamptic signs of elevated blood pressure, swelling, and protein in the urine.
C-sections are not recommended over vaginal births for mothers with preeclampsia or gestational hypertension because of the increased risks of the surgery compared to vaginal births with these conditions. Epidurals are recommended to help decrease blood pressure during birth. No contraction increasing or causing drugs should be given to induce or speed labor as they increase the severity of these conditions.
Both Chiropractic care and Yoga have been shown to help reduce blood pressure during pregnancy probably because it reduces pregnancy stresses on the body in general by keeping the spine well placed and reducing kinks in the blood flow. (in another plus both also help with smoother, less painful, less complicated and shorter labors)
Remember to do your own research and discuss your care with your prenatal care provider.
Calyn Leake Zeiger
- I'm a semi crunchy stay at home wife and mama of two boys. Extend Breastfeed, Cloth diaper, Cosleep, Babywear, Homeschool, Homebirth. My sons and I have some serious health concerns (allergies, growth hormone, kidney, lung, spine, etc...). We didn't realize they were genetic (or I had) until after Trace's birth. Tristian had some big medical and possibly/probably autism related delays in early childhood but also taught himself to read at 2yrs and started on math equations at 4yrs. Trace is bit delayed across the board by about 6 months, but as he's 1yr+ behind in height... it's not very noticable ;-) Trace is very musical and hands on. With plenty of common sense, love, good doctors and faith we are doing wonderfully!
This wonderful chapter in my life of discovering the green subculture has (mostly) ended. Living green on a budget has changed from the thrill of discovery to habit. This blog remains in rememberance- with occasionally crossover posting. I hope you join me- the same green mama on a budget, in a new blog celebrating life's daily experiences- LIFE O'KAY http://lifeokay.blogspot.com/ Still lots of crafts & crunchiness- with even more sweet family moments.