Posteclampsia

Preeclampsia affects up to eight percent of pregnant women worldwide, and kills 75,000 mothers and 500,000 babies each year (1). As the stats reveal, the syndrome is neither adequately predicted, prevented nor treated. This is partly due to the fact that preeclampsia presents differently in different individuals, partly due to the lack of sufficiently accurate predictive screening methods and partly due to money and politics.

According to the current model, the condition is driven by a complex of related immunological, vascular and inflammatory changes in the placenta (1). This placental dysregulation then drip-feeds pro-inflammatory factors into the circulation which cause chronic maternal inflammation, endothelial dysfunction and hypertension.

If untreated, these can lead to end-organ damage ranging from kidney injury to pulmonary edema, retinal pathology, heart attack, seizures and stroke (2-4).

Low dose aspirin helps prevent or delay the onset of preeclampsia in high-risk individuals (5) by reducing thromboxane  synthesis (6), leading to reduced inflammation and improved placental / fetal blood flow (7). In established cases, magnesium salts and antihypertensive drugs are used to treat the hypertension and seizures respectively, with varying success. Nifedipine, a calcium channel blocker which lowers blood pressure and also reduces thromboxane synthesis, is the antihypertensive of choice (8).

Drugs, however, come with their own risks, primarily to the fetus, and I was curious to know if nutritional and lifestyle factors might provide useful management tools as they do in so many other pathologies. There are after all well–known major nutrient classes with potent anti-inflammatory and vasoprotective effects; and unlike pharmaceuticals these are inherently safe for both mother and fetus.

Omega-3 HUFAs

Back in ‘95 a group of Seattle scientists published a gem of a paper which documented the protective effects of fish oil (9). In this relatively small study (n=62), a 15% increase in the critical erythrocyte omega 3:6 ratio was associated with a 46% reduction in the risk of preeclampsia. A decade later lead author Dr Michelle Williams repeated the study on a larger scale in Peru, generating similar albeit less spectacular results (10).

In 2016 an Indian group (11) and in 2019 a Copenhagen / Boston (12) team published confirmatory findings. In 2021 Chinese (13) and Indonesian (14) scientists independently came up with similar outcomes, and the case for lowering the omega 6:3 ratio in vulnerable women now looks very strong indeed.

And of course, if you do this by eating oily fish (or using Balance oil), you are also ingesting polyphenols.

Polyphenols

The polyphenols constitute another group of highly relevant nutrients. Their pharmacology is on point, as they have potent anti-inflammatory, immune-modulatory and vasoprotective effects.

The biggest meta-analysis of (human) dietary patterns to date (15) drew a blank, but as the study was restricted to dietary inputs of polyphenols, which are at an historic low (16, 17), its significance in my view is questionable.

Higher doses of resveratrol have already shown clinical efficacy when combined with nifedipine (18). Higher dose curcuminoids are effective in a pre-clinical model of eclampsia (19, 20) and are being considered for more general clinical use (21, 22).

N.B. The ‘higher doses’ considered to be pharmacological doses today lie within the dietary range consumed in the pre-transitional era (16, 17).

Self-medicators should consider curcuminoids with proven high bioavailability such as HydroCurc (23). They should keep in mind that the combination of omega 3 HUFA’s and the right polyphenols is synergistic (24), and that prebiotic fibers will likely add further benefit.

Prebiotics

One excellent paper out of Shandong and Jinan demonstrates how prebiotics restore eubiosis, leading to increased bacterial synthesis of short chain fatty acids which protect the placenta (25). The researchers showed that bacterial butyrate reduced inflammation in the placental bed, while bacterial propionate improved placental circulation.

A second Chinese group linked dysbiosis to an increased risk of preeclampsia via mechanisms which included gut bacterial translocation into the uterus with subsequentuterine dysbiosis and inflammation (26). Three other teams generated supportive results (27-29). I am now entirely convinced of the importance of the gut/placenta axis, dysbiosis as a critically important risk factor for preeclampsia and the significance of prebiotics in reducing risk.

Probiotics

The outcomes of trials of probiotic supplements are variable. Some (large-scale) studies have generated positive results (30), but other trials have shown that probiotics may make preeclampsia worse (ie 31). I would urge caution until the reason for this discrepancy (different probiotic strains?) has been discovered.

As the above research illustrates, a rapidly growing body of evidence shows that diet has a significant and perhaps determining effect on the risk of developing preeclampsia.

Little of this has filtered through to the front line. ‘Patient advocacy groups’ such as the Preeclampsia Foundation (which is indirectly funded by the pharma and biotech industries)continue to promote the message that diet is irrelevant, and body weight relatively unimportant (32).

The Foundation might not wish to bite the hand that feeds them, but to de-emphasize lifestyle factors that women could modify in order to reduce their own risk is morally repugnant. If I were a pregnant woman (and in these enlightened times, why not?), I would rather change those risk factors I could control than ignore them and wait for medical intervention.

Risk factors currently recognized by the medical profession include chronic high blood pressure or kidney disease before pregnancy, and high blood pressure or preeclampsia in an earlier pregnancy (1). Obesity is a risk factor (33, 34), as is diabetes of any type (34, 35).

Clinical anxiety and depression are also associated with increased risk (36), and so is air pollution (ie 37). Maternal infections such as UTI’s and periodontal disease are further risk factors (38), possibly via modification of the uterine microbiota (38), and Covid is a recent addition (39).

Many of the above risk factors are modifiable, and all theminvolve chronic inflammation.

Pregnancy itself produces pro-inflammatory elements during parts of the first and third trimesters (40), which exacerbate existing inflammation and thus contribute to existing subclinical vascular disease. This is most likely to become clinically significant in those whose diet, life-style and condition arealready excessively pro-inflammatory.

This would help to explain why women with pre-eclampsia are at least twice as likely to go on to develop cardiovascular disease (41). It likely also explains observed differences in ethnic and regional groups (42-44), and the very different trends observed in different countries (42, 44).

Chronic inflammation is bad for baby too.

Readers of this blog already know that fetal brain development is skewed by inflammation, making spectrum disorders (45) and schizophrenia (46) more likely. Pre-eclampsia increases the risk of these conditions very significantly (46-48), and the rise in pre-eclampsia has probably contributed to the astonishing 300%increase in autism recorded in the last decade (49).

As all the above conditions are substantively linked to dietary issues it would be astonishing, despite the Preeclampsia Foundation’s denials, if diet did not affect the risk of preeclampsia. It is worth adding that the global average age of onset is falling (50), and the incidence is increasing in nations and areas where industrial foods are most frequently consumed (50–53), with resulting increases in obesity, diabetes and hypertension.

The industrial diet, characterized by high consumption of simple sugars and vegetable oils, obesity and inflammatory stress,certainly appears to increase risk (53, 54). Conversely, two new studies suggest that the Mediterranean diet may be significantlyprotective (55, 56). The first (55) found that among women who adhered most closely to the Mediterranean diet, there was a 28 percent lower risk of preeclampsia and a 37 percent lower risk of gestational diabetes. The second (56) generated broadly similar findings.

While at least one earlier study found a null effect (57), this previous trial may have suffered from structural (reporting) problems.

There is a prima facie case for thinking that a Mediterranean dietmight be protective. It has been repeatedly shown to be cardio- (ie 58–60) and vasoprotective (57–61), benefits mediated by an array of anti-inflammatory effects (62–64) which include the alleviation of endothelial dysfunction (62, 64, 65).

As chronic inflammation, vascular and microvascular pathology are at the core of preeclampsia (1), the Mediterranean diet certainly seems like a sensible first step in reducing the risk of this condition. And because obesity and hypertension are recognized risk factors (1, 34), the Mediterranean diet’s tendency to promote general health (63, 66), weight loss (66, 67) and reduce blood pressure (60, 61) provides two more reasonsfor breaking out the olive oil (and all the rest).

Tangential support for a more natural diet comes from two more sources.

I have been informed by Old Amish mid-wives that pre-eclampsia does occur in their community but is uncommon, as is autism (68). And there is new research which links higher intakes of fruits, vegetables and seafoods, and basic produce in general, to a reduced risk of miscarriage (69). That same study found that consuming larger amounts of processed foods (iemore pro-inflammatory diets) were associated with increased miscarriage risk …

A sad postscript.

The Preeclampsia Foundation is typical of ‘patient advocacy groups’, many of which are effectively owned by Big Pharma(69–72). They provide vague dietary advice but despite the proliferation of evidence being generated by independent scientists, none mention pharmaconutrition. They are happy,however, to promote the latest commercial drugs and to recruit patients for next-gen drug trials. The fact that they are generously funded by drug companies (69–74) clearly has nothing to do with this.

Next week: How a dry spell shortens your life, and how to end it.

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