|L-Arginine with antioxidant support||6.6gm|
|Diet and Lifestyle||Rich in fruit and vegetables, low in processed foods|
|Vitamin D||10 – 20ug/L|
Pre-eclampsia (PE) affects 3 – 5 % of pregnancies and is characterised by proteinuria, sudden oedema, slowed foetal growth, hypertension and clotting disturbances (Mol et al., 2016).
Having a positive family history gives a relative risk of developing PE of 2.6 and it being a first pregnancy carries a relative risk of developing PE of 2.9 (Glover et al., 2003). Here’s what the scientific papers tell us you can do to minimise this risk.
If your daily calcium intake is low I would recommend taking a calcium supplement of 1 – 2 gm daily. Calcium supplementation has been shown to reduce resistance in umbilical and uterine arteries thereby preserving uterine-placental blood flow (Carroli et al., 2010).
A Cochrane systematic review of calcium supplementation during pregnancy showed benefits were greatest with high dose (>1gm) calcium supplementation (Hofmeyer et al., 2014).
Another meta-analysis and systematic review showed the maximum benefit was seen in women who were at highest risk with lowest calcium intake (Tang et al., 2015).
However, if your dietary intake of calcium is adequate then supplementation would be unlikely to confer any additional benefit.
Diet and Lifestyle
Dietary and lifestyle interventions are also important. A systematic review of 10 studies showed dietary and lifestyle interventions reduced risk of PE by 26%. Dietary interventions alone reduced risk by 33%.
(Thangaratinam et al., 2012)
A more recent systematic review by Allen et al., 2014, including eighteen studies, also showed that lifestyle and dietary interventions have the potential to reduce risk of preeclampsia.
I would recommend a non processed diet, rich in fruit and vegetables and low in processed foods (Englund-Ogge et al., 2014).
If you are over weight or obese then you should explore healthy weight loss strategies. A population based cohort study in Canada showed that a 10% reduction in weight resulted in a 10% reduction in risk of PE (Schummers et al., 2015).
I would also recommend a high fibre diet. A study of 1538 women showed a high fibre diet reduced the risk of PE. Fibre reduces triglyceride levels which improved pregnancy related dyslipidemia and thereby reduced risk of pre-eclampsia (Qiu et al., 2008). Frederick et al., (2005) also found that women with the highest fibre intake had a 51% reduction in pre-eclampsia risk compared to those in the lowest quartile for preeclampsia risk.
Prenatal probiotic intake may affect PE occurrence by reducing placental and maternal systematic inflammatory systems (VandeVusse et al., 2013). Brantsaeter et al., 2011 found, in their adjusted model, that high probiotic consumption in pregnancy reduced risk of PE by 20% compared to non consumption. Although based on dietary recall the study involved 33,399 women and showed that those with the highest intake of probiotic foods had the lowest risk of pre-eclampsia.
I also recommend dietary supplementation with 10 – 20 ug/L of vitamin D. In pregnancy the placental metabolism of vitamin D is altered. Vitamin D supports pregnancy by aiding the maternal immunological adaptation that is required to maintain a normal pregnancy (Hyponnen et al., 2011).
The Norwegian mother and child cohort study showed a 27% reduction in risk of PE in those taking supplemental vitamin D of 10 – 20 ug/L compared to those who didn’t. Interestingly dietary vitamin D intake did not alter risk (Haugen et al., 2009).
Bodner et al., 2007 showed that a 50-nmol/liter decline in serum 25(OH)D concentration doubled the risk of preeclampsia. Baker et al., 2010 supported these findings showing a mid gestation vitamin D < 50nmol/L was associated with an almost 4 fold increased risk of severe PE compared to women with a level > 75nmol/L. Observational studies by Aghajafari et al., 2013, and Tabesh and Wei et al., 2013 also support these findings.
Chinese women at high risk of developing PE given 100ug daily of Selenium showed a reduction in oedema and PIH (Han and Zhou, 1994). An epidemiological study of 45 countries showed that the lower your selenium levels the higher your risk of developing pre-eclampsia (Vanderlelie et al., 2011).
A study by Rayman et al., in 2003 showed that median toenail selenium concentrations in pregnant women with pre-eclampsia were significantly lower than controls.
A more recent 2014 study showed that selenium supplementation in women in the lowest quartiles of selenium status significantly reduced biomarkers of pre-eclampsia (Rayman et al., 2014).
A study in Pittsburg showed a 45% reduction in risk of PE in multivitamin users compared to non users. After adjustment for weight, lean multivitamin users had a 71% reduction in risk compared
to non-users. There was no difference in PE rates in over weight women regardless of multivitamin use (Bodnar et al., 2006).
Vanderlie et al., 2011 showed a statistically significant reduction in risk of PE in overweight women but the difference was not statistically significant in women with a normal BMI.
One large randomised controlled trial has shown that 6.6gm of L-arginine given with antioxidants reduces risk of PE development (Vadillo-Ortega et al., 2011). Camarena Pulido et al., 2016 also found that l-arginine alone reduces the risk of pre-eclampsia. A meta-analysis of eight studies supported this finding that women at high risk of developing pre-eclampsia reduced their risk by taking l-arginine (Dorniak-Wall et al., 2014). L-arginine is a mediator of vasodilation which will help reduce blood pressure.
Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M & Rabi DM (2013) Association between maternal serum 25-hydroxy-vitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 346, p.f1169.
Allen R, Rogozinska E, Sivarajasingam P, Khan KS & Thangaratinam S (2014) Effect of diet‐and lifestyle‐based metabolic risk‐modifying interventions on preeclampsia: a meta‐analysis. Acta obstetricia et gynecologica Scandinavica, 93, 973-985.
Asemi Z & Esmaillzadeh A (2015) The effect of multi mineral-vitamin D supplementation on pregnancy outcomes in pregnant women at risk for pre-eclampsia. International journal of preventive medicine, 6.
Baker AM, Haeri S, Camargo Jr CA, Espinola JA & Stuebe AM (2010) A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clin Endocrinol Metab 95, 5105-5109.
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