Preventing Preeclampsia

I developed preeclampsia in the final week of my fourth pregnancy, and ended up
with postpartum preeclampsia as well, necessitating a month of bedrest, as well
as a far from ideal birth experience (having to lie in bed to whole time,
ending up hooked up to everything in sight, an epidural, etc.).

What can anyone tell me about avoiding a recurrence of this problem? I know to
eat lots of protein, but I was doing that all along.

Leslie

Leslie wrote:
What can anyone tell me about avoiding a recurrence of this
problem? I know to eat lots of protein, but I was doing that all
along.

I did a lot of research on this when I had high BP (without PE) in my third
pregnancy. One of the things I read is that PE has only about a 6%
recurrence rate (high BP has about a 13% recurrence rate, FWIW). So, first
of all, it's far likelier than not that the PE won't recur, regardless of
what you do.

In addition to the protein, I have read that calcium, magnesium, and
essential fatty acid supplementation seem to be associated with a lower risk
of developing high BP/PE, so you might try that. I believe that moderate
exercise throughout pregnancy may help as well, since there seems to be some
suggestion that poor blood flow is to blame and exercise can improve the
efficiency of your heart (which is going to be working harder as your blood
volume increases throughout pregnancy).

Good luck and HTH!
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [2] mom)

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

On 16 Mar 2004 03:08:23 GMT, (Leslie) wrote:

What can anyone tell me about avoiding a recurrence of this problem? I know to
eat lots of protein, but I was doing that all along.

Things to lower your risks include: not getting pregnant (surefire,
and not helpful, I know), having the same father for all of your
children*, having more than one child (your risk decreases with each
child), and not getting high BP during the pregancy.

I will tell you my story. I got severe PE with #1. I had a severe
migraine for 3 days straight (nothing helped), and I ended up in the
hospital having a c-section at 38 weeks because they could only
control my BP with IV meds. I was scared to get pregnant with #2, but
I did anyway.

Pregnancy and birth of #2 was totally different. I didn't have a
problem with my BP. No signs of PE were ever there. I did have a
c-section, but it was planned and my choice.

Just because you got PE with #1 does not mean you will get it with any
of your other children. Just be sure to pay attention to your body,
and watch carefully for any signs of PE.

*If you change partners, your first child with the new partner is the
same as your first child. Each new partner has a risk.
--
Daye
Momma to Jayan and Leopold
See Jayan and Leo: http://www.aloofhosting.com/jayleo/
Updated 28 Feb 2004

Daye wrote:
Just because you got PE with #1 does not mean you will get it with
any of your other children. Just be sure to pay attention to your body,
and watch carefully for any signs of PE.

Leslie's PE occurred during her fourth pregnancy, though, and all of them
have the same father.

I still think the 6% recurrence rate applies, though. I've never read
anything that suggested getting PE in a second or subsequent pregnancy as
opposed to a first pregnancy increased the likelihood of recurrence.

That said, I note that Leslie is 37 going into this pregnancy. The one
pregnancy I had any trouble with BP in was my third, when I was also 37. So
I would definitely be inclined, in Leslie's shoes (or if I ever get pregnant
again) to do everything in my power to stave off high BP, but most
especially, I would exercise religiously from early in pregnancy. I really
believe that a big part of the reason my BP shot up towards the end of
pregnancy was that I was too sedentary throughout and my heart was not in
the right condition to handle the extra blood volume very well.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [2] mom)

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

On Wed, 17 Mar 2004 09:19:13 -0800, "Circe" wrote:

Leslie's PE occurred during her fourth pregnancy, though, and all of them
have the same father.

I must have missed that post. I only skim the group these days.
Well, my advice is still good for most people.

--
Daye
Momma to Jayan and Leopold
See Jayan and Leo: http://www.aloofhosting.com/jayleo/
Updated 28 Feb 2004

I don't have information as good as the BTDT women here, but are you
following the Brewer diet?


Mary S.
mom to the Sproutkin
and a new wee babysprout, due Oct 1

(Leslie) wrote in message ...

What can anyone tell me about avoiding a recurrence of this problem?

Not enough, unfortunately. However, there is some new research which
has some tantalizing clues. It's all very preliminary, but I'll
summarize what I understand of it. (I am just a layman, but a highly
motivated one, as I also would like to avoid pre-eclampsia next time.)

You probably know that lots of different things (calcium, vitamin C,
aspirin) have been suggested, but that none have panned out in further
studies as preventative measures. This appears to be because the
symptom trigger for pre-eclampsia/ PIH/ gestational hypertension is
hypoxia (iow, not getting enough oxygen) which can be caused by *lots*
of different things. Hypoxia isn't what goes seriously wrong in the
first place, but if you can avoid getting hypoxic, you might not
experience any symptoms.

Some of the latest research seems to indicate that a shortage of
oxygen causes the placenta to produce a protein (not a dietary
protein, but a biological protein, like a hormone), which binds to
another protein called VEGF and takes it out of circulation. VEGF is
responsible for growing new blood vessels and repairing existing blood
vessels ("angiogenesis"); without enough in your bloodstream, your
blood vessels are slowly destroyed. As your liver and kidneys fail,
you start to spill albumin in your urine (the protein dipstick test)
and to swell up. Blood PIH tests can detect this failure by finding
screwy levels of creatine and uric acid.

(Oddly enough, it looks this is ordinarily a *good* thing for the
placenta to produce, because ordinarily the placenta is only
temporarily short of oxygen during labor. When it produces the
protein which kills off blood vessels, it probably contributes to the
detachment of the placenta from the uterine wall following delivery of
the baby, along with (probably) some other chemical signalling. This
might partially explain the high incidence of placental abruption with
pre-eclamptic and HELLP pregnancies.)

If you want to find this newer research, it's in PubMed. Search
"sFLT1". The next treatment to be researched for pre-eclampsia is
likely to be nicotine. We know that smokers have a lower rate of
pre-eclampsia; it turns out that nicotine raises production of VEGF
and inhibits sFLT1.

Lots of things can cause hypoxia, of course, and most of them have at
one time or another been tied to pre-eclampsia. Living in a polluted
valley. Living at a high elevation. Snoring and sleep apnea (this
may be why being overweight is correlated, actually). Not eating a
diet with sufficient anti-oxidants. Liver and/or kidney disease.
Being in lousy aerobic condition. Etc. Even correcting all of them
might not be enough to help, depending on the state of the placenta,
which has to do with some *more* of the research.

The latest research on what it is that goes wrong in the first place
in first pregnancies is still preliminary as well and may not apply to
a fifth pregnancy with the same father. It looks very similar to an
immune system response known as graft rejection. The implanting
embryo has foreign proteins -- it's not the same as the maternal
tissue -- and so it can trigger an immune system response which
prevents proper implantation of the placenta in the first place,
during the first trimester.

If you want to find this research, it's in PubMed. Search "spiral
artery remodelling".

Lots of immune system factors have been linked to pre-eclampsia at one
time or another as well. Using barrier methods of contraception,
which would prevent sufficient exposure to one's partner's proteins.
Having a new partner for a subsequent pregnancy. Carrying a boy.
Having a strong family history of essential hypertension (this one is
because some genetic forms of hypertension are caused by a hyperactive
immune system which inflames the blood vessels in response to just
about anything).

I know to eat lots of protein, but I was doing that all along.

My guess (and it is *just* a guess) is that high levels of dietary
protein may help somewhat, in an odd way that isn't directly related
to prevention of hypoxia or to the immune system issues. Certainly
many midwives report that it helps, but there aren't any controlled
studies which agree with those reports.

Lots of dietary protein means an excess of the amino acid methionine.
The liver converts this into choline. The placenta (along with the
brain) is what is known as a cholinergic system, which means just that
it's a low-pressure area of the body to which blood is attracted. We
can actually diagnose shallowly implanted placentas now with
ultrasound scans of the spiral arteries; if there's a high peak with
each beat of the maternal heart, it means that blood is being forced
across the placenta rather than flowing across easily, which means
that implantation has been compromised.

Anyway, a cholinergic system means that there's lots of acetylcholine
rattling around in that system. Acetylcholine is a potent
vasodialator and lowers blood pressure, which is what creates the
low-pressure area. You get acetylcholine from dietary protein and
folic acid (or some other methylator). So lots of protein might mean
more acetylcholine which might mean more bloodflow to the placenta.
PubMed has some intriguing stuff on this; search "non-neuronal
nicotinic acetylcholine receptors" (notice the word "nicotine" in
there...) But ordinarily your diet has plenty of protein in it to
produce sufficient acetylcholine, unless you are not eating actual
food (i.e. you are eating lots of sugar and fat) when you eat.

That said, I was on the Brewer diet from day one, took extra C, E, and
calcium, exercised routinely with walking or swimming at least four
times a week, was a hiker before I got pregnant and kept it up for the
first trimester. I was 30 when I got pregnant and had been with my DH
for over a decade and hadn't used barrier contraception for over a
year.

I got severe pre-eclampsia (they classed it as "sudden-onset", because
my bp went from 130/80 to 220/116 in a week, and my protein went from
trace to off the scale) in my 33rd week of pregnancy and delivered my
son by emergent C-section at 34 weeks 1 day after he stopped moving,
stopped practice breathing, and started having heart decels as a
result of the magnesium sulfate drip and the labetelol. They whisked
some vials of my blood and the placenta off to research (it was
abnormally small and highly oxidized) and my DS off to NICU for a
week. (He's fine; he wasn't even IUGR, which they said proved I'd been
eating well. I told them since that whole nutrition thing had worked
so well for me this time that with my next pregnancy my diet would be
marijuana and Pixie Stix.)

This ****ed me off rather a lot; I'd read my Goer, Gaskin, Simkin, and
Kitzinger, I'd been at three births, and I was planning a homebirth
with a birthing pool option. And I have a strong family history of
hypertension. Sibai, a fairly prominent researcher in blood pressure
disorders during pregnancy, says women who deliver under those
circumstances (severe pre-eclampsia before week 34) have abbout a 40%
chance of recurrence, so that's why I've been paying so much attention
to this.

Good luck avoiding it; I'd guess that you'll have very little immune
system response to contend with and that hypoxia is the primary issue.
I'd say exercise (maybe yoga, for the deep breathing), supplement
antioxidants, and if you start snoring, get a CPAP.

--
C, mama to nursling O who is seventeen months *today*

Barbara said:

I did a lot of research on this when I had high BP (without PE) in my third
pregnancy. One of the things I read is that PE has only about a 6%
recurrence rate (high BP has about a 13% recurrence rate, FWIW). So, first
of all, it's far likelier than not that the PE won't recur, regardless of
what you do.

Oh, thanks for telling me that!


In addition to the protein, I have read that calcium, magnesium,

Doing that already, so that's good.

and
essential fatty acid supplementation

What would I get these from?

seem to be associated with a lower risk
of developing high BP/PE, so you might try that. I believe that moderate
exercise throughout pregnancy may help as well, since there seems to be some
suggestion that poor blood flow is to blame and exercise can improve the
efficiency of your heart (which is going to be working harder as your blood
volume increases throughout pregnancy).

That's good too, because I belong to a gym and plan to keep going. Thanks,
Barbara!

Leslie

Daye said:

Things to lower your risks include: not getting pregnant (surefire,
and not helpful, I know), having the same father for all of your
children*, having more than one child (your risk decreases with each
child), and not getting high BP during the pregancy.

That's what's so strange about my experience--I got PE on my fourth child, and
all had the same father!

Leslie

Mary asked:

I don't have information as good as the BTDT women here, but are you
following the Brewer diet?

IIRC, isn't that just high protein, or is there more to it than that?

Leslie