Preeclampsia is a hypertensive disorder that occurs only during pregnancy and the postpartum period, affecting both the mother and the unborn baby. During Preeclampsia Awareness Month in May, WIC staff can help spread awareness about this potentially life-threatening condition, as well as other hypertensive disorders. Preeclampsia and other hypertensive disorders during pregnancy are a leading cause of maternal and infant morbidity. If the condition results in lower blood supply to the fetus, less oxygen and fewer nutrients may be available for optimal fetal development. Eclampsia and HELLP Syndrome are two other pregnancy related blood pressure conditions. Some examples of preeclampsia symptoms may include a headache that will not go away, changes in vision, nausea or vomiting, and swelling of the face or hands. Some have no symptoms, which is why it is important for pregnant women to visit their health care team regularly. Share resources that can help WIC moms understand the importance of early and regular prenatal care and talking with their health care provider about symptoms of preeclampsia and high blood pressure during pregnancy.
While managing preeclampsia is outside WIC's scope, managing high blood pressure that existed before pregnancy includes lifestyle changes consistent with general recommendations for a healthy pregnancy: eating a heart healthy diet, managing stress, and not smoking.
Understanding Preeclampsia and Its Impact
Preeclampsia is a multisystem syndrome of pregnancy. Pre-eclampsia results from placental malperfusion followed by syncytiotrophoblast stress that releases soluble factors into the circulation causing an early imbalance between proangiogenic and antiangiogenic factors. Pathways that influence the development of pre-eclampsia include genetic, epigenetic, lifestyle and environmental factors. However, there is little published information on diet and pre-eclampsia. In this narrative review, we will concentrate on relevant dietary components that interact with lifestyle and environment. We will include factors that affect metabolic function, including weight, weight gain, hypertension, adverse lipid profile, inflammation, dietary patterns and factors that provide endothelial protection. Our investigation will develop a set of nutritional guidelines to reduce the risk of pre-eclampsia in pregnancy, this being of particular importance for those at high risk.
Preeclampsia affects 3%-5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia.
CDC resources for WIC staff to learn and help educate participants on this topic include information about: The types of high blood pressure conditions before, during, and after pregnancy, such as gestational hypertension and preeclampsia; The complications of having high blood pressure during pregnancy; Steps to take before, during, or after pregnancy if high blood pressure is present; and Ways to prevent and manage high blood pressure.
Read also: More on Preeclampsia
The Role of Diet in Managing High Blood Pressure During Pregnancy
High blood pressure during pregnancy is common-in fact, it’s one of the most frequent medical conditions that can occur in pregnant women. Lifestyle, age, and type of pregnancy can cause gestational hypertension. “Being overweight or obese, or not staying active are major risk factors for high blood pressure,” advises Healthline. If you’re a mama who is experiencing high blood pressure during your pregnancy, we’ve created a guide just for you. Inside it, you’ll learn what gestational hypertension is, ways to control it, and which ingredients help reduce high blood pressure.
General Dietary Recommendations
The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25-30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk.
From the latter part of the last century, a range of dietary components was suggested as having the potential to reduce the risk of pre-eclampsia. Since that time, some of those previously identified factors have now been shown to have no effect on risk.
Key Nutrients and Dietary Components
Following a brief review of the literature on diet/nutrients and pre-eclampsia, we decided which diet/nutrients/nutritional supplements to search for in this review. The key factors of interest were maternal weight before and during pregnancy, calcium, vitamin D, selenium, multivitamins/multiminerals, fibre, prebiotics and probiotics and dietary patterns. Dietary factors that were also considered despite a previous lack of evidence included antioxidants, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (LC-PUFAs), zinc, iodine and folate/folic acid. Abstracts and finally articles were reviewed to determine their eligibility for inclusion. They were eligible if they assessed the risk of pre-eclampsia as defined by the ISSHP. Reference lists from selected articles were manually checked to identify further relevant studies. Two hundred and ninety papers were used to compile the review of which 169 have been cited.
Fiber
A 2005 case-control study assessed fibre intake in 172 women with pre-eclampsia and 339 controls using Food Frequency Questionnaires (FFQs). After adjusting for confounders, women in the highest quartile of fibre intake (>24.3 g/day) had a 51% reduced risk of developing pre-eclampsia (OR 0.49, 95% CI 0.24 to 1.00) than women in the lowest quartile of fibre intake (<13.1 g/day). Moreover, use of logistic regression procedures suggested that as total fibre intake increased to around 27-30 g/day, pre-eclampsia risk decreased.
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A 2008 study investigated the fibre intake of 1538 pregnant women living in Washington, referred to above. FFQs were used to assess dietary fibre intake 3 months prior to and during gestation. After adjusting for confounders, the RR of pre-eclampsia for women in the highest (≥21.2 g/day) versus the lowest quartile (<11.9 g/day) of fibre intake was 0.28 (95% CI 0.11 to 0.75). A high-fibre diet is recommended for pregnant women. They should aim for a dietary fibre intake of 25-30 g/day to reduce the risk of pre-eclampsia.
Probiotics
A protective association was seen in the use of milk-based probiotic products on pre-eclampsia risk, including severe pre-eclampsia, especially when consumed during late pregnancy. Pregnant women should therefore aim to incorporate dairy-based probiotics into their diet.
Fruits and Vegetables
Research suggests that diets characterised by higher intakes of fruits and/or vegetables reduce the risk of pre-eclampsia. For example, a Norwegian observational study assessed the diet of 23 000 mothers and found that a diet characterised by higher vegetables, plant foods and vegetable oils was associated with a reduced risk of pre-eclampsia (OR 0.72, 95% CI 0.62 to 0.85). Furthermore, a prospective study of over 30 000 nulliparous women found that intakes of fresh and dried fruits reduced the risk of pre-eclampsia. Consuming ≥330 g/day of fresh fruits was associated with an OR of 0.79 (95% CI 0.67 to 0.93), while consuming ≥4 g/day of dried fruits was associated with an OR of 0.79 (95% CI 0.68 to 0.92).
Omega-3 Fatty Acids
A prospective cohort study in Massachusetts found that women who consumed 100 mg/day of the ω-3 LC-PUFAs, docosahexaenoic acid (DHA) along with eicosapentaenoic acid (EPA), had a non-significant reduction in developing pre-eclampsia: OR 0.84 (95% CI 0.69 to 1.03). The same study found that intake of one portion of fish per day was associated with a non-significant reduction: OR 0.91 (95% CI 0.75 to 1.09).
Vitamin D
There is some controversy about the amount of vitamin D that is necessary for avoidance of deficiency and the required concentration of the serum vitamin D metabolite, 25(OH)D, for adequacy. The interest in vitamin D status in recent years means that a plethora of studies have looked at the effect of vitamin D on pre-eclampsia risk. When considering the evidence outlined, multiple studies suggest that the risk of pre-eclampsia was probably reduced with vitamin D supplementation. Many investigators noted that well-designed clinical trials with vitamin D supplementation are still needed. Vitamin D supplementation in pregnant women is frequently required to achieve sufficient status as recommended by vitamin D guidelines so pregnant women should take a daily vitamin D supplement of 10-25 µg (400-1000 IU) to ensure they are not deficient. This may reduce their risk of pre-eclampsia.
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Calcium
Low calcium intake decreases plasma calcium concentration leading to activation of the renin-angiotensin-aldosterone system (RAAS). Activation of the RAAS stimulates the release of parathyroid hormone and parathyroid hypertensive factor and the release of calcitriol. The evidence suggests that increasing calcium intake in pregnancy may effectively reduce pre-eclampsia incidence, especially among populations at heightened risk. All pregnant women should be supplemented with 1 g calcium per day from 20 weeks’ gestation to delivery.
Selenium
A systematic review and meta-analysis was published in 2016 that looked at 13 studies with 1515 participants. It showed an inverse association of blood selenium level with the risk of pre-eclampsia and that supplementation with selenium significantly reduces the incidence of pre-eclampsia. In a study from the Boston Birth Cohort, 1274 women were followed and levels of selenium and other trace minerals from red blood cells collected within 24-72 hours after delivery were measured. No association was observed between selenium and pre-eclampsia in that cohort, perhaps because American populations are selenium replete. However, the large MoBa study in Norway had a similar finding; maternal selenium concentrations were measured in whole blood collected around gestational week 18 in a subset of 2572 pregnant women.
In a double-blinded, placebo-controlled pilot trial, 230 primiparous pregnant women in Oxford, of relatively low selenium status (median whole-blood selenium 103 (range: 66.3-261.4) µg/L), were randomised to selenium (60 µg/day, as selenium-enriched yeast) or placebo treatment from 12 to 14 weeks of gestation until delivery. The concentration of sFlt-1 was significantly lower at 35 weeks in the selenium-treated group than in the placebo group in participants in the lowest quartile of selenium status at baseline (mean 0.70, 95% CI 0.49 to 0.98, p=0.039) showing that supplementation affected the risk of pre-eclampsia in those of low selenium status. Selenium status was measured in toenail clippings at 16 weeks’ gestation; this is a measure of pre-pregnancy selenium status as the toenails would have been laid down before pregnancy. The disparity in results from the large MoBa cohort study and the UK studies is hard to reconcile. Selenium status at 18 weeks in the MoBa cohort and at 12 weeks in the UK trial was the same; as selenium status falls with gestational week, the MoBa cohort may have had a somewhat higher status than that in the UK.
The median selenium intake in MoBa was 53 µg/day which is close to the recommended intake for pregnant women of 60 μg/day. Intake in the UK was not measured but 2008/2010 data from the UK National Diet and Nutrition rolling programme give a median of 39 µg/day in women of 19-64 years which is considerably lower than that in MoBa. Low selenium status may be a risk for pre-eclampsia in women with low selenium status though the level of status at which the risk increases is unclear.
Vitamin B12
A recent meta-analysis of 19 studies looked at the serum vitamin B12 concentrations of women with pre-eclampsia and found that they were significantly lower than those of healthy pregnant women (mean −15.24 pg/mL, 95% CI −27.52 to −2.954, p<0.015). However, the heterogeneity between the studies was very high (I2=97.8%;…
Other Dietary Factors
Vitamin intake from diet and supplement from previous 4 weeks estimated from 25-week FFQ. Vitamin C was not associated with an increased risk of any type of PE. Vitamin C showed an increased incidence of severe pre-eclampsia, eclampsia and HELLP. No difference in PE risk. A somewhat lower risk of PE was associated with higher intake of the elongated ω-3 fatty acids DHA and EPA (OR 0.84, 95% CI 0.69 to 1.03 per 100 mg/day). ω-3 LC-PUFA supplementation was not associated with maternal blood pressure, infant death, stillbirth or PE risk. There was no association between magnesium supplementation and the risk of perinatal mortality or small for gestational age. RCT.
The Importance of Weight Management
The clearest link between diet and pre-eclampsia is the effect of weight and gestational weight gain (GWG) on risk. Pre-pregnancy body mass index (BMI) is positively associated with the risk of pre-eclampsia. The OR for pre-eclampsia and the percentage of women with pre-eclampsia against maternal pre-pregnancy body mass index (BMI). Values are ORs (95% CIs) on a log scale from multilevel binary logistic regression models that reflect the risk of pregnancy complications per pre-pregnancy BMI group compared with the reference group (largest group, 20.0-22.4 kg/m2). The bars represent the percentage of pre-eclampsia per BMI group. In a population-based retrospective study in Missouri, results showed that women who were superobese with a high rate of GWG were at an increased risk of pre-eclampsia than were normal-weight women (OR 7.52, 95% CI 2.70 to 21.0). The Norwegian Fit for Delivery study examined GWG in 550 pregnant women and explored possible associations with body composition. Women who developed pre-eclampsia gained more weight than women who did not (difference 3.7 kg, p=0.004), with a 3.5 kg difference in total body water observed in week 36. A 1 kg increase in GWG was associated with an adjusted 1.3 times higher odds of pre-eclampsia (OR 1.31, 95% CI 1.15 to 1.49, p<0.001). Independently, fat mass in week 36 was inversely associated with pre-eclampsia (OR 0.79, 95% CI 0.68 to 0.92). The Institute of Medicine defines recommended GWG for pregnant women, stratified by pre-pregnancy BMI (see table 3). Interpregnancy weight gain has also been shown to increase the risk of pre-eclampsia and of recurrent pre-eclampsia; therefore, excessive weight gain during pregnancy and between pregnancies should be avoided. The aim is to maintain a healthy weight prior to conception. However, in women at risk of pre-eclampsia who are overweight and/or obese, dietary interventions to reduce excessive GWG may be beneficial both for the mother and the baby.
Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain.
Dietary Patterns and Approaches
Adherence to the New Nordic Diet (NND) in over 72 000 women from the MoBa study was assessed. High adherence to the NND was defined by various parameters such as eating ≥24 meals per week, eating cabbage at least two times per week and drinking at least six times as much water as sugar-sweetened beverages.
In the ESTEEM (Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes) study, intercity pregnant women in five UK maternity units with metabolic risk factors were randomised to a Mediterranean-style diet (593 women) versus usual care (612 women). Women in the intervention arm consumed more nuts (70.1% vs 22.9%) and extra virgin olive oil (93.2% vs 49.0%) than controls; increased their intake of fish (p<0.001), white meat (p<0.001) and pulses (p=0.05); and reduced their intake of red meat (p<0.001), butter, margarine and cream (p<0.001).
Sample Recipes for a Pregnancy Diet Focused on Managing High Blood Pressure
Looking for pregnancy dessert recipes that will satisfy your sweet cravings? This is for you! While this pregnancy-safe dessert addresses your calcium needs through milk, it also has vitamin C from the blackberries and lemons.
Here are a few recipe ideas focusing on key nutrients:
- Lentil Daal: One of the best things you can do for gestational hypertension is to choose lean proteins. This daal recipe meets this need with lentils! This recipe also calls for tomatoes. Tip: This recipe is freezer-friendly!
- Sweet Potato and Brussels Sprouts with Nuts: The sweet potatoes, brussels sprouts, and nuts make this a potassium-rich meal.
- Halibut Recipe: Your high blood pressure pregnancy diet should include omega-3 fatty acids and vitamin D. Both omega-3 fatty acids and vitamin D play roles in blood pressure regulation. This recipe calls for halibut, a fish that’s high in omega-3 and vitamin D.
- Chicken Fajita Bowl: Chicken is a good source of lean protein as it has less saturated fats compared to red meats. This fajita bowl also calls for brown rice, a whole grain that can help regulate blood sugar levels and boost heart health.
Additional Resources
Examples to share include: Recipes from WIC Meals of the Month and What Do I Do With (the latter is a series featuring recipes highlighting possibly unfamiliar WIC-eligible foods); Tip sheets (offering active play suggestions and daily food checklists for pregnant and breastfeeding moms), and other nutrition education publications you can download; and MyPlate print materials including recipes, food fact cards, posters, games, and coloring sheets. Additionally, find Food Group Quizzes and digital tools like the Start Simple with MyPlate and MyPlate on Alexa apps. Looking for activity resources? BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Department of Agriculture. 2021. FoodData Central. American College of Obstetricians and Gynecologists. 2021. Nutrition During Pregnancy. Mayo Clinic. 2021. Dietary fiber: Essential for a healthy diet. Mayo Clinic. 2019. Nuts and your heart: Eating nuts for heart health. Harvard Medical School. 2016. Is eating dried fruit healthy? National Institutes of Health. 2021. Iron. National Institutes of Health. 2021. Choline. National Institutes of Health. 2021. Folate. National Institutes of Health. 2021. Potassium. National Institutes of Health. 2021. Vitamin B12. National Institutes of Health. 2021. Magnesium. National Institutes of Health. 2021. National Institutes of Health, National Library of Medicine. 2021. Dietary Proteins. Department of Agriculture, MyPlate. 2021. Vegetables. Marangoni F, et al. 2015. Role of poultry meat in a balanced diet aimed at maintaining health and wellbeing: an Italian consensus document. Cleveland Clinic. 2021. The 6 Best Seeds to Eat. Cleveland Clinic. 2021. Does Magnesium Help You Sleep? Harvard Medical School. Undated. Quinoa. Harvard Medical School. Undated. Mushrooms. Mayo Clinic. 2021. Prebiotics, Probiotics and Your Health. Mayo Clinic. 2019. Discover the Health Benefits of Farro. Abu-Raya B, et al. 2020. Maternal Immunological Adaptation During Pregnancy. Haldar S, et al. 2018. Effects of Two Doses of Curry Prepared with Mixed Spices on Postprandial Ghrelin and Subjective Appetite Responses-A Randomized Controlled Crossover Trial. Kwon Y. 2016. Association of curry consumption with blood lipids and glucose levels. Spahn JM, et al. 2019. Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review. Hewlings SJ, et al. 2017. Curcumin: A Review of Its' Effects on Human Health. Hamed M, et al. 2019. Capsaicinoids, Polyphenols and Antioxidant Activities of Capsicum annuum: Comparative Study of the Effect of Ripening Stage and Cooking Methods. Sebastiani T, et al. 2019. The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Bjerregaard AA, et al. 2019. Mother's dietary quality during pregnancy and offspring's dietary quality in adolescence: Follow-up from a national birth cohort study of 19,582 mother-offspring pairs. Murphy M, et al. 2014. Associations of consumption of fruits and vegetables during pregnancy with infant birth weight or small for gestational age births: a systematic review of the literature. Lönnerdal B. 2009. Soybean ferritin: implications for iron status of vegetarians. Cleveland Clinic. 2013. Soy Foods. Cleveland Clinic. 2020. Is Red Meat Bad for You? Mayo Clinic. 2019. Iron deficiency anemia during pregnancy: Prevention tips. Dreher ML, et al. 2013. Hass Avocado Composition and Potential Health Effects. Maia SB, et al. 2019. Vitamin A and Pregnancy: A Narrative Review. National Institutes of Health. 2021. Vitamin E.
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