Tuesday, May 1, 2012

Preeclampsia: You Might Get It, You Can't Cure It

It's Preeclampsia Awareness Month! Yay!  Before I got preeclampsia, I had no idea that there was such a month, and therein lies a serious problem with issue months-the only people who care are those who have already "been touched" by the disease.  But, in any case, this is my combination PSA and rant.

The Preeclampsia Foundation (a group of smart women with good information) tells us that the risk factors for preeclampsia are as follows:

  • Previous history of preeclampsia
  • Multiple gestation (i.e., pregnant with more than one baby)
  • History of chronic high blood pressure, diabetes, kidney disease or organ transplant
  • First pregnancy
  • Obesity, particularly with Body Mass Index (BMI) of 30 or greater. Calculate your BMI here.
  • Over 40 or under 18 years of age
  • Family history of preeclampsia (i.e., a mother, sister, grandmother or aunt had the disorder)
  • Polycystic ovarian syndrome
  • Lupus or other autoimmune disorders, including rheumatoid arthritis, sarcoidosis and multiple sclerosis
  • In-vitro fertilization
  • Sickle cell disease

  • Of these risk factors, I had exactly one: it was my first pregnancy.  I developed preeclampsia sometime between week 23 and 27, went into the hospital on bedrest at week 27, and then delivered at week 29 with a diagnosis of severe preeclampsia.

    When I got the call to head to the hospital immediately, I was feeling fine-a little tired, but normal for the third trimester.  I had no headaches, no rib or shoulder pain, no swelling, and no visual disturbances.  My only symptoms were silent ones-blood pressure of 160/100 and elevated liver enzymes.

    There are a variety of current theories about preeclampsia.  This article from the New Yorker "The Preeclampsia Puzzle" discusses some of the theories, as well as some of the problems involved in trying to conduct medical research about pregnant women.

    What I took away from my experience with preeclampsia: 1) Generalized risk doesn't matter as much as  what actually happens to you.  In my case, knowing that I was statistically unlikely to develop preeclampsia made me less willing to acknowledge the seriousness of my rising blood pressure.  2) Keep a close eye on your blood pressure in pregnancy and don't be embarrassed to call your care provider if you feel off.  Many of the symptoms of preeclampsia are also normal pregnancy symptoms, but the good news is that the tests for preeclampsia (blood pressure checks, 24hr urine collection, and pre-e bloodwork) are relatively cheap, easy, and non-invasive.  When in doubt, get checked out!

    And now the rant....

    If you are a health food eating, healthy living, natural birthing type pregnant woman with signs of preeclampsia, you have probably come across online advice about nutritional therapy for preeclampsia. This advice comes in a few flavors, preeclampsia only happens to poor women who don't eat well (and we feel bad for them), you got preeclampsia because you ate white bread and fried chicken (and if you say you didn't you're a liar), and no one who follows the Brewer's diet will get preeclampsia.  Some natural birthers do disagree with these ideas, but dietary solutions to preeclampsia seem pretty widely accepted, particularly by those affiliated with the Bradley Method.

    This advice is based on the research of Dr. Tom Brewer who experimented with nutritional therapy for malnourished pregnant women.  When his book came out in 1967 it was very poorly received.  But even the fact that the Brewer's diet is old hack research wouldn't necessarily lead me to dismiss it.  Sometimes you have the right solution at the wrong historical moment.  For example, the Ketogenic Diet was used to treat epilepsy in the 1920s, then it fell out of favor, and now it is back.  But those who promote the Ketogenic diet do not suggest that it can be used successfully for all people with epilepsy, and it is really the 100% cure absolutism of the Brewer's Diet folks that drives me crazy.  To me someone who says they have a 100% cure for preeclampsia is the same as someone who says they have a 100% cure for cancer-he or she is a person with some snake oil to sell you.

    And really, if preeclampsia was all about nutrition, wouldn't having an eating disorder prior to or during pregnancy, or having hyperemesis be major risk factors for developing pre-e?

    And below is a couple days of Mary's Diet to Promote Early and Severe Preeclampsia (from my pregnancy food diary).  Interestingly I ate a ton of calories, but gained very little weight.  I was also taking a prenatal, vitamin B, and fish oil with vitamin D.

    B. hardboiled egg, 1 slice Ezekiel, 1 orange
    S. hardboiled egg, almonds
    L. hummus and cheese on Ezekiel, yogurt, carrots
    S. steamed whole milk, almonds
    D. meat and bean chili (homemade) on baked potato, sour cream, broccoli, melon, pint of whole milk, homemade ice cream
    S. Cheerios with whole milk

    B. oatmeal with whole milk
    S. hardboiled egg, berries and melon
    L. hummus and cheese on Ezekiel, orange, salad
    S. hardboiled egg, cheese and wasabread
    D. chicken, tomatoes, collard greens in homemade cream sauce on pasta, pint of whole milk, berries
    S.Cheerios with whole milk

    My other preeclampsia posts are here and here.

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