Pre-Eclampsia - Natural Treatments

Pre-eclampsia is a potentially life-threatening condition that occurs after 20 weeks gestation which is during the third trimester of pregnancy.^[1] There are two subtypes: early-onset pre-eclampsia occurs prior to 34 weeks gestation, whereas late-onset occurs after the 34th week.^[2] This condition can also occur days following delivery.^[3] Although uncommon, pre-eclampsia does occur in approximately 5–7% of all pregnant women, and medical attention should be taken immediately as the condition is serious enough to threaten the mother’s life and damage the fetus. If pre-eclampsia is not properly managed, it has the potential to progress to eclampsia. Eclampsia is more dangerous than pre-eclampsia; statistics show that eclampsia occurs in 3% of cases. According to the World Health Organization (WHO), approximately 100,000 women die annually from pre-eclampsia and its complications.^[4] It is presently the leading cause of maternal and fetal mortality and morbidity worldwide.^[2]

Causes

The definitive underlying cause of pre-eclampsia is not known at this time. However, there are multiple factors which do play a role in its pathogenesis: a history of insulin resistance; being overweight; lack of exercise; excess intake of sugars and high-glycemic foods; increased free-radical production; decreased antioxidant levels; increased homocysteine levels; poor blood flow to the placenta and other organs (leading to blood vessel constriction); nutritional deficiencies (particularly calcium, magnesium, omega-3 fatty acids, arginine, and protein); as well as emotional stress and dominance of the sympathetic nervous system.^[3] Several risk factors put one at increased risk of developing pre-eclampsia: those with a previous or family history of pre-eclampsia; women younger than 20 or older than 35 years of age; nulliparous women; and multiple pregnancies. In addition, those individuals with high blood pressure before or during pregnancy, and with diabetes or a strong family history of it, have an increased likelihood of developing pre-eclampsia.^[3] Some sources theorize that an imbalance between thromboxane A2 (vasoconstrictor and platelet aggregator) and prostacyclin (vasodilator) may exist in pre-eclampsia patients. Another theory is that of abnormal trophoblastic invasion of spiral arteries,^[5] resulting in a lack of oxygen being delivered to the placenta and fetus, and subsequently endothelial injury occurs, which is responsible for the symptom manifestation of pre-eclampsia.^[6] Therefore, pre-eclampsia manifests as an abnormal vascular response to placenta formation. It is characterized by an increase in systemic vascular resistance, an increase in platelet activation, activation of the coagulation system, and endothelial cell dysfunction.^[4] Endothelial cell dysfunction is responsible for the inflammation seen in pre-eclampsia. The inflammatory response is thought to cause symptoms of hypertension and proteinuria.^[2] Pre-eclampsia has long been considered an immune-mediated syndrome, as pre-eclamptic women show high levels of inflammatory cytokines and auto-antibodies in circulation.^[7]

Prevention

Pre-eclampsia results from a state of malnutrition during pregnancy. It can be prevented by making dietary and lifestyle modifications. It is recommended that women who plan on conceiving, or who have conceived, eat foods high in calcium and consume 60 to 80 g of protein daily.^[1] Protein sources should include nuts, seeds, beans, tofu, organic chicken, and eggs. Avoid saturated and trans fats as well as vegetable oils (which are high in inflammatory omega-6 fatty acids). Women are encouraged to consume complex carbohydrates including whole grains, beans, and vegetables. Foods high in magnesium (tofu, soybeans, almonds, Swiss chard, brown rice, banana, and avocado to name a few) are recommended for a healthy blood pressure. Also, increase intake of fruits and vegetables to increase antioxidant levels and offset free-radical production.^[3] Salt intake should not be limited, and adequate caloric intakes prior to and throughout pregnancy are recommended for a safe and healthy delivery. Food sources high in potassium are also effective: avocados, sweet potatoes, and bananas are only a few.^[1] General consensus is focusing on nutritional education as a preventative measure.^[8] Stress reduction techniques are also beneficial for blood pressure and help the body shift to a parasympathetic state: try yoga, meditation, or deep-breathing exercises. Stress reduction techniques should be used in conjunction with other interventions for best results (see Natural Treatments section for more details).^[1]

Diagnosis

Pre-eclampsia is diagnosed when a specific set of symptoms present themselves in the later stages of pregnancy. In order to make an accurate diagnosis, the following symptoms must be present: new-onset hypertension (high blood pressure readings above 140/90 mmHg); swelling/edema (water retention that is usually seen in or around the face and in the extremities); and protein in the urine (significantly high levels of protein: greater than 3 g of protein in 24 h).^[1] Severe pre-eclampsia can be diagnosed if any of the following symptoms are present: hypertension (greater than 160/110 mmHg); protein in the urine (less than 5 g in a 24 h urine collection); oliguria (excessive urination greater than 400 ml in 24 h); cerebral or visual disturbances; epigastric pain (in the right upper quadrant of the abdomen); pulmonary edema (fluid in the lungs); thrombocytopenia (low platelet count); liver dysfunction; or severe intrauterine growth restriction.^[5] Eclampsia patients may present primarily with seizures, altered mental status,^[4] blurred vision, headaches, liver damage, breakdown of red blood cells, and low platelets.^[3] Skilled professionals are required to help manage pre-eclampsia and eclampsia. Women with mild pre-eclampsia are prescribed bed rest, and are monitored every couple of days. If the condition appears to be worsening, an emergency Caesarean section is performed.^[3] Presently, delivery of the placenta is the only cure for the disease.^[2]

Natural Treatments

Folic Acid, Vitamin B6, and Vitamin B12 — Homocysteine levels may be higher in women who have pre-eclampsia. Homocysteine is known to cause inflammation in the blood vessels and is correlated with heart attacks and strokes. Folic acid (2 mg), and vitamins B6 (100 mg) and B12 (800 mcg) are known to lower blood homocysteine levels.^[3]

Vitamin C and Vitamin E — Free radical production is high in women with pre-eclampsia. Vitamins C (1000 mg) and E (400 IU) are antioxidants that can help offset and decrease free radical production in the body.^[3] beta-Carotene, beta-cryptoxanthin, lutein, and zeaxanthin are additional antioxidants that can help reduce the risk of pre-eclampsia.^[9]

Fish Oil — Inflammation, hypertension, and a reduction in placenta blood flow are all common in pre-eclampsia. Fish oil (3000 mg) has anti-inflammatory properties and is also good at improving placental blood flow and hypertension through its vasodilating properties.

Calcium and Magnesium — An overactive sympathetic nervous system may be a causative factor in this condition. Calcium (1200 mg) and magnesium (600 mg) activate the parasympathetic nervous system and also help to reduce blood pressure.

Selenium — Oxidative stress is a common predisposing factor to numerous pathologies. Selenium (200 mcg) is known to help decrease oxidative stress, and thus may help with symptom management.

Chromium and alpha-Lipoic Acid — Insulin resistance is a risk factor for pre-eclampsia. Chromium (400 mcg) and alpha-lipoic acid (200 mg) are known to help regulate blood sugar levels.

l-Arginine — Hypertension can cause long-term problems if not treated quickly, especially to the blood vessels. l-Arginine (3000 mg) may help protect the endothelium of blood vessels and decrease blood viscosity.^[3]

Brief Overview of Pharmaceuticals

Aspirin (at a low dose) is known to be an effective preventive measure for women at high risk of developing pre-eclampsia.^[9]

Magnesium sulphate is the anticonvulsant of choice for treating eclampsia. It has been shown to reduce the risk of future seizures and is more effective than other anticonvulsive agents such as diazepam and phenytoin. This treatment is also safer for baby, but is not without risk.^[7]

Methyldopa is the drug of choice for mild-to-moderate hypertension; however, it may cause drowsiness. Alternative choices include labetalol and calcium-channel blockers. Avoid atenolol, angiotensin-converting enzyme inhibitors, and angiotensin receptor antagonists, as these are contraindicated in pregnancy.^[7]

Make sure to consult with a medical doctor prior to taking any medication.

Conclusion

Pre-eclampsia is a condition that has life-threatening consequences if not treated immediately. If you are a pregnant woman experiencing symptoms of pre-eclampsia, it is important to seek medical attention. Although the cause remains unknown, advancements in research are being made, and several theories exist for the cause of the condition. It is thought that endothelial cell dysfunction and inflammation are ultimately responsible for symptom manifestation. Dietary and lifestyle modifications made prior to and following conception may reduce the likelihood of developing pre-eclampsia and eclampsia. Several natural therapies exist which may help with symptom management, although there is currently no cure for the condition besides delivery of the placenta. Pharmaceuticals may be prescribed by a medical doctor for symptom management. Remember to consult with a health-care professional before taking any supplements or medication.