Preeclampsia and pregnancy: 3 things you should know

There are three important things you should know about pregnancy and preeclampsia:

1. 5% of all pregnancies and 11% of first pregnancies are complicated by preeclampsia.
2. Preeclampsia is a major cause of death and complication for both mothers and babies.
3. In patients at risk for preeclampsia, nutritional supplementation has been shown to significantly reduce the incidence of preeclampsia.

What is preeclampsia?

Preeclampsia is a complication in pregnancy often referred to as toxemia. Preeclampsia can result in severe and even fatal problems for both mother and baby. The exact cause of preeclampsia is not well defined but thought to originate in the blood vessels that nourish the placenta. Researchers believe that these blood vessels have an abnormal development and may be narrower. This can lead to restricted blood flow resulting in elevated blood pressure.

While the causes of preeclampsia are unclear, the complications impact thousands of pregnancies in the U.S. every year. And the rates have steadily risen over the last 30 years. A recent study by Columbia University Medical Center examined 120 million births in the U.S. between 1980 and 2010. The findings showed that the “relative rate of severe pre-eclampsia rose by 322%, from 0.3% in 1980 to 1.4% in 2010.” Women born more recently showed an increased risk of severe preeclampsia over women born around the 1970s¹. This trend is concerning. Yet aside from diagnosis and treatment, little is done to prevent this condition.

The role of calcium

Studies have shown that taking 1,000mg of calcium per day can drastically reduce the rates preeclampsia. In fact, a recent study showed a 50% reduction in the rate of preeclampsia with appropriate calcium supplementation². There were no additional risks associated with taking the extra calcium. In fact, the WHO (World Health Organization) has recommended calcium supplementation in patients who live in areas of low calcium intake or are at risk of developing preeclampsia. This includes one or more of the following risk factors:

• obesity,
• first pregnancy,
• previous preeclampsia,
• chronic hypertension,
• diabetes,
• advanced maternal age (older than 35 years.),
• adolescent pregnancy,
• renal disease,
• autoimmune disease, and/or
• multiple gestations (twins or triplets)³.

Given this information, you would think most prenatal vitamins would contain at least 1000mg of calcium—given the risks posed by preeclampsia. Yet, most available prenatal vitamins on the market only contain between 250-300mg of calcium.

This contradiction illustrates a common problem in medicine. There is a vast amount of research that struggles to make its way into clinical application. Many OBGYN’s are familiar with this data and are aware of the potential benefits of taking 1000mg of calcium a day. However, few OBGYN’s recommend anything beyond a traditional prenatal vitamin.

What you can do

Why is this?  Why not recommend taking a sufficient amount of calcium? It’s not that this represents a lack of concern by doctors or a lack of education. In general, physicians are so overwhelmed with everyday demands of practicing medicine. Often, there is little room for innovation or new thought, and small things fall through the cracks. Valuable new information accumulates and languishes while we attempt to keep up with patient care.

As a physician, I understand the daily pressures that shape the practice of medicine. I have come to realize that patients must have a voice in their own health care and must advocate for their best interests. The risks posed by preeclampsia are great. Yet, there is an opportunity for mothers to protect themselves and their babies. Stay informed!

There are many ways you can feel safe during your pregnancy. You can:

• read up on the science.
• research risks surrounding certain conditions and deficiencies.
• choose supplement products that contain enough of the essential nutrients, such as calcium.
• always check with your doctor. You never know the insights or knowledge your doctor might have. Don’t hesitate to ask!

One final word of caution; the Internet is a great tool, giving us vast information at our fingertips. Most of this information is helpful. However, there is also a large amount of useless or even harmful information. Be selective in the sites you use. Try and stick with sites that have a good reputation. Your doctor can give you some ideas of sites to trust.

The application of nutritional science has been available for years. Only trust supplements that are designed to provide you with all the vitamins, minerals, and nutrients needed to:

• to support healthy gestation,
• reduce the risk of preeclampsia, and
• prepare you for the physiologic stress of delivery.

Some aspects of pregnancy and delivery are out of your control. However, you can control what you put in your body. If you provide your body with the needed nutrition, you can feel more confident and in control during your pregnancy.

Jefforey R. Thorpe, MD

 
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Ananth Cande V, Keyes Katherine M, Wapner Ronald J. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis BMJ 2013; 347:f6564

Hofmeyer GJ et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. The Cochrane Library 2014, Issue 6. 

World Health Organization Guidance Summary ‘Calcium supplementation during pregnancy for the prevention of pre-eclampsia’ May 2016 http://www.who.int/elena/titles/calcium_pregnancy/en/