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Pregnancy-Induced Hypertension (PIH)

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About BPLog -Your Free Personal Blood Pressure Log.  I like this logging software for those who are monitoring their BP at home.

About Pregnancy-Induced Hypertension (PIH) aka Pre-Eclampsia aka Toxemia aka Metabolic Toxemia of Late Pregnancy (MTLP)

Variants in the fetal genome near FLT1 are associated with risk of preeclampsia.

McGinnis R, Steinthorsdottir V, Williams NO, et al
Nat Genet. 2017 Jun 19. doi: 10.1038/ng.3895. [Epub ahead of print]

Preeclampsia, which affects approximately 5% of pregnancies, is a leading cause of maternal and perinatal death. The causes of preeclampsia remain unclear, but there is evidence for inherited susceptibility. Genome-wide association studies (GWAS) have not identified maternal sequence variants of genome-wide significance that replicate in independent data sets. We report the first GWAS of offspring from preeclamptic pregnancies and discovery of the first genome-wide significant susceptibility locus (rs4769613; P = 5.4 × 10-11) in 4,380 cases and 310,238 controls. This locus is near the FLT1 gene encoding Fms-like tyrosine kinase 1, providing biological support, as a placental isoform of this protein (sFlt-1) is implicated in the pathology of preeclampsia. The association was strongest in offspring from pregnancies in which preeclampsia developed during late gestation and offspring birth weights exceeded the tenth centile. An additional nearby variant, rs12050029, associated with preeclampsia independently of rs4769613. The newly discovered locus may enhance understanding of the pathophysiology of preeclampsia and its subtypes.

How a cheap, simple test could stop a pregnancy killer - [8/21/14] Pre-eclampsia is a common and deadly complication of pregnancy worldwide, but that may be about to change. . . .

"The urine test doctors currently use simply looks for the presence of protein, Rood says, which can be caused by many things: a urinary tract infection, diabetes, kidney disease or pre-eclampsia. The protein misfolding discovery has led to the development of a new test—the paper-based Congo red dot urine test, which identifies pre-eclampsia specifically. “You mix the dye and urine together and put a drop on a piece of paper,” says Rood. “If the patient has pre-eclampsia, Congo red attaches to the proteins, and a large red dot appears.” Not only is the test extremely simple, she adds, it’s “very cheap,” costing less than two cents per test. That makes it ideal for developing countries, and that’s where Rood and her team will deploy it.

In mid-August, a clinical trial will begin at Ohio State. Not long after, trials of the new urine test will follow in Bangladesh, Mexico and South Africa. (The project is funded under the Saving Lives at Birth program, of which the government-funded Grand Challenges Canada is a partner.) “This test could have a huge global impact, especially in lower-resource countries,” says Rood, who’s overseeing the trials. Meanwhile, Buhimschi’s discovery raises questions for future research, including how a pre-eclampsia diagnosis might affect women in years or decades to come. “Are they more susceptible to the protein misfolding diseases of old age, or are they protected against them?” Buhimschi wonders. “We need to study this.

Gene Variants for Preeclampsia Identified [3/23/11]

Preeclampsia [9/16/13] from Medscape

Hypertensive Disorders of Pregnancy - from the UK, a look look at the midwife’s role in caring for women with hypertensive disorders of pregnancy

Low Carbs Cut Diabetes Inflammation by David Mendosa Health Guide June 05, 2014 - Let's face it - pre-eclampsia isn't well understood.  Many people say that inflammation plays a role.  It makes sense to try a low-carb diet for a week to see if that reduces blood pressure and other metabolic markers.

Pre-eclampsia - from the CAM Newsletter, Feb. 2011 - This is a great update.  Compiled by Tenaya Jackman from the sources listed

Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. [full text]
Hernández-Díaz S, Toh S, Cnattingius S.
BMJ. 2009 Jun 18;338:b2255. doi: 10.1136/bmj.b2255.

Conclusions: Having pre-eclampsia in one pregnancy is a poor predictor of subsequent pregnancy but a strong predictor for recurrence of pre-eclampsia in future gestations. The lower overall risk of pre-eclampsia among parous women was not explained by fewer conceptions among women who had had pre-eclampsia in a previous gestation. Early onset pre-eclampsia might be associated with a reduced likelihood of a future pregnancy and with more recurrences than late onset pre-eclampsia when there are further pregnancies. Findings are consistent with the existence of two distinct conditions: a severe recurrent early onset type affected by chronic factors, genetic or environmental, and a milder sporadic form affected by transient factors.

Ed: In simpler language:  Yes, pre-eclampsia is more common in first pregnancies, BUT this may be because many women who develop severe pre-eclampsia in a first pregnancy never get pregnant again.  The rate of pre-eclampsia in non-first pregnancies was around 1% for women without a history of pre-eclampsia but 14.7% in the second pregnancy for women who had had pre-eclampsia in their first pregnancy.

Brief overview of maternal triglycerides as a risk factor for pre-eclampsia.
Ray JG, Diamond P, Singh G, Bell CM.
BJOG. 2006 Apr;113(4):379-86.

AUTHOR'S CONCLUSIONS: There exists a consistent positive association between elevated maternal TG and the risk of pre-eclampsia. Given that maternal hypertriglyceridemia is a common feature of the metabolic syndrome, interventional studies are needed to determine whether pre-pregnancy weight reduction and dietary modification can lower the risk of pre-eclampsia.

Poor Pregnancy Outcomes Linked To Increased Uric Acid

Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension.
 Roberts JM, Bodnar LM, Lain KY, Hubel CA, Markovic N, Ness RB, Powers RW.
Hypertension. 2005 Dec;46(6):1263-9. Epub 2005 Oct 24.

Women with only hypertension and hyperuricemia have similar or greater risk as women with only hypertension and proteinuria.

Preeclampsia as a Maternal-Fetal Conflict by Michel Odent, MD

Regular Consumption of Cola May Be Linked to Hypertension in Women CME - 11/8/05 [Medscape registration is free]

Pregnancy Induced Hypertension – A Case Summary By: Lisa Murray-Doran B.Sc., N.D.

Paternal role in pre-eclampsia etiology confirmed - A study of Norwegian birth registry data has confirmed that fetal genes from both the mother and father, as well as maternal genes, contribute to the risk of pre-eclampsia.

Recurrence of pre-eclampsia across generations: exploring fetal and maternal genetic components in a population based cohort
Skjaerven R, Vatten LJ, Wilcox AJ, Ronning T, Irgens LM, Lie RT.
BMJ. 2005 Sep 16; [Epub ahead of print]

CONCLUSIONS: Maternal genes and fetal genes from either the mother or father may trigger pre-eclampsia. The maternal association is stronger than the fetal association. The familial association predicts more severe pre-eclampsia.

vitaminshoppe.com has surprisingly good resources about Pregnancy-Induced Hypertension and Nonproteinuric PIH

Clue to pregnancy disorder found [10/11/04] Scientists believe they are closer to understanding why a condition that can threaten pregnancy occurs.

MTLP or Preeclampsia - Here's a great handout for parents from  the Perinatal Education Associates, Inc. except that they're still using the OLD definition of PIH as being relative to baseline values, i.e. rise in diastolic blood pressure of at least 15 mm Hg or in systolic blood pressure of 30 mm Hg.  It should be defined as a sustained blood pressure to levels of 140 mmHg systolic or 90 mm Hg diastolic.

Circadian Blood Pressure Variability as a Function of Parity in Normotensive Pregnant Women [Medscape]

According to ACOG technical bulletin (Number 219 January 1996), hypertension is defined as a sustained blood pressure to levels of 140 mmHg systolic or 90 mm Hg diastolic. The concept of increase in blood pressure of 30 mm Hg systolic or 15 mm Hg diastolic from second trimester values as diagnostic is no longer considered valid.

Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.
Helewa ME, Burrows RF, Smith J, Williams K, Brain P, Rabkin SW
CMAJ 1997 Sep 15;157(6):715-25

This is also the definition used by ACOG.

Here's the old information for comparison - OBGYN.net - Definitions of Preeclampsia

Preeclampsia and Eclampsia Revisited - (12/16/2003) [Medscape registration is free.]

Pregnancy Woe Uncovered: Protein may underlie preeclampsia (March 8, 2003)

" Many of the symptoms of preeclampsia, a major cause of maternal death and premature birth worldwide, stem from a single protein, researchers have found. The discovery could lead to new ways of detecting and treating the disease.

Paternal Genetic Polymorphism Contributes to Pre-Eclampsia Risk (J Med Genet 2002;39:44-45. ) [medscape registration is free]

Hypothesis: Preeclampsia as a Maternal-Fetal Conflict [Medscape registration is free]

Theoretically, the most direct way to prevent preeclampsia would be to consume sea fish that is rich in n-3 polyunsaturates and also in minerals that are essential nutrients for the brain (eg, iodine, selenium, and zinc).

Hormones Involved in Preeclampsia Shed Light on High Blood Pressure [Medscape registration is free]

Issue 143 Fruit, vegetables and blood pressure
Arbor Clinical Nutrition Updates 2002 (Dec);143:1-2 ISSN 1446-5450
It is feasible to increase people’s fruit and vegetable intake with a relatively simple intervention in a general practice setting.
This will increase antioxidant levels and may reduce blood pressure.
[Editor's Note - some of my clients do well with compressed Wheat Grass tablets.]

Summary of Pre-Eclampsia Issues

Eclampsia in the Real Organism: A Paradigm of General Distress Applicable in Infants, Adults, Etc. from RayPeat.com

Causes of PIH and Prevention

Pre-eclampsia is a set of symptoms associated with pregnancy that includes high blood pressure and increased protein in the urine, and which can eventually be harmful to both mother and child.

Pregnant females who had a previous history of developing pre-eclampsia during past pregnancies, and who were supplemented with a combination of L-arginine and antioxidants, demonstrated a significantly decreased risk of developing pre-eclampsia during their current pregnancy.

In the body, arginine is instrumental in the formation of nitric oxide. One function of nitric oxide is as a blood vessel dilator, meaning it can help decrease blood pressure.

Effect of supplementation during pregnancy with L-arginine and antioxidant vitamins in medical food on pre-eclampsia in high risk population: randomised controlled trial
Vadillo-Ortega F, Perichart-Perera O, Espino S, Avila-Vergara MA, Ibarra I, Ahued R, Godines M, Parry S, Macones G, Strauss JF.
BMJ. 2011 May 19;342:d2901. doi: 10.1136/bmj.d2901.


Supplementation during pregnancy with a medical food containing L-arginine and antioxidant vitamins reduced the incidence of pre-eclampsia in a population at high risk of the condition. Antioxidant vitamins alone did not have a protective effect for prevention of pre-eclampsia.

Quercetin Lowers Blood Pressure [7/26/16] - Quercetin supplementation is associated with small declines in systolic and diastolic blood pressure.

Quercetin is a bioflavonoid. Really, vitamin C w/bioflavonoids is so helpful to so many aspects of health for all people and especially pregnant women that it seems like an excellent, inexpensive health insurance.  It helps to make all your tissues stronger and more elastic, which is probably how it helps with blood pressure, by making the blood vessels more elastic.  It also helps prevent constipation and hemorrhoids, make the amniotic sac stronger, help the perineal tissues to be stronger to prevent tearing, and build a baby with stronger tissues.  What's not to like about it?

For any clients having blood pressure issues, it makes sense to look at their glucose levels, since elevated glucose can cause inflammation.  Home testing with an accurate glucometer, backed up with a fasting draw at the lab to compare with the glucometer, is more useful than a GTT or GD screen.

It also makes sense to do some DNA testing to look at all the methylation-related genes.  I like 23AndMe and then geneticgenie.org to get their methylation report.  For women with methylation issues, lack of proper bioactive vitamins can increase inflammation and related issues.

Stretching Exercises May Reduce Risk Of Pre-eclampsia During Pregnancy

A comparison of walking versus stretching exercises to reduce the incidence of preeclampsia: a randomized clinical trial.
Yeo S, Davidge S, Ronis DL, Antonakos CL, Hayashi R, O'Leary S.
Hypertens Pregnancy. 2008;27(2):113-30.

Low levels of omega-3s associated with preeclampsia
Williams MA, Zingheim RW, King IB, Zebelman AM; Omega-3 fatty acids in maternal erythrocytes and risk of preeclampsia; Epidemiology 1995;6(3):232-237.

After adjusting for confounders, women with the lowest levels of omega-3 fatty acids were 7.6 times more likely to have had their pregnancies complicated by preeclampsia as compared with those women with the highest levels of omega-3 fatty acids (95% CI = 1.4-40.6).

Periconceptual multivitamin use reduces the risk for preeclampsia, particularly in lean women - CME

The Role of Regular Physical Activity in Preeclampsia Prevention [01/04/2005 - Medscape registration is free]

Hypothesis: Preeclampsia as a Maternal-Fetal Conflict
Michel Odent, MD
APPPAH Journal : 20 (4). Summer Issue

ABSTRACT: The association of preeclampsia with both high and low birth weight challenges the current belief that reduced uteroplacental perfusion is the unique pathophysiologic process in preeclampsia. Preeclampsia is thus presented from a new perspective, in the framework of maternal/fetal conflict. Interspecies comparisons encourage us to raise new questions concerning the potential for conflict among humans. The spectacular brain growth spurt during the second half of fetal life is a specifically human trait. A conflict between the demands expressed by the fetus and what the mother can do without depleting her body leads us to consider first the needs of the developing brain.

It's possible that an overly acidic system may contribute to the problem.

Acid-alkaline balance: role in chronic disease and detoxification.
Minich DM, Bland JS.
Altern Ther Health Med. 2007 Jul-Aug;13(4):62-5.

In conclusion, the increasing dietary acid load in the contemporary diet can lead to a disruption in acid-alkaline homeostasis in various body compartments and eventually result in chronic disease through repeated borrowing of the body's alkaline reserves. Adjustment of tissue alkalinity, particularly within the kidney proximal tubules, can lead to the more effective excretion of toxins from the body. Metabolic detoxification using a high vegetable diet in conjunction with supplementation of an effective alkalizing compound, such as potassium citrate, may shift the body's reserves to become more alkaline.

Long-term persistence of the urine calcium-lowering effect of potassium bicarbonate in postmenopausal women.
Frassetto L, Morris RC Jr, Sebastian A.
J Clin Endocrinol Metab. 2005 Feb;90(2):831-4.

Potassium bicarbonate (KBC) potently reduces urine calcium excretion in adult humans, including patients with hypertension or calcium urolithiasis, and postmenopausal women.

My recommendation would be to increase fluids as well as protein (110-115 grams

Remember back to basic biology class where the cell membranes are composed of protein molecules which govern the passage of fluid into and out of each cell.  Blood vessel walls are particularly sensitive to this lack of protein.  As the protein is needed in third trimester for the needs of the fetus, protein molecules are robbed from wherever they are most available. Unfortunately, in a protein deficient diet, the likely source of protein will be the blood vessel walls, leaving them with the appearance of swiss cheese.  The fluid "leaks" out due to the lack of sufficient protein molecules, dropping the blood pressure inside the blood vessel and causing edema.  The heart senses the drop in pressure and increases the pressure to compensate.  This causes increased pressure in the kidneys which can further reduce the protein absorption necessary to the fetus, and feed this vicious cycle. Also causes increased pressure across the placenta, which lowers the amounts of nutrients available to the fetus (hence the connection with PIH and IUGR).

So, logically, one would increase dietary protein, and allow sufficient water to ease the strain on the kidneys and allow protein re-absorption into the general blood flow.  But not to overload the kidneys with excess fluid, which dulls the appetite.

I have cared for many women with pre-existing PIH, and some with a history prior pregnancies with full blown pre-eclampsia.  With dietary and fluid adjustments, they all safely delivered at home, and did well, without any reoccurrence of blood pressure or kidney problems.

Herbal Allies for Pregnancy by Linda Woolven from Mothering Magazine - has a section on Preeclampsia.

Maternal periodontal disease is associated with an increased risk for preeclampsia.
Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S.
Obstet Gynecol 2003 Feb;101(2):227-31

"[A]ctive maternal periodontal disease during pregnancy is associated with an increased risk for the development of preeclampsia."

It's not at all clear whether this is a causative relationship, but if I were developing PIH and also noticed increasing gum problems, I'd certainly want to start treating the gum problems.  Increased dental hygiene could include more diligent brushing, flossing and use of herbal or chemical oral disinfectants.  You could use an echinacea mouthwash or use tea tree oil on your gumline after brushing.  Also, herbal and vitamin immune support would also seem sensible.

Placental Defect May Cause PIH/Eclampsia

Stress increases pregnancy risks.

The following article cites the critical time when interventions to decrease stress should be implemented. One positive approach would be the use of hypnotherapy techniques and/or relaxation techniques, started early on in pregnancy. One problem is many of these folks aren't interested in these techniques. Glad to see more research to support the things I've believed for years.

(Reuters) Two studies shown high-stress occupations triple the risk of pregnancy-induced hypertension, and high levels of personal stress in pregnant women double the risk of premature birth. Drs. Landsbergis and Hatch say pregnancy-induced hypertension occurred independently of a number of factors, including parity, amount of physical work involved in the job and total hours of paid work. "In particular, was associated with low decision latitude and low job complexity among women in lower-status jobs," the Cornell researchers report. In a study conducted by researchers at Aarhus University in Copenhagen Dr. Morten Hedegaard and others report that: "Women who had one or more highly stressful life events had a risk of preterm delivery 1.76 times greater than those without stressful events... was observed primarily with events experienced between the 16th and 30th week of gestation." Epidemiology 1996:7:339-345, 346-351.

Underlying Disease

Pre-eclampsia which recurs or which arises in a subsequent pregnancy without occurring first time round is more commonly associated with underlying disease - renal, essential hypertension, auto-immune, thrombogenic disorders. There may be a case for screening these women for auto-immune and thrombogenic diseases after pregnancy ( > 6 weeks post- partum ), especially if they're planning another - if positive low-dose aspirin, steroids or heparin may have a role, not to mention preventive measures for general health. 

Semen May Prevent Pre-Eclampsia

Another study referred to ( referenced elsewhere in this thread ) showed ( as I recall ) pre-eclampsia to be more common in short duration relationships than in longer one's in multips also. A number of studies have shown PE to be more common in multips with new partners than women sticking with the same partner.

In regards to a recent post that mentioned research published in the last year about immunological intercourse preventing pre-eclampsia:

I have a copy of a couple of articles about this subject that were published in Lancet 344: 8 Oct 94 #8928. One is found on page 969, and is titled: Does immunological intercourse prevent pre-eclampsia?

The other article is page 973 and 975, and is titled: Association of pregnancy-induced hypertension with duration of sexual cohabitation before conception.

Lastly, there was an article published in Science news 146: 246, dated 15 Oct 94. This article basically sums up what is in the articles in Lancet. This article's concluding paragraphs say (and I quote):

"Something in male ejaculate may help protect a woman from pre-eclampsia - - If she's been repeatedly exposed to it, says David A. Clark of McMaster University in Hamilton, Ontario. Researchers don't know whether the sperm itself, the accompanying white cells, or the nourishing liquid called seminal plasma is responsible for the shielding effect.

Such a concept is not as far-fetched as it may sound. For example, scientist already know that substances from the father lead to a beneficial immune response in the mother that helps sustain a healthy placenta. In pre-eclampsia, blood flow through the placenta in inadequate. -K.A. Fackelmann"

White-Coat Hypertension in Pregnancy

White Coat Hypertension: Take It Home [7/9/13]

[Y]ou were a true white coat hypertensive if only your office readings were elevated but your home readings and your ambulatory readings were not. What they considered elevated home readings were anything above 132/83. What they considered elevated ambulatory readings were 125/79 and above. . . . What they found is that true white coat hypertensives -- that is, people [whose blood pressure was] really elevated in the office, more than 140 and more than 90, or more than 90 -- had almost no increase in risk, at least during the first 6-8 years. Those who had partial white coat hypertension, where one of the other readings was above those numbers, tended to have a much greater risk than the so-called true white coat hypertensives but still less than the normal tensives.

How Should Blood Pressure Be Measured During Pregnancy?  [Medscape registration is free].  This article has an excellent discussion of the high rate of misdiagnosis of white-coat hypertension as pre-eclampsia.

At our midwife meeting, we took a poll.  All the midwives said that for a woman who has white-coat hypertension, it is fine for her to be taking her own blood pressure with a machine in her home on a daily basis, and that it is fine for her to decline office readings.  Assuming these levels are normal, four of the seven midwives felt that it was safe and reasonable for the woman to decline to have her blood pressure taken during labor or to ignore high readings in the absence of any other signs.

It would be prudent for someone with white-coat hypertension to take precautions in the last trimester to make sure that her blood pressure remains normal. Acupuncture is very safe, and nettles are generally recognized as safe in the last trimester: each day, an ounce of nettles should be put in a 1 quart jar and covered with hot water for 4-8 hours or overnight.  It can be sipped throughout the day.

Freeze-Frame - is the simplest of the HeartMath tools. It is a one-minute technique that allows a major shift in perception. More than positive thinking, it creates a definitive, heartfelt shift in how we view a situation, an individual or ourselves.

Freeze-Frame - is the simplest of the HeartMath tools. It is a one-minute technique that allows a major shift in perception. More than positive thinking, it creates a definitive, heartfelt shift in how we view a situation, an individual or ourselves. When under stress:
   * Shift out of the head, and focus on the area around your heart. Keep your attention there for at least ten seconds. Continue to breathe normally.
   * Recall a positive time or feeling you had in your life, and attempt to re-experience it. Remember, try not simply to visualize it, but rather to feel it fully.
   * Ask a question from the heart: "What can I do in this situation to make it different?" or "What can I do to minimize stress?"
   * Listen to the response of your heart. 

You may hear nothing, but perhaps feel calmer. You may receive verification of something you already know, or you may experience a complete perspective shift, seeing the crisis in a more balanced way. Although we may not have control over the event, we do have control over our perception of it.

Diagnosing Toxemia

The diagnosis and treatment has changed . We are realizing women can have Pre-eclampsia w/o protein also . There is a one urine test called a protein /creatinine ratio that is considered diagnostic  if above 0.3 . There are many references available – the new ACOG bulletin is quite good. Delivery at 37 wks is recommended for women diagnosed with pre-eclampsia unless severe and then delivery may be advised much sooner.

Pregnancy Pre-Eclampsia Tests Approved in England [5/11/16] - The NHS in England is to fund two new blood tests to help rule out pre- eclampsia in pregnancy. The tests detect changes in the blood that can mean the placenta is not developing properly. NICE has assessed and approved the Triage PlGF test and the Elecsys immunoassay sFlt-1/PlGF ratio. For now, their use is approved to rule out pre-eclampsia, not to diagnose it. NICE says more evidence is needed to approve them for diagnosis.

A Paper Dye Test May Be More Accurate Preeclampsia Diagnosis Tool [2/12/16] - A simple new paper-and-dye test for preeclampsia may be more accurate than current methods of detecting the condition, and fast enough to serve as labor and delivery triage, researchers say.

The test leverages a discovery about the condition, that it is characterized by an influx of misfolded proteins in the urine, similar to those found in Alzheimer's patients. The proteins interact with the textile dye Congo red. A dot of dye on a piece of paper smears when it comes in contact with urine from a woman with preeclampsia, but it remains intact if the woman is healthy.

Urinary podocyte excretion as a marker for preeclampsia.

Garovic VD, Wagner SJ, Turner ST, Rosenthal DW, Watson WJ, Brost BC, Rose CH, Gavrilova L, Craigo P, Bailey KR, Achenbach J, Schiffer M, Grande JP.
Am J Obstet Gynecol. 2007 Apr;196(4):320.e1-7

CONCLUSION: Podocyturia is a highly sensitive and specific marker for preeclampsia. It may contribute to the development of proteinuria in preeclampsia.

Hormone Test for Eclampsia

Make sure you check her hemoglobin because if she doesn't have a contracted hemoglobin then she isn't toxic. There have to be other things in place before she would have toxemia. I have had clients who had high BP and protein and swelling and no contracted blood volume so no toxemia. Have her eat a very high protein diet and see what happens. Usually this will correct the protein problem.

What are your experiences using deep tendon reflexes in management of pih?

It's been several years since I did a thorough investigation of this, in association with a case where an L&D nurse thought the clonus much more significant than I did. Generalized hyperreflexia can be a normal result of labor. Because it is a highly non-specific and insensitive finding, no authoritative case definition of pre-eclampsia uses the presence or absence of hyperreflexia to contribute to the diagnosis. (I'll append below the list I've sent here before, with the repeated caution that it was assembled several years ago and newer versions may have superseded these. I also have not gone through and niced up the line formatting, non-ASCII characters, etc. I believe that this is also now on the list's web site.)

IMHO, it is a test that should not be performed, as it does not contribute information of sufficient quality to base a clinical decision on.

Treating Toxemia

Bed Rest for Hypertension in Pregnancy Not Backed by Strong Evidence

Preventing Pregnancy Induced Hyptertension (PIH)

"I know PIH far too well... Here's what has worked for me, but others should research for themselves to see what works.

1. Drink water, drink some more, and drink some more. You'll know the bathrooms around town like no one else. We're talking 2+ quarts/day.
2. Up your protein to 80 - 100 mg, a day.
3. Calcium... up that as much as possible, combining w/ magnesium.
4. Take baths w/ Epsom salts (the magnesium helps) [see Homemade Detox Baths]
5. Visualizations and affirmations (sounds corny, but if you can visualize your blood pressure going down and your body relaxing, it CAN help)
6. Eat a cucumber each day; as well, bananas help with potassium, too, so eat one/day.
7. Herbs like Passionflower help relax the circulatory system. Uva Ursi helps reduce edema, but talk with an herbalist/midwife before consuming.
8. I also take Grape seed extract (w/ some vit E and C) and garlic capsules and Evening Primrose Oil.
9. Stop wearing a bra. I have no scientific evidence to support this, but relaxing the chest area from a tight fitting bra can help relax everything.
10. Chiropractics

Also: spend at least 30 mins a day in a pool. Studies have shown that full body immersion (in a pool, not a tub) for 30+ minutes a day will help bring the BP down." -Heather McCue

The Role of Regular Physical Activity in Preeclampsia Prevention [01/04/2005 - Medscape registration is free]

Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy.
Moutquin JM, Garner PR, Burrows RF, Rey E, Helewa ME, Lange IR, Rabkin SW
CMAJ 1997 Oct 1;157(7):907-919

Role of Magnesium Deficiency in Pre-Eclampsia

Evening Primrose Oil and Fish Oil to Prevent PIH

Effects of a combination of evening primrose oil (gamma linolenic acid) and fish oil (eicosapentaenoic + docahexaenoic acid) versus magnesium, and versus placebo in preventing pre-eclampsia.
D'Almeida A, Carter JP, Anatol A, Prost C
Women Health 1992;19(2-3):117-131

In the Dec. 1997 issue of Journal Watch/Women's Health, there is a synopsis of a Lancet article on Ketanserin, an antihypertensive drug that also prevents platelet aggregation and its ability to reduce the rate of preeclampsia.  In the study of 138 pregnant women with diastolic BP higher than 80 before 20 weeks, some were given ASA and Ketanserin, the rest given ASA and placebo.  The rates of preeclampsia were higher with placebo (19% vs 3%).  Delivery was significantly earlier with placebo (mean 36.2 vs 37.6 wks) and mean birthweights in babies born between 28-34 weeks was significantly lower with placebo (2791 vs 3074 g).  There were 6 perinatal deaths in the placebo group and 1 in the Ketanserin group, but this was nonsignificant (!).

Anyway, I have never heard of this before - does anyone know if this drug is being used anywhere in the U.S.?

In my state a rise of 30 systolic and/or a rise in diastolic of 30/15 on 2 occasions is an indication for a consult.  Of course, I start on
125 g of protein and 2000 mg of ca++ and 3 qts h2o- probably the same as you- after the 1st high bp.  I've only had one mom not respond, so the second bp is usually back to nl.

There is an article by Anne Frye in MT#35 called TURNING TOXEMIA AROUND. Here, Anne says two things in regard to protein in the urine: (1) Minor degrees of proteinuria frequently occur during pregnancy due to the increased filtration rate of the kidneys and is not a problem.... (2) Proteinuria appears as toxemia becomes most severe, not in its early stages, and indicates the kidneys are being severely stressed. However, as mentioned previously, the majority of proteinuria cases in pregnancy is related to vaginal discharge, urinary tract infection, or is benign.

Does anyone out there know anything about cream of tartar taken by the teaspoonful being a picnoginol source?

I use 2 t cream of tartar with the juice of half a lemon taken 3 days skip a day repeat to treat high blood pressure. It will drop the pressure about 20/10 right away.

Nonpharmacologic Management of Hypertension

Deep Water Immersion for High Blood Pressure

As the Guide to Effective Care in Pregnancy reminds us, "Although treatment of hypertension does not strike at the basic disorder, it may still benefit the mother and the fetus.  One of the important objectives in severe hypertension in pregnancy is to reduce blood pressure in order to avoid hypertensive encephalopathy and cerebral haemorrhage."

[The diuretic effect of a bath. Study in healthy pregnant females and patients with edema and gestosis]
Schnizer W, Mesrogli M, Seichert N, Schops P, Knorr H, Schneider J, Wassmann M
Zentralbl Gynakol 1989;111(13):864-70

A comparison of bed rest and immersion for treating the edema of pregnancy.
Katz VL, Ryder RM, Cefalo RC, Carmichael SC, Goolsby R
Obstet Gynecol 1990 Feb;75(2):147-51

Effect of daily immersion on the edema of pregnancy.
Katz VL, Rozas L, Ryder R, Cefalo RC
Am J Perinatol 1992 Jul;9(4):225-7

Influence of head-out water immersion on plasma renin activity, aldosterone, vasopressin and blood pressure in late pregnancy toxaemia.
Kokot F, et al. (Proc Eur Dial Transplant Assoc. 1983)

Renal responses to immersion and exercise in pregnancy.
Katz VL, et al. (Am J Perinatol. 1990)

[Effect of exercise in water on maternal blood circulation].
Asai M, et al.  (Nippon Sanka Fujinka Gakkai Zasshi. 1994)

Fetal and uterine responses to immersion and exercise.
Katz VL, et al. (Obstet Gynecol. 1988)

Continuous measurement of blood pressure, heart rate and left ventricular performance during and after isometric exercise in head-out water immersion.
Fujisawa H, et al. (Eur J Appl Physiol. 1996)

Interstitial and intravascular pressures in conscious dogs during head-out water immersion.
Miki K, et al. (Am J Physiol. 1989)

My daughter is 37 weeks pregnant, and having BPs, this week for instance, 136/100, and thereabouts. Generalized edema, 2+ reflexes, trace protein, no headaches. The midwife said she needs to get into water (pool) up to her neck and soak twice a day. It really helps the BP after swimming and floating around in the pool, her BP is 98/62........Of course she is resting on her side a lots, and not going to work any more. No shopping, just 'makin a baby'.

Calcium for PIH/Pre-Eclampsia

Ran across this weblink through the Perinatal List: it has information regarding the McMaster's University study on PIH reduction through increased Calcium intake during pregnancy (recommendation of 1,500 to 2,000 mg. daily). Offhand, the numbers look good to me.

Problem is, it's a meta-analysis, which means that they took a bunch of small RCT's, assessed their quality and crunched the numbers therein. Although meta-analyses can be quite valid, and certainly indicators of where to look next, they can also be flawed. There's certainly some controversy about their usefulness (although that's essentially what the Cochrane database is). In this case, a more recent RCT published in the New England Journal of Medicine last July which enrolled 4589 women appears to demonstrate that calcium supplementation does not prevent pre-eclampsia. I haven't read either work at source, so can't comment further than that. But it does demonstrate that you have to be careful about what you accept as an authoritative source. To me, this is one of the fascinating things about research.

Calcium Supplementation May Reduce the Severity of Preeclampsia  CME/CE - Calcium supplementation does not reduce the incidence of preeclampsia but does reduce the severity

World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women.
Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali MM, Zavaleta N, Purwar M, Hofmeyr J, Nguyen TN, Campodonico L, Landoulsi S, Carroli G, Lindheimer M; World Health Organization Calcium Supplementation for the Prevention of Preeclampsia Trial Group.
Am J Obstet Gynecol. 2006 Mar;194(3):639-49.

CONCLUSION: A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity, maternal morbidity, and neonatal mortality, albeit these were secondary outcomes.

Study Shows Calcium Doesn't Reduce PIH/Eclampsia

I have the perfect "cure" for PIH with almost total compliance...................ready..................................... ...............................................................M I L K C H O C O L A T E .................CALCIUM AND MAGNESIUM............................. now about the dose!

The article quotes JAMA -- A new Canadian study analysed 14 calcium trials (1966 to 1994) and finds strong evidence that calcium supplementation "results in an important reduction in blood pressure and pre- eclampsia.. in pregnant women".

Drs. McCarron and Daniel Hatton from OHSU are quoted in an accompanying editorial -- McCarron says that 2000 milligrams of calcium would be closer to our needs than is the government-NIH recommendation of 1500.. and he says the average US woman enters pregnancy consuming only 600 milligrams a day!, prenatals contain only 200 milligrams of calcium.. McCarron is quoted "I tell women that at a bare minimum they need to be getting at least another 1,000 milligrams of calcium from a calcium- carbonate supplement every day during pregnancy".

Now we all 'know" that there are probably better sources of calcium than calcium carbonate[grin].... but the research was DONE with calcium carbonate so it clearly absorbs well enough to show an effect -- It works! If we can recommend something better than we should, but I hate to hear people say "calcium carbonate is worthless" or "calcium carbonate doesn't absorb" or "calcium carbonate is a poor source of calcium".. (and I do hear this pretty often; calcium carbonate has a bad reputation around here[Grin]). There may be better sources, but it must absorb "well enough" because it does work to reduce blood pressure and the incidence of pre-eclampsia.

Questions..... Would anyone with a nutritionist background like to translate this "2000 milligrams" into servings of milk/dairy/broccoli/whatever? Can a non-dairy user get enough calcium without supplementation, and if not, which supplements would you recommend over calcium carbonate (and why?)?

Experts Urge Pregnant Women: Get Your Calcium! This point was supported in an accompanying editorial written by David A. McCarron, M.D., Co- Director of the Calcium Information Center, Co-Head of the Division of Nephrology, Hypertension and Clinical Pharmacology at the University of Oregon Health Sciences University and an accomplished hypertension researcher in his own right. "There is a calcium crisis in this country ," said Dr. McCarron. "The most recent government survey shows that women of child-bearing age are consuming less than 600 mg of calcium a day, with many getting less than 400! The pre- natal vitamins most doctors prescribe just don't make up the difference -- they contain 200, maybe 300 mg of calcium. The bottom line is that pregnant and lactating women should increase their calcium intake to recommended levels through dietary means whenever possible, by including low-fat dairy products (such as milk, cheese, yogurt), certain dark green vegetables (such as broccoli and kale), and making up the difference by adding a reliable calcium supplement.


A woman's need for meeting the current recommended levels of calcium just took on new urgency. In today's Journal of the American Medical Association (JAMA), scientists from McMaster University (Ontario, Canada ) report that consuming sufficient calcium during pregnancy can reduce the risk of pregnancy-induced hypertension (PIH) and pre- eclampsia, a potentially fatal disorder of high blood pressure and kidney failure. Pregnancy-induced hypertension and pre-eclampsia affect up to one in seven American women and are leading causes of c- sections, pre-term births and low birth-weight babies, making them among the most important issues in pregnancy care.

The most extensive summary of randomized controlled trials in this area to date, McMaster researchers reviewed the data from 14 trials involving nearly 2,500 pregnant women. The compelling results indicate that 1,500 to 2,000 mg daily of calcium supplementation can lower the risk of pregnancy-induced hypertension by 70% and the risk of pre- eclampsia by over 60%!

Experts Urge Pregnant Women: Get Your Calcium! This point was supported in an accompanying editorial written by David A. McCarron, M.D., Co- Director of the Calcium Information Center, Co-Head of the Division of Nephrology, Hypertension and Clinical Pharmacology at the University of Oregon Health Sciences University and an accomplished hypertension researcher in his own right. "There is a calcium crisis in this country ," said Dr. McCarron. "The most recent government survey shows that women of child-bearing age are consuming less than 600 mg of calcium a day, with many getting less than 400! The pre- natal vitamins most doctors prescribe just don't make up the difference -- they contain 200, maybe 300 mg of calcium. The bottom line is that pregnant and lactating women should increase their calcium intake to recommended levels through dietary means whenever possible, by including low-fat dairy products (such as milk, cheese, yogurt), certain dark green vegetables (such as broccoli and kale), and making up the difference by adding a reliable calcium supplement (like TUMS(R)) . This simple, yet significant intervention could save thousands of lives and billions of dollars every year if employed by all women of child-bearing age."

Calcium Information Center To reach a healthcare professional regarding today's news about the importance of calcium during pregnancy, phone the CIC CALCIUM INFORMATION LINE -- 1-800-321-2681. Established in 1991, The Calcium Information Center is a component of the Clinical Nutrition Research Units of the New York Hospital--Cornell Medical Center and Memorial Sloan-Kettering Cancer Center and Oregon Health Sciences University.

To receive a fax of further information on this study, call toll free, 1-800-753-0352, ext. 707, or contact Anne FitzSimons, 212-326-9800.

The study linking high intake of milk during pregnancy to pre-eclampsia was published in the American Journal of Epidemiology, April 1, 1995.

Protein for PIH/Pre-Eclampsia

I was recently told of a study where women on a high protein diet (about 70-80 g I believe) had a significantly smaller incident of pre-eclampsia than the average ( 0.5% compared to 17%). Does anyone know anything about this study and if it exists?

Tom Brewer MD has written several books covering this. I suggest reading his book "Metabolic Toxemia of Late Pregnancy: A disease of mal- nutrition" Keats Publishing 1982. Other sources of knowledge on this topic are most of the direct entry midwifery community (it has been standard practice for most of us to Rx a 100g protein diet as a preventive for years). In your reading of Brewer please note that he had great success with REVERSING the pre-eclampsia process utilizing increased fluids (gallon of water a day) salting of food to taste and protein. My sources list the toxemia hot line [Tom Brewer MD] as [603] 778 1476 or 66 High Street, Exter, NH 03833 USA

Other documents/presentations: James,Dawn, "New Thoughts About Pre-eclampsia" presentation 9/15/89 Royal College of Medicine, London Eng. Available thru President, Pre-eclamptic Toxemia Society, Ty Iago, High Street, LLANBERIS, Caerarvon, Gwynedd, LL55 4HB, England.

Brewer diet articles about the importance of high-quality protein for treatment of elevated blood pressure and pre-eclampsia

Vitamins D, C, E and A for Eclampsia

Vitamin D deficiency is a major cause of high blood pressure

Vitamins may not protect against pre-eclampsia - "Concomitant supplementation with vitamin C and vitamin E does not prevent pre-eclampsia in women at risk, but does increase the rate of babies born with a low birth weight," the team writes. "As such, use of these high-dose antioxidants is not justified in pregnancy."  [King's College London, Lancet 2006; Early online publication]

This contradicts a previous study:

Vitamins May Help to Prevent Pre-Eclampsia in High-Risk Women

9/3/99 LONDON (AP) - Women at high risk for toxemia, one of the most dangerous complications of pregnancy, might avoid the condition by taking vitamin C and E pills, new research suggests. But the British scientists who conducted the study - the first to investigate the vitamins' potential to prevent the condition also known as pre-eclampsia - warned pregnant women should not rush to start taking large doses of the vitamins, since the findings are preliminary. Researchers haven't even yet determined if the high doses are safe for the developing fetus. The benefit suggested by the study must be confirmed in large-scale experiments, said lead researcher Lucilla Poston, a professor who runs the fetal health research group at Guy's, King's and St. Thomas' School of Medicine in London.

JAMA/Reuters Summary

Women should talk with their care providers about vitamin supplementation!

HerbsHomeopathics/Misc for Eclampsia

HerbLore carries a great new product - Pregnant Mother's Liver Tonic. So many people have loved our Liver Cleanse caps, but they're not appropriate for pregnant or nursing mothers! So we added a Nursing Mother's Liver Tonic for women after birth, and it became clear that we needed to add another product for pregnant (or wanting to become pregnant) women. So we give you Pregnant Mother's Liver Tonic, formulated specifically for pregnant (and wanting to become pregnant) women and their needs!

According to Susun Weed in her book Wise Woman Herbal for the Childbearing Year Crataegus (Hawthorn Berry) is a strong and relatively safe vasodilator. "[hawthorn] berries work cumulatively and are taken for extended periods for best results. Essential hypertension then, rather than gestational hypertension, is the focus of Hawthorn berry use. The standard preparation is a cold infusion: one ounce of crushed dried berries steeping in two cups of cold water overnight brought quickly to a boil, strained and taken in sips, one cup per day , every day. The tincture dose is 15 drops, two or three times daily."

Here's what Weed recommends for hypertension in order of strength (and probably toxicity):

Weed also recommends Dandelion, eating lots of fresh leaves, for to prevent and treat preeclampsia, due to its high mineral content and the fact that it also contains choline, an alkaloid that support healthy liver function (and Tom Brewer links preeclampsia to abnormal liver function).

Weed also mentions nettles and raspberry leaf teas to tone and nourish in general (nettles are especially good for kidneys). And raw beet juice (up to 4 oz daily) or a raw salad of equal parts of one freshly grated raw apple and one grated raw beet. Raw beet is the fastest and most effective way to naturally increase available calcium to the body and it balances the sodium/potassium ratio of your blood. Plus the salad tastes really good, especially with walnuts added -- no dressing required!

She only recommends valerian root for elevated bp IN THE CONTEXT OF BEING IN LABOR (along with hops and skullcap -- she recommends a handful of each valerian root, hops and skullcap in a quart jar, steeped for two hours to temporarily lower bp).

Of course there's also taking an extra b complex vitamin in addition to your regular prenatal vitamins, high protein, NOT limiting salt, etc. for preeclampsia.

I have seen a study where EPO was shown to reduce the incidence of PIH. The study was conducted on the Farm, and it was a double-blind, placebo controlled study. I'm so sorry that I don't have the reference for it. Maybe someone else has seen it?

The researchers attributed the decreased incidence of PIH to the essential fatty acids in EPO, however, instead of to the prostaglandin precursors.

I have personally used the cream of tartar recipe in Susan Weed's book. Once a day put 2 t of cream of tartar in the juice of half a lemon (reallemon works too) with a little water. Drink that for three days skip a day and repeat for three days. It drops my bp about 15/10 after one day.

The Hazards of Diuretics in Pregnancy - some additional information about the dynamics of blood volume and blood pressure during pregnancy, and some cautions about herbal diuretics.

Gemmotherapy (from plant buds) for Hypertension, from Dolisos
English Hawthorne (Crataegus Oxycantha) Young Shoots 1DH: 50 drops in the morning
European Olive (Olea Europea) Young Shoots 1DH: 50 drops in the afternoon
Black Poplar (Populus Nigra) Buds 1DH: 50 drops in the evening

Epsom Salts/Egg Nog

Take ice cream, milk, 2 tbs non-fat dry milk, 2 raw eggs, tsp vanilla and beat into a milk shake (thin).  It tastes quite yummy.  I have them follow the salts with it as the salts taste quite bitter and found that in doing it this way, it seems to immediately bring down the b/p. [NOTE - Be sure you can trust your source of raw eggs to be free of salmonella.  Also, note that it is important to take the epsom salts WITH the egg nog.] Epsom salts are magnesium sulfate, and the sulfates help detox liver hormones.

HELLP - severe sequela of PIH

The acronym stands for: H - hemolysis: breakdown of red cells in vessels in vasospasm from high blood pressure; EL - elevated liver enzymes, SGOT and LDH; think liver congestion and symptom of epigastric pain; LP - low platelets; used up in damaged vascular endothelium; risks for bleeding and DIC.

HELLP Syndrome - Here's a great handout for parents from  the Perinatal Education Associates, Inc.

HELLP Syndrome: Recognition and Perinatal Management from the AAFP

Effects of Mag. Sulfate on Breastfeeding

This Web page is referenced from another page containing related information about Pregnancy-Induced Hypertension (PIH)


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