Brenda Khan
Preeclampsia is a multisystem pregnancy syndrome that affects 3-5% of pregnant women worldwide and is one of the leading causes of maternal and perinatal mortality. It is defined by hypertension after 20 weeks of gestation and maternal organ dysfunction. While the exact pathophysiology of preeclampsia is unknown, it is influenced by a combination of genetic, clinical, social, and environmental risk factors. Nutritional risk factors interact with these other risk factors, and certain dietary patterns may increase or decrease the likelihood of developing preeclampsia. For example, diets high in ultra-processed foods and added sugars increase the odds of developing preeclampsia, while diets rich in fruits, vegetables, and fibre are associated with a reduced risk. Calcium supplementation is also recommended for pregnant women with low calcium intakes to help reduce the risk of preeclampsia.
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What You'll Learn
Calcium intake
Calcium is an essential mineral for pregnant women, and calcium intake is a key factor in preventing preeclampsia. Preeclampsia is a serious condition that affects about 3-5% of pregnancies and can lead to maternal and fetal health complications, including death. It is characterized by hypertension after 20 weeks of gestation and maternal organ dysfunction, affecting the uterus, kidneys, liver, blood, and brain.
Calcium supplementation has been recommended by the World Health Organization (WHO) as a preventive measure for preeclampsia, especially in populations with low dietary calcium intake. The recommendation suggests that pregnant women with low calcium intake take daily calcium supplements of 1-2 grams of elemental calcium from 20 weeks of gestation until delivery. This intervention is particularly important in low-income countries, where calcium intake is often insufficient, and preeclampsia is a leading cause of maternal mortality.
The protective effect of calcium supplementation is well-established, and it works by reducing arterial vasoconstriction in the uterus and placenta. Low calcium intake can lead to decreased intracellular calcium concentration, causing vasoconstriction, increased vascular resistance, and elevated blood pressure. Calcium supplementation helps to maintain adequate calcium levels, reducing the risk of hypertension and preeclampsia.
Additionally, calcium supplementation can have anti-inflammatory effects, which may contribute to its protective role in preeclampsia. Calcium from the mother's diet is also crucial for the developing baby's bone formation. During pregnancy, there is an increased demand for calcium to support the baby's growth, and insufficient calcium intake can impact the mother's calcium stores.
While calcium supplementation is a recommended intervention, it is essential to note that nutrition is complex, and dietary changes alone may not guarantee the prevention of preeclampsia. Genetic, clinical, social, and environmental risk factors also play a role in the development of this condition. Combining dietary counseling with supplementation can be a sensible approach to increasing calcium intake and reducing the risk of preeclampsia.
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Processed foods
Preeclampsia is a complex condition with a range of genetic, clinical, social, and environmental risk factors. Nutritional risk factors interact with all of these other risk factors. However, developing preeclampsia is not solely due to eating unhealthy foods.
A maternal diet high in ultra-processed foods and added sugars increases the odds of developing preeclampsia by 28%. This is compared to a heart-healthy diet of lean, unprocessed meats, fruits, vegetables, and whole grains, which has been shown to reduce the risk of preeclampsia.
Ultra-processed foods include hamburgers, French fries, cakes, ice cream, pizza, sausages, and soft drinks. These types of foods have been linked to poor health in non-pregnant patients, and researchers have found a similar link for pregnant patients.
In addition to a diet of unprocessed foods, a high-fibre diet is recommended for pregnant women and those at risk of preeclampsia, aiming for a fibre intake of 25-30 grams per day to reduce the risk. A case-control study found fibre intake to be inversely associated with the risk of preeclampsia. The study showed that women who consumed more than 24.3 grams of fibre per day had a 51% reduced risk of developing preeclampsia compared to those who consumed less than 13.1 grams per day.
Other nutritional factors that may reduce the risk of preeclampsia include calcium supplementation, vitamin D, omega-3 fatty acids, and probiotics.
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Fruit and vegetables
Preeclampsia is a complex condition with a number of genetic, clinical, social, and environmental risk factors. Nutritional risk factors interact with all of these other risk factors. Diets that are high in vegetables and fruits and low in saturated fats significantly reduce the risk of preeclampsia. A study of pregnant Hispanic women found that plant-based eating patterns may help prevent preeclampsia.
A high-fibre diet is recommended for pregnant women and those at risk of pre-eclampsia, aiming for a fibre intake of 25–30 g/day to reduce the risk. Dietary fibre can be found in fruits and vegetables, as well as in starchy carbohydrates and beans. Observational evidence suggests that diets higher in fruits and vegetables are protective against hypertensive disorders.
Pregnant women should aim to consume ≥400 g of fruit and vegetables per day (equivalent to 5-a-day). Calcium is found in green leafy vegetables and broccoli, sesame seeds, calcium set tofu, dried figs, almonds, fortified cereals and bread and fortified orange juice.
A case-control study found fibre intake to be inversely associated with the risk of pre-eclampsia. This study showed that women who had >24.3 g fibre/day had a 51% reduced risk of developing pre-eclampsia compared to those who had <13.1 g/day.
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Mediterranean diet
Preeclampsia is a complex condition with a number of genetic, clinical, social, and environmental risk factors. Nutritional risk factors interact with all of these other risk factors. Developing preeclampsia is not solely due to eating unhealthy foods. However, maternal diets high in ultra-processed foods and added sugars increased the odds of developing preeclampsia by 28%.
A Mediterranean diet is primarily made up of vegetables, fruits, legumes, nuts, olive oil, whole grains, and fish. A Johns Hopkins Medicine study that surveyed a racially diverse group of over 8,000 women found that following a Mediterranean-style diet could lower the risk of preeclampsia by at least 20%. The study also found that the risk reduction was greatest among Black women, a population at high risk for preeclampsia.
A separate study by the Smidt Heart Institute at Cedars-Sinai found that women who conceived while adhering to the anti-inflammatory Mediterranean diet had a significantly lower risk of developing preeclampsia during pregnancy. The study evaluated the association between the Mediterranean diet and other adverse pregnancy outcomes, including gestational diabetes and hypertension, preterm birth, delivery of a small-for-gestational-age infant, and stillbirth. The study concluded that a healthier eating pattern is associated with a lower risk of adverse pregnancy outcomes, the most exciting being a 28% lower risk for preeclampsia.
The Mediterranean diet is also associated with a lower risk of gestational diabetes. Additionally, it has been found to reduce blood pressure in pregnant women at high risk for preeclampsia. This is particularly encouraging for Black women, who have higher rates of preeclampsia and adverse outcomes compared to other groups.
Calcium supplementation is also recommended for pregnant women with low calcium intakes to help reduce the risk of preeclampsia. Calcium supplementation can reduce the risk of developing preeclampsia by half. Increased calcium intake may help reduce the risk of preeclampsia by reducing arterial vasoconstriction in the uterus and placenta.
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Healthy Eating Index
While diet alone does not cause preeclampsia, nutritional risk factors interact with other risk factors, such as genetics, clinical, social, and environmental factors, to increase or decrease the risk of developing preeclampsia. For instance, maternal diets high in ultra-processed foods and added sugars increase the odds of developing preeclampsia by 28%. Calcium supplementation, on the other hand, can reduce the risk of developing preeclampsia by half in women with low dietary calcium intake. Increased fibre intake may also aid in weight maintenance and reduce the risk of preeclampsia by 51%.
The Healthy Eating Index (HEI) is a scoring metric that assesses overall diet quality and the quality of specific dietary components. The scores range from 0 to 100, with 100 reflecting that the set of foods aligns with key dietary recommendations and dietary patterns published in the Dietary Guidelines for Americans. The HEI is a valuable tool for research and can be used to address different types of questions. The most recent versions of the HEI are the Healthy Eating Index–2020 (HEI–2020) for ages 2 and older, and the Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020) for ages 12 to 23 months. These indices were developed following the same set of key principles, but the HEI-Toddlers-2020 differs in scoring standards to reflect the unique guidance for young children.
The total HEI-2020 score for ages 2 and older is 58 out of 100, while the average HEI-Toddlers-2020 score for ages 12 to 23 months is 63 out of 100. These scores indicate that average diets in the U.S. do not conform to dietary recommendations. Each step closer to eating a diet that aligns with Dietary Guidelines recommendations can help reduce the risk of developing diet-related chronic diseases such as heart disease, type 2 diabetes, and cancer.
The HEI is a valuable tool for individuals, communities, and industries to support Americans in making lifestyle choices that align with the Dietary Guidelines.
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Frequently asked questions
While diet is a "modifiable risk factor", it is not the only cause of preeclampsia. Nutritional risk factors interact with other risk factors, such as genetics, clinical, social, and environmental factors.
Preeclampsia is a multisystem syndrome of pregnancy, affecting 3-5% of pregnant women worldwide. It is characterised by hypertension after 20 weeks of gestation, along with maternal organ dysfunction.
A diet high in solid fats, refined grains, and cheese increases the likelihood of developing preeclampsia. Meanwhile, a diet rich in vegetables, oils, and fruits is linked to a lower risk.
A high-fibre diet (25-30g/day) can help reduce blood pressure and inflammation. Calcium supplementation is also recommended for pregnant women with low calcium intake, as it can reduce the risk of preeclampsia by half.
Adherence to a Mediterranean-style diet has been associated with a lower risk of adverse pregnancy outcomes, including hypertensive disorders of pregnancy.
