Hypertensive Disorders of Pregnancy

Author: Emily Rydbom, CN, BCHN, CNP

Reading news about a single maternal death is always disheartening. There is never a situation where such an occurrence is acceptable. Therefore, we have some practical, evidence-based preventive suggestions to incorporate into this discussion!

Nutrition/Nutrients & Lifestyle (You know we will always start with a food first approach!)

Consider the following:

 1.     Folate

2.     Dietary calcium assessment

3.     Resveratrol

4.     Plant-based Melatonin (our favorite is Herbatonin from Symphony Natural Health*)

5.     Zinc

6.     Nitric Oxide support – dietary nitrate intake – In chronically hypertensive pregnant women there was an association between increased nitrate intake via beetroot juice and a reduction in blood pressure.

7.     Oral microbiome support – Women with gestational hypertension have higher periodontal pathogens compared to normotensive pregnant controls – targeted strain support Lactobacillus reuteri, Lactobacillus salivarius, Lactobacillus brevis.

8.     Increase dietary fiber – soluble & insoluble, phytochemical prebiotic substrates

9.     Gut microbiome - targeted strain support – Akkermansia Muciniphilia

10.  Sodium awareness : high potassium dietary support

11.  Aspirin – as clinically indicated

12.  Movement

13.  Cessation of smoking

 Integrated Team:  

More eyes/ears/hearts that extend established OB care & can help with continued screening, at-home visits, telehealth check-ins!

·       Perinatal Nutritionist

·       Doula

·       Midwife

Screening factors:

Advanced maternal age (risk for late-onset PE has been shown to increase by 4% with every one-year increase in maternal age above 32 years), nulliparity, previous history of PE, short and long inter-pregnancy intervals, use assisted reproductive technologies (specifically hyper-estrogenic ovarian stimulation medications), family history of PE, obesity, Afro-Caribbean and South Asian racial origin, co-morbid medical conditions including hyperglycemia in pregnancy, pre-existing chronic hypertension, renal disease, autoimmune diseases, such as systemic lupus erythematosus and anti-phospholipid syndrome

Clinical Biomarkers:  

·       Elevated WBC across all trimesters (particularly 1st & 2nd trimesters)

·       Elevated soluble fms-like tyrosine kinase (sFlt-1)

·       Low placental growth factor (PlGF)

·       sFlt‐1:PlGF ratio 

·       Elevated Homocysteine

·       Deficient & Insufficient Vitamin D (25 OH2D3)

·       Zinc Deficiency

 Oral Findings (We use Biocidin DentalFlora probiotic & Dentalcidin toothpaste for support):

·       P. gingivalis 

·       Prevotella

·       F. nucleatum

Genomic Association (We use our DNALife GrowBaby Genomic Test):

·       APOe4

·       CYP1A1

·       GSTM1

·       GSTA1

·       GSTP1

·       MTHFR C677T

·       VDR

At-Home:

·       Home Blood Pressure readings for at least 10 days after delivery (Society for Maternal Fetal Medicine, maintained blood pressure readings of < 120/80 mmHg)

·       Attend ALL postpartum visits/schedule your integrated team to visit you (in-person or telehealth) as a priority

 Awareness across the lifespan:

·       Women with a history of preeclampsia and gestational hypertension are at increased risk of hypertension in later life – associated elevated blood pressure on average 14 years after a pregnancy with hypertensive disorder.   

·       Those with a history of hypertensive disorders of pregnancy are more likely to have ASCVD (Atherosclerotic cardiovascular disease) risk scores greater than 7.5%.

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*We receive no affiliate compensation for this product or from this company, yet we believe in its quality, the scrupulous research they preform, their partnership with farmers & stewardship of the land, and in their leadership/clinical team.  

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Sources:

Fogacci S, Fogacci F, Cicero AFG. Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence. Nutrients. 2020 Jan 31;12(2):378. doi: 10.3390/nu12020378. PMID: 32023928; PMCID: PMC7071166.

Gare J, Kanoute A, Meda N, Viennot S, Bourgeois D, Carrouel F. Periodontal Conditions and Pathogens Associated with Pre-Eclampsia: A Scoping Review. Int J Environ Res Public Health. 2021 Jul 5;18(13):7194. doi: 10.3390/ijerph18137194. PMID: 34281133; PMCID: PMC8297070.

Ishimwe JA. Maternal microbiome in preeclampsia pathophysiology and implications on offspring health. Physiol Rep. 2021 May;9(10):e14875. doi: 10.14814/phy2.14875. PMID: 34042284; PMCID: PMC8157769.

Martin AS, Monsour M, Kawwass JF, Boulet SL, Kissin DM, Jamieson DJ. Risk of Preeclampsia in Pregnancies After Assisted Reproductive Technology and Ovarian Stimulation. Matern Child Health J 2016; 20: 2050–6.

Poon LC, Shennan A, et al., The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynaecol Obstet. 2019 May;145 Suppl 1(Suppl 1):1-33. doi: 10.1002/ijgo.12802. Erratum in: Int J Gynaecol Obstet. 2019 Sep;146(3):390-391. doi: 10.1002/ijgo.12892. PMID: 31111484; PMCID: PMC6944283.

Poon LCY, Kametas NA, et al., Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach. J Hum Hypertens 2010; 24: 104–10. 

 Wu K, Gong W, Ke HH, Hu H, Chen L. Impact of elevated first and second trimester white blood cells on prevalence of late-onset preeclampsia. Heliyon. 2022 Nov 23;8(11):e11806. doi: 10.1016/j.heliyon.2022.e11806. PMID: 36458313; PMCID: PMC9706692.