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Re : high protien diet

Post by annegarrett » Sun Dec 14, 2003 11:45 am

Just reiterating some basic facts as we know them based on frankly some pretty poor stats--even in the US they don't necessarily keep good stats:

TRUE preeclampsia (meaning hypertension after 20 weeks and proteinuria in a first pregnancy ONLY) occurs in about 3% of pregnancies (2.87%). This is important for research purposes and so we do not use that stat for occurrence rates.

About 10% of all pregnancies are complicated by hypertension with or without proteinuria.

For more information about death in pregnancy around the world--check out www.safemotherhood.org or Google "Safe Motherhood" or "Family Care International".



5-8% of all pregnancies have preeclampsia (hypertension, proteinuria, during any pregnancy, with the hypertension occurring at any point in the pregnancy--so some doctors might call it "Gestational Hypertension Superimposed with Preeclampsia".

To the extent that your hypertension (pre-existing or gestational) is caused by poor diet or excessive body weight, you may be able to reduce your risk to that degree by reducing your weight through a proper diet prior to pregnancy. It is about the only "area" where we have any control over this disease and the control we have in that area is limited. We do encourage keeping your weight at a healthy level and eating well during pregnancy.

As for the international stats--unfortunately--the reason women and infants die of preeclampsia and eclampsia in countries like India is largely because of the following:

1) Access to Care: less than 10% of them receive ANY prenatal care at all. The World Health Organization LITERALLY recommends a woman get "at least" four prenatal visits. FOUR!
2) Access to Emergency Obstetrical Services: in India, in regions like Andra Pradesh, roughly the size of Texas, there are few (I think I heard four) anesthesiologists. It is pretty hard to have an emergency c-section when you can't get anesthesia.
3) The Value of Women's Lives: I was in India last year at a conference called "Saving Mother's Lives" where a midwife reported that there was a woman who was having eclamptic seizures and her husband would have to sell his farm to pay for her care. His family told him, "You can always get another wife--you cannot replace your farm."
4) Access to Magnesium Sulfate. Over HALF of the countries in the world do not have access to Magnesium Sulfate even though studies show it prevents eclampsia 50% of the time. In India--where they have access to magnesium--they do not use it because they are using Diazapam primarily. This is a sedative--basically you feel less pain as you die. Magnesium is cheap but not patentable. Diazepam has a drug company who will promote and even give it away. Magnesium is painful--if injected it is two LARGE syringes that hurt like h..ll. AND it is uncomfortable. How many times have we complained about it here? And if overused--it can kill a mother. It used to be used to euthanize animals in vetrinary hospitals--so it is not a benign drug--it requires training, access to IVs, and oversight.

I am sure malnutrition contributes to women's problems--but as Erin points out--the occurence rates are level across the board around the world--5-8%. The death rate is largely due to poverty and lack of care.

I have to say--when in India--I lived with a local family in a village and ate daal (lentils) and naan bread (flatbread) every single day--three times a day--for 13 days. I looked good. I lost weight. This diet is high in iron and protein and what most poor people live on. The preeclampsia rate is just the same in that village--but the death rate is much higher. I daresay the women in the US who live on McDonalds are getting a fair bit of protein.

Definitely nutrition is important and probably a factor--maybe THE factor for some women--but it isn't the whole picture.

FYI: These stats have been verified by the World Health Organization and have been quoted by the NYTimes, the BBC News and CNN. I think we are safe using them.



Anne Garrett
Executive Director
Preeclampsia Foundation

Re : high protien diet

Post by annegarrett » Sun Dec 14, 2003 11:44 am

Just reiterating some basic facts as we know them based on frankly some pretty poor stats--even in the US they don't necessarily keep good stats:

TRUE preeclampsia (meaning hypertension after 20 weeks and proteinuria in a first pregnancy ONLY) occurs in about 3% of pregnancies (2.87%). This is important for research purposes and so we do not use that stat for occurrence rates.

About 10% of all pregnancies are complicated by hypertension with or without proteinuria.

5-8% of all pregnancies have preeclampsia (hypertension, proteinuria, during any pregnancy, with the hypertension occurring at any point in the pregnancy--so some doctors might call it "Gestational Hypertension Superimposed with Preeclampsia".

To the extent that your hypertension (pre-existing or gestational) is caused by poor diet or excessive body weight, you may be able to reduce your risk to that degree by reducing your weight through a proper diet prior to pregnancy. It is about the only "area" where we have any control over this disease and the control we have in that area is limited. We do encourage keeping your weight at a healthy level and eating well during pregnancy.

As for the international stats--unfortunately--the reason women and infants die of preeclampsia and eclampsia in countries like India is largely because of the following:

1) Access to Care: less than 10% of them receive ANY prenatal care at all. The World Health Organization LITERALLY recommends a woman get "at least" four prenatal visits. FOUR!
2) Access to Emergency Obstetrical Services: in India, in regions like Andra Pradesh, roughly the size of Texas, there are few (I think I heard four) anesthesiologists. It is pretty hard to have an emergency c-section when you can't get anesthesia.
3) The Value of Women's Lives: I was in India last year at a conference called "Saving Mother's Lives" where a midwife reported that there was a woman who was having eclamptic seizures and her husband would have to sell his farm to pay for her care. His family told him, "You can always get another wife--you cannot replace your farm."
4) Access to Magnesium Sulfate. Over HALF of the countries in the world do not have access to Magnesium Sulfate even though studies show it prevents eclampsia 50% of the time. In India--where they have access to magnesium--they do not use it because they are using Diazapam primarily. This is a sedative--basically you feel less pain as you die. Magnesium is cheap but not patentable. Diazepam has a drug company who will promote and even give it away. Magnesium is painful--if injected it is two LARGE syringes that hurt like h..ll. AND it is uncomfortable. How many times have we complained about it here? And if overused--it can kill a mother. It used to be used to euthanize animals in vetrinary hospitals--so it is not a benign drug--it requires training, access to IVs, and oversight.

I am sure malnutrition contributes to women's problems--but as Erin points out--the occurence rates are level across the board around the world--5-8%. The death rate is largely due to poverty and lack of care.

I have to say--when in India--I lived with a local family in a village and ate daal (lentils) and naan bread (flatbread) every single day--three times a day--for 13 days. I looked good. I lost weight. This diet is high in iron and protein and what most poor people live on. The preeclampsia rate is just the same in that village--but the death rate is much higher. I daresay the women in the US who live on McDonalds are getting a fair bit of protein.

Definitely nutrition is important and probably a factor--maybe THE factor for some women--but it isn't the whole picture.

FYI: These stats have been verified by the World Health Organization and have been quoted by the NYTimes, the BBC News and CNN. I think we are safe using them.



Anne Garrett
Executive Director
Preeclampsia Foundation

Re : high protien diet

Post by deerhart » Sun Dec 14, 2003 09:28 am

Oh btw, doctors and midwives do not get into big discussions aobut nutrition because it could lead to malpractice suits. They are not necessarily trained in nutrition and what you should/shouldn't be eating. Plus there are many other factors that need to be taken into account when prescribing a diet, like other medical issues.
If your concerned about your diet, you should ask to be referred to a nutritionist as they have the training to set up an individualized diet plan for you that will meet your needs working around food likes/dislikes, any medical issues you need to deal with, etc..

Erin

Mommy to Alex and Mason

Re : high protien diet

Post by deerhart » Sun Dec 14, 2003 09:22 am

Actually occurance rate and mortality rate is much different. Mortality rate may be higher, but occurance rate isn't. But because better medical care is available in more developed countries, less woman and babies die from PE.
This does not mean that more third world woman suffer from PE then in countries like the US. The occurance rate in the us is about 10%, which is about the same occurance rate as almost every other country in the world (ranges from 8-10%).
Eclampsia rates by my first guess would be higher in third world countries then in more modern countries. This is because in places like the US Doctors try to deliver before a woman siezes and the medical intervention may lower this. But medical intervention does not change occurance rates.

Some doctors do inquire about your nutrition, it just depends on the doctor you have. Mine did discuss nutrient among other things with me, but better or worse nutrient would not have changed my outcome.

If PE was caused by malnutrition, you would expect rates to be much higher in the inner cities and some of the poor rural areas of the US, for woman on welfare etc.. But its not. Woman in affluent subarbs suffer it at the same rate as the inner city. Also, you would expect thrid world countries rates to be significantly higher but they aren't. So either the entire world nutritional gets the same thing or its not playing a large part of why woman get PE in most woman that suffer from it.
Sure nutrition may make a difference on whether a woman/baby dies from PE, but the numbers just don't add up to show that nutrition is what is causing PE.
Nutrition is important, but its important to your overall health and not necessarily to prevent PE.

Erin

Mommy to Alex and Mason

Re : high protien diet

Post by joanne » Sun Dec 14, 2003 07:48 am

Sarah

This is an interestng debate but I dont think we disagree all that much.

I understand the necessity of and agree with a good diet in pregnancy for many reasons.

I would argue that the rate of PE occurrence is not that different around the world but that the outcome is better here because of the medical treatement available. If you look at our advantages (drugs , scans, tests, surgery access, special care facilities) in the Western world our access to good emergency health care is what saves our lives rather than our diet. There would be many more deaths here if we only had health care facilities to the standard available to others less fortunate.



Jo



Jo 30
Sandy 33
Kit 31 weeks
EDD 12/28/03

Re : high protien diet

Post by sarahedgcomb » Sun Dec 14, 2003 04:39 am

Hello

I couldn't help but chime in on this conversation. As some of you might have read in earlier posts, I think nutrition plays a big role in a healthy pregnancy - specifially protien - healthy protien from lean meat, nuts, beans, milk and eggs. Even "mainstream", well accepted pregnancy books from authors like Dr. Sears and others, recommend that a pregnant women eats at least 100 grams of protein a day - espeically in the 2nd trimester.

Of course, there are other reasons that women get preeclampsia, PIH and eclampsia - genetic mutations, metabolic disorders, underlying medical conditions like chronic hypertension, age, number of pregnancies and simply bad luck. I don't think that Megdemar was trying to insult the women on this site or downplay that there might be other reasons why one would become preeclamptic.

I've read a few posts on this site say that the rate of preeclampsia in poor and developing countries where malnutrition is commonplace, isn't any higher than in developed countries. Well, that is simply not true. In India, the infant mortality rate is something like 90 out of 1000. In the US, it's 6.8 - or around there. India has a very very high rate of eclampsia, and the mortality rate for the mothers with eclampsia is very very high as well. Most of this is linked to malnutrition.

I think that doctors and midwives, and us (as mothers and moms-to-be) should look at the "whole picture". I haven't run into a midwife or doctor, in the US or The Netherlands, who has asked me at my first appointment, what my diet is like. Never has a doctor or midwife talked to me about how much protein I should consume and what role nutrition plays in pregancy. Sure, I've gotten a pamphlet or booklet about what not to eat during pregnancy - like soft cheese and raw foods like fish - but never a question or a conversation about what's really important to eat during pregnancy. What's more (and on a slightly different train of thought..)every pregnancy magazine and pictures of pregnant women that you see, shows very thin model-like women, with little "bumps" where the baby is. I don't of any pregnant women who really look like that. Maybe, when they're 3 or 4 months along.

Of course, nutrition alone isn't going to solve the preeclampsia mystery and there are lots of women who eat well and still get preeclampsia. But I think instead of getting a bit defensive or guilt-ridden when someone comes on this site and suggests that nutrition plays a role in preeclampsia, we should be pushing our doctors and midwives to educate us and other women on the importance of nutrition during pregnancy. As well as pushing for the appropriate tests and screenings and proactive care that helps lessen the severity of preeclampsia.


Sarah

Re : high protien diet

Post by joanne » Sat Dec 13, 2003 05:35 am

Laura

I too have a thing about some midwives and their views or ignorance of PE. I might try that voodoo suggestion......

Quotes

" its hot weather thats why your BP is up and you are dizzy.."
" you have white coat syndrome..."
" BP is supposed to be raised in 2nd trimester....."
" no-one ever gets it the second time...."
" take a sleeping tablet"
" you have been overworking..."
" take these antiboiotics..."
" why are your lips blue - take off your make up.......(girl was have an asthma attack!!!)
"140/89 - thats normal" - without looking at my history
" you'll get to 36 weeks - stop worrying"

I have to say there were one or two brilliant midwives who got me through, listened to my concerns and advised me truthfully.

Jo


Jo 30
Sandy 33
Kit 31 weeks
EDD 12/28/03

Re : high protien diet

Post by joanne » Sat Dec 13, 2003 05:19 am

Laura

My own experience of PE treatment in the UK is "wait and see". ie reactive and not proactive. This ties in with no one knows what causes or cures it so whatever you take can't be guaranteed to work.

Specialists and they are reluctant to prescribe anything in particular. Advice is usually, eat normally ( nothing special you do will make any difference), rest if your BP is going up.

Of course if you are in your first pregnancy and start to develop PE symptoms there is very little you can do at that stage ( as regards food to make a difference).

There are some good specialists. My specialist advised me to eat normally, aspirin ( in my circumstances ) and vitamin C and E after 12 weeks and not to overdo the stress. He had carried out plenty of tests to look for underlying conditions. There was the caveat at the end that there are no guarantees the same would not happen again anyway.

No one I have come across expressly recommends or disapproves of Brewer.

I ran Brewer past my consultant who smiled and said I could try it but there was no evidence to say it worked. I did for a bit but felt constantly bloated so toned it down to a normal healthy diet.

p.s. this is only my experience and there are probably different views and opinions from others in the UK.



Jo 30
Sandy 33
Kit 31 weeks
EDD 12/28/03

Re : high protien diet

Post by mada » Fri Dec 12, 2003 01:18 am

Too funny Laura...I to agree that no one needs to feel more guilt about this disease....I mean we are constantly blaming ourselves during pregnancy thinking it was something we did. And yes diet is important but so many women do eat tons of protien ect. and still develope PE. This is about saving moms and babys.....ANd that means more than just eating well.It is imperative to have the right tests, medications (if needed) and bedrest.....

Mada Harpster

Sam 6-29-00 36weeks P.E.
Ben 11-03-01 No P.E.

Re : high protien diet

Post by laura » Fri Dec 12, 2003 11:33 am

Jo, are people familiar with the Brewer diet in the UK? What are the perceptions there? Is it common for providers to "prescribe" the diet for sick women?

I would hope that if providers do advocate this diet, at the very least they don't abdicate for their responsiblity as providers to run the requisite tests, and watch closely for worsening symptoms.

I developed a lasting, profound mistrust for providers as my midwife quite literally told me to "go have a steak" as I became increasingly ill. If she had said- "do this 24 hour urine and come back for a NST and then go have a steak", perhaps I wouldn't have a little voodoo doll bearing a striking resemblance to her with pins sticking out of interesting parts of the anatomy....

Laura-28
DH Jack-30
Allie 5-13-98 (35 weeks-pre-e)
Baby Camille 4-17-03 (36 weeks- htn and oligo)
http://www.babiesonline.com/babies/c/camilleandallie/

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