Open Letter to Pregnancy at About.com

[annegarrett]

This article has got me steamed--so excuse me while I vent. Sit back, take it in, and if you are so inclined, please email About.com and suggest that next time they get a "real" doctor to write about a subject that is this important.

The article:
http://pregnancy.about.com/cs/healthduringpreg/a/aa102698.htm

Here's the contact info:
http://ourstory.about.com/contact.htm

Here's my vent:

About.com: "Pregnancy induced hypertension (high blood pressure during pregnancy), PIH, is not a recognized term by the National Workshop on Hypertension and Pregnancy."

PF: There has been no such workshop. The National Institute of Health (NIH) sponsored a High Blood Pressure in Pregnancy Working Group which developed guidelines and does recognize the term PIH. I would know--as I was in the working group and the only lay person there. The other 16 attendees were all perinatologists (High risk pregnancy obstetricians) or researchers.

About.com:
"• Generally these women will have readings consistently above 140/90 prior to 20 weeks gestation.
• Transient Hypertension: Basically this diagnosis is everyone else. An elevation of blood pressure during the third trimester without signs of preeclampsia, in a client known to not have blood pressure problems prior to pregnancy."

PF: Maybe I am just being nit-picky but PIH is simply an elevation of blood pressure during the third trimester without proteinuria… The signs of preeclampsia are only two—proteinuria and hypertension.

About.com:
"Is there a group of women who are more at risk for high blood pressure?
Yes, here are a few:
• Women during their first pregnancy
• Extremes of childbearing age ([ 15 years and ] 35 years)
• African Americans
• Malnourished women *
• Multiple gestations"

PF: *This is inaccurate, misleading and potentially harmful information. No significant studies link malnutrition with preeclampsia. PIH or preeclampsia occurs as commonly in areas of famine as they do in the protein-rich diet of Americans (even the poor eat their share of McDonalds). PIH and preeclampsia occur at a rate of 5-7% internationally—regardless of diet and nutrition. It happens as often in war-torn Sudan, famine-ridden Ethiopia, as it does in the protein-rich diet of the Alaskan Inuit. While a good diet is naturally important—malnourishment does not automatically lead to high blood pressure and to suggest so falsely lays blame on the hearts of women who are already bearing the burden of losing their first born babies. It is just plain misinformation and unkind.

Additionally—she left out the leading risk factors:
Previous pregnancy complicated by preeclampsia or PIH
Obesity
Diabetes
Pre-existing hypertension
Polycystic Ovarian Syndrome
Repeat miscarriages
Fertility treatment
Lupus and other autoimmune disorders
History of hypertension, cardiovascular disease, diabetes, or preeclampsia in the family

About.com:
"Why is Pregnancy Induced Hypertension (PIH) a problem?
Due to the poor functioning of the placenta being more likely these women run the risk of having babies who have Intrauterine growth retardation (IUGR), abruption of the placenta, and a greater incidence of still birth. These women also have a greater risk of developing preeclampsia and all of the associated risks."

PF:
The poor functioning of the placenta is CAUSED by the disease...not more likely...a fact of the disease. Women who have PIH have approximately a 50% risk of preeclampsia.

About.com:
"What can be done to prevent or treat PIH?
Prevention:
• Lifestyle management, and Dietary Habits
• Evening Primrose Oil and Fish Oils"
Treatment:
• Low Dose Aspirin Therapy
• Head out of water immersion
• Calcium Therapy
• Protein, as outlined by Dr. Tom Brewer
• For the woman with PIH and no signs of preeclampsia: home bed rest, fetal monitoring in the form of ultrasound to assess the growth of the baby.

PF: No one is going to say that taking EPO or Fish Oils (if frankly your hormonally challenged upset tummy can keep them down) is bad for you, lifestyle management and dietary habits is so vague...The only treatment for preeclampsia or PIH is delivery. There is no known prevention or treatment. Low-Dose Aspirin therapy has been associated with an increased risk of still-birth, Calcium has been studied ad infinitum in multi-million dollar multi-center studies (CPEP, among others) and shown it to be insignificant as a treatment; protein and the inclusion of Dr. Tom Brewer in this list is disturbing…particularly as Dr. Brewer’s research is based in part on 1920s research and his own research from the 60s has never been endorsed by anyone (other than himself) in the preeclampsia research community. Moreover, preeclampsia and PIH have renal (kidney) complications and excessive protein is dangerous for a woman with a compromised renal system. There is some research that shows that Head out of the water therapy is beneficial, if only for a short time, and generally--none of these suggestions (except the high protein diet) are dangerous--just relatively unhelpful. Nothing, at this point, can stop, slow, or hasten the course of preeclampsia or PIH and to suggest otherwise raises a woman's risk of not getting timely medical treatment when her alternative therapies fail her. By all means--take OEP, take fish oil, go swimming, eat well, take extra calcium, eat enough protein, but don't let any of that be a substitute for your prenatal care.

About.com:
"Not all of these treatments or preventions will work for every woman. You should talk to your practitioner if you have the risk factors prior to pregnancy, or as early in pregnancy as possible to help improve your chances of a better outcome."

PF: This is about the only thing they got right.

About.com References
• American College of Obstetricians and Gynecologists: Hypertension and Pregnancy. ACOG Tech Bull 219, 1996.
• Day, LD: Hypertension in Pregnancy. In Frederickson H, Wilkins-Haug L (eds): OB/GYN Secrets, 2nd, ed. Philadeplphia, Hanely & Belfus, 1997, pp 171-175.
• Roberts, JM: Pregnancy-related hypertension. In Creasy R, Resnik, R (eds): Maternal-Fetal Medicine: Principles and Practice, 3rd ed. Philadelphia, W.B. Saudners, 1994, pp804-843.

PF: Dr. Roberts is not only on our board, but also was the leader of the NIH Working group. I know he doesn't recommend Oil of Evening Primrose, fish oil or aspirin therapy.

This is just a joke. By inserting Dr. Brewer’s reference in this article she is suggesting he is on par with ACOG. She does not reference the National High Blood Pressure in Pregnancy Taskforce recommendations—though she cites it (inaccurately) and she does not reference Dr. Brewer but just tosses him in there. The Preeclampsia Foundation is not suggested as a place for more information despite it being routinely cited by the NYTimes, CNN, Reuters, BBC, NBC, among others...

Our organization is led by 6 perinatologists and our website has been vetted by all of them (as well as other internationally known researchers) top high risk pregnancy specialists with an interest in preeclampsia and PIH—five of whom were ON the taskforce she erroneously quotes.

Next time you want to do an article about a disease that is the leading cause of women and infants dying in the USA and the world (some 2 women a week in this country alone) and the leading known cause of prematurity—find a real doctor to do the article (we would be happy to help you find one—we would be happy to write it) and get professional references. Inaccurate, incomplete, poorly researched and downright dangerous information can do more harm than good.

Sincerely

Anne Garrett
Executive Director
Preeclampsia Foundation

[mada]

Anne,
That is so weird!! We must be on the same wavelength because I saw that article on about.com like 2 days ago and was totally aggravated!! This is just the sort of thing that does not need to be out there filling women with false info and worse off false hope...thinking if they change their diets ie..Brewew[}:)] Outcomes will be different..let's not even start on the guilt people could feel...Ridiculous!!!

Mada Harpster-moderator for pregnant again

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

[denise]

Oh, I will be sending an email to them as well. [:(!][:(!][:(!]

-------
Denise (28)
Jason (31)
Ariana (15 months)-born 5/3/03 at 35 weeks due to HELLP
TTC #2 starting in October!
http://hometown.aol.com/scrapperlang/Home.htm

[frasiah]

This is what I sent the lady:

Ms. Weiss

I hope that you are well. This email as in response to your article on about.com. I am greatly distressed by the content of your email because I believe it gives a lot of incorrect information. My daughter was born last year at 29 weeks due to severe preeclampsia which started out as PIH. Your solutions as presented in your article would not have done anything for me and in fact would have endangered my life and that of my daughter even further. It surprises me that you would recommend eating excesses in protein for a pregnancy woman already having kidney problems. Also, if your theory on malnutrition was true, then I would expect to find more women presenting with PIH and Preeclampsia in third world countries where hunger is rampant. Yet, the statistics for occurrence of the disease are about the same in the whole world, 5-7%. Of course, in third world countries where the level of care is not at its greatest, the disease would have more severe outcomes. There are more mothers and children who die from preeclampsia and its complications in third world countries than in more developed western countries. Oh, I have seen women who could be termed as clinically malnourished having successful pregnancies and deliver big healthy babies in Kenya. The average woman in Kenya for whom eating that much protein (especially meat protein) is a luxury, has healthy term pregnancies . While this is not scientific proof that protein is not a cure for PIH and Preeclampsia, it does pose a lot of questions for Dr. Brewer and his supporters. The goal in pregnancy should be to eat a healthy balanced diet.

Lifestyle changes as a cure for the disease is also a very vague term. May I assume that you are referring to diet and exercise habits? Is it changes before, during or after the pregnancy? A pregnancy woman on strict bedrest cannot do anything in terms of exercise or any movement. And I am not advocating for sedentary lifestyles once a woman is pregnant, but to write that engaging in exercise and diet changes would have changed the outcome of the disease is not only downright unfair and cruel but it is misinformed. What are you trying to do, convince afflicted women that it is their fault that their children were born early and or died?

I do not know what was the intent of your article because if it was to inform, I would assume that you would have contacted the Preeclampsia Foundation to find out what they have to say about the disease.

Could you please rewrite your article so that it may help women get the care they need and help those who have already been afflicted learn more about a dangerous and potentially deadly disease? Could you please rewrite your article so that women in Kenya who come across it will not blame themselves for the death of their unborn children? Will you please rewrite your article so that should a father read it, they will understand what is happening to the mother and his child and know how best to help them?

Thank you very much for reading this email. Below is a link to the preeclampsia foundation and the people there would be more than happy to discuss this disease with you.

www.preeclampsia.org

Sincerely,
Frasiah
DD sev PE

[tinalowe]

Oh my! I absolutely hate crap like this (almost as much as the diet Mada referred too). How is an article filled with so much mis-information supposed to help someone! In fact it hasna't helped me...I can feel my bp rising even as I type!!!!! Just the idea that someone would suggest that if I ate better I could have prevented this...there are no words to describe how I feel about that. (and the few that do come to mind are not for sensitive ears) I will definetely be emailing her as well!

Tina 23
DH Dereck 26

Emma Victoria stillborn 12-28-03 severe pre-e
ttc#2

[pdorsey]

Did about.com respond to your letter?
Paul

[jyn]

It is so sad that there is a huge source of misinformation in this world. I with past PreE pregnancys did feel it was my fault. Not until I found your website did I truely understand what was happening to me. In fact during my 2nd pregnancy I used diet and exercise to try and control preE but it did not work!
Thank you for this wonderful site!!!!!!!


Jyn 30
DH Andy 33
Logan 8yrs preE 38 weeks
Aleck 4yrs preE 36 weeks
due 11/21/04 on partial bedrest since June full since August 19th

[tafkap]

I mistakenly thought that the PF forum was not doing anything to prevent this misfacts about Tom Brewer and about P.E. I'm happily, wonderfully, and THRILLED to be so wrong.

THANK YOU, Anne, for taking the time to write. I will try to send a letter as well.




Jessica & Corey~ baby #1
Katherine Grace born
10-13-2003
34weeks,6days,39minutes PIH/ Pre-E www.coreyandjess.info

[annegarrett]

Thanks for the kudos Jessica. I try to really stay on the fence because--hey--that diet might work for some woman--but the fact is--we don't know and to suggest we do is just wrong. There is no plot by the drug companies to keep our women "addicted" to epidurals and c-sections and away from a healthy lifestyle. We have no support from the drug companies.

I just get a little steamed but yes, I personally think the Brewer diet is dangerous and think so because I stupidly tried it with my third pregnancy--the one that nearly killed me. I know women though who swear by it. I know that juicing and a vegan diet bought my mom five full years with terminal cancer. I am the last person to suggest that diet and stress reduction aren't important--they are--o it, absolutely, but not at the expense of your common sense. If you are seeing spots--no amount of fish oil will fix that, if you have lost your baby, no one needs to hear "You should have eaten more meat." That is just cruel.



Anne Garrett
Executive Director
Preeclampsia Foundation

[denise]

Okay, I don't know what kind of response you ladies received from your letters to About.com, but this is what I received today......

quote:

---

Denise,

Thanks for writing me. As you know with many subjects in pregnancy, the experts disagree often. What one swears by the other finds to be
worthless. Each piece of information here is to be used as a starting
point to ask questions of their practitioner. I hope you also noticed
that this is just one page of information about this topic on my site. I have many other links to other sites with opposing viewpoints, including the link you listed.

This piece was written with the information provided by Dr. Tom Brewer and other experts who have written and published extensively about PIH, pre-e and ecclampsia.

Thanks again.

Robin

---

Um, Dr. Brewer was consulted as an expert????[xx(] Has anyone found any info provided by Dr. Easterling at this site??


-------
Co-coordinator for WI
Denise (28)
Jason (32)
Ariana (16 months)-born 5/3/03 at 35 weeks due to HELLP

http://hometown.aol.com/scrapperlang/Home.htm