by annegarrett (2525 Posts), Mon Aug 23, 2004 04:06 pm
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.
Here's the contact info:
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.
"ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Generally these women will have readings consistently above 140/90 prior to 20 weeks gestation.
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ 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 proteinuriaÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¦ The signs of preeclampsia are only twoÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âproteinuria and hypertension.
"Is there a group of women who are more at risk for high blood pressure?
Yes, here are a few:
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Women during their first pregnancy
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Extremes of childbearing age ([ 15 years and ] 35 years)
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ African Americans
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Malnourished women *
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ 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% internationallyÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âregardless 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 importantÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âmalnourishment 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.
AdditionallyÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âshe left out the leading risk factors:
Previous pregnancy complicated by preeclampsia or PIH
Polycystic Ovarian Syndrome
Lupus and other autoimmune disorders
History of hypertension, cardiovascular disease, diabetes, or preeclampsia in the family
"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."
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.
"What can be done to prevent or treat PIH?
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Lifestyle management, and Dietary Habits
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Evening Primrose Oil and Fish Oils"
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Low Dose Aspirin Therapy
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Head out of water immersion
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Calcium Therapy
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Protein, as outlined by Dr. Tom Brewer
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ 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 disturbingÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¦particularly as Dr. BrewerÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢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.
"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.
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ American College of Obstetricians and Gynecologists: Hypertension and Pregnancy. ACOG Tech Bull 219, 1996.
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ Day, LD: Hypertension in Pregnancy. In Frederickson H, Wilkins-Haug L (eds): OB/GYN Secrets, 2nd, ed. Philadeplphia, Hanely & Belfus, 1997, pp 171-175.
ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â¢ 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. BrewerÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢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 recommendationsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âthough 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 PIHÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âfive 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 prematurityÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âfind a real doctor to do the article (we would be happy to help you find oneÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âwe would be happy to write it) and get professional references. Inaccurate, incomplete, poorly researched and downright dangerous information can do more harm than good.