by annegarrett (2525 Posts), 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.