Elevated blood pressure in an otherwise healthy pregnancy, often called "Pregnancy Induced Hypertension", is caused by low blood volume. This in turn is caused by a lack of the foods necessary for maintaining a healthy pregnancy.

One of the main tasks of the pregnant body is to increase the blood volume by 50-60%. The liver works at increasing the blood volume by making albumin from the protein that the mother eats. The salt that the mother eats also helps to increase the blood volume. Both albumin and salt create osmotic pressure, which helps to hold fluid in the mother's circulation, so that it doesn't leak out into the tissues of her ankles and fingers.

When the mother doesn't eat enough salt, and protein, and calories (to save her protein from getting burned up for calories), the blood volume stops increasing, and it plateaus or begins to drop. When the blood volume is less than it should be for that stage of pregnancy, the body reacts the same way as it would if the blood volume were too low due to hemorrhaging. The kidneys produce renin to constrict the capillaries and send all the available blood to the internal organs, as they would do in the case of hemorrhaging, to save the internal organs at the expense of the limbs, if necessary. In the case of pregnancy, however, where the inadequate blood volume is due to lack of proper nutrition, and not from hemorrhage, this constriction of the capillaries makes the blood pressure go up.

Salt in Pregnancy

	High Salt Diet	Low-Salt Diet
Toxemia	37/1000	97/1000
Perinatal deaths	27/1000	50/1000
C-section	9/1000	14/1000
Abruptio placenta	17/1000	32/1000

If the mother will increase the amount of salt, protein, and calories that she eats, the blood volume will increase, and the blood pressure will come down to a normal level. Sometimes this means that she will need to eat an ounce or two of protein every hour. Some examples of items that she could eat every hour are a handful or two of nuts, or cheese cubes, or trail mix. She could also eat a hard-boiled egg, or a slice of cold cuts, or a cup of yogurt, or 1/4 cup of cottage cheese.

Nutritional Deficiency in Pregnancy

Complications	Control Group (750)	Nutrition Group (750)
Preeclampsia	59	0
Eclampsia	5	0
Prematures (5 lb. or less)	37	0*
Infant Mortality	54.6/1,000	4/1,000

Once the process of pre-eclampsia has started, Anne Frye recommends having the mother eat a high protein item every waking hour. She also suggests, "Initially recommend an increase to 150 to 200 grams of protein daily (250 to 350 grams or more with multiple gestations), with 3,000 to 4,000 calories and 500 mg of choline daily...If the woman has a history of liver disorders, recommend less protein (120-150 grams for a single fetus); her liver may be overwhelmed otherwise, and monitor her lab work closely for changes...Once liver enzymes and blood proteins have normalized, the hemoglobin has dropped appropriately, the fetus is an appropriate size for dates and secondary symptoms have subsided, the woman can cut back to 100 grams of protein daily (150 grams with multiples)."

See here for more information on the best ways to treat pre-eclampsia

If she also wants to use herbs to help address her elevated blood pressure, the herb that I have seen work is Passionflower. According to Wise Woman Herbal for the Childbearing Year, the recommended dose is 2-4 capsules daily, or 15 drops of the tincture three times a day. However, in my experience the best results occur when the hourly doses of protein, and the other aspects of the Brewer Diet, are used alongside the use of the Passionflower, because in the absence of some kind of heart or kidney problem, the basic cause of the elevated blood pressure in pregnancy is the lack of enough of the right kinds of food.

She can also try adding beet juice to her daily nutrition (see news item below). But here again, she needs to use beet juice in addition to beefing up her food intake (adding more foods from the Brewer food groups), rather than instead of adding more food to her daily eating plan.

Susun Weed suggests up to 4 oz a day of beet juice, in her book titled "Wise Woman Herbal for the Childbearing Year." She also suggests that women can grate one raw beet and combine it with one grated raw apple, for a tasty and healthy snack that can help relieve elevated blood pressure and pre-eclampsia.

Susun Weed also suggests taking 2-10 capsules of garlic oil a day for lowering blood pressure. Once again, if you try this, do it alongside your hourly doses of protein, rather than instead of the protein. If you are expecting to have some kind of surgery soon, pass on this one, since garlic can lengthen the clotting times of your blood.

I do not recommend using herbs if you are on some kind of prescription medication. If your midwife or doctor is knowledgeable about herbs and their interactions with prescription medications, you can consult with her/him on this issue. If you want to try the beet or garlic suggestions, take care to start with the lower doses of the range suggestions and gradually increase them, keeping an eye on your blood pressure day by day, so that your blood pressure doesn't drop too fast.

Please see the "Physiology" page of this website, for a more detailed description of how an inadequate blood volume can cause an elevated blood pressure. You can also read one or more of the Brewer books, available in most public libraries, or through inter-library loan, and consult with your midwife, and decide what the best path is for you and your baby.

See Physiology Page here

Prevention of Convulsive MTLP (Eclampsia)

	Number of Pregnancies	Cases of Convulsive MTLP (Eclampsia)
Tompkins 1941	750	0
Hamlin 1952	5,000	0
Bradley 1974	13,000	0
Davis 1976	500	0
Brewer 1976	7,000	0
Total	26,250	0

Note from Joy: Please note that the use of diuretics in pregnancy was much more common when Dr. Brewer first started working with pregnant women. I believe that Dr. Brewer can be given a lot of the credit for the fact that they are rarely or never used in pregnancy now. The principle that weight control and salt restriction during pregnancy is hazardous to both the mother and the baby still stands, regardless of whether diuretics are used to assist in that control or not.

Unfortunately, some areas of the "alternative medicine" community have followed mainstream medicine in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties. Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant women to watch which herbs they are taking.

See here for more information about the use of herbal diuretics in pregnancy

At the Salt & Pregnancy Forum of May 2006 (1), organized by EuSalt, Prof. Dr. Markus G. Mohaupt already underlined that pregnancy is no time to reduce salt intake and that additional salt may benefit women suffering from pre-eclampsia.

Recently, Prof. Dr. Mohaupt published a case study (2) showing that an additional salt intake of 20g stopped hypertension during pregnancy… In this case, a 33-year-old woman with normal renin activity was diagnosed with essential arterial hypertension 15 years ago. During the 6 month period before conception, her blood pressure was well-controllable by dual antihypertensive treatment. Throughout pregnancy, blood pressure recordings were collected daily, and at five weeks of gestation in her first pregnancy, she stopped all antihypertensive drugs. As a result, the average blood pressure increased, whereas the expected increase in aldosterone synthase activity in pregnancy did not show. Given this hypoaldosteronism, sodium supplementation aiming at 20g total NaCl intake per day was initiated, and pursued throughout pregnancy, and resulted in a decrease of the blood pressure during pregnancy.

After delivery, maternal blood pressure rose again, NaCl supplementation was terminated and antihypertensive treatment was reinstalled. The observation that blood pressure was responsive to NaCl supplementation is in line with the hypothesis that intravascular volume decrease causes increased blood pressure in pregnancy. The absence of the expected increase in aldosterone synthesis was associated with a mutation of the aldosterone synthase gene, similar to earlier findings in pre-eclamptic women. This persistenthypoaldosteronism together with earlier findings on NaCl supplementation led the researchers to supplement salt in this woman. This salt supplementation was associated with a reduced blood pressure throughout pregnancy. In addition to this case, Mrs Sabine Kuse, founder of a support group (1984) for women in acute state and after pregnancy with pre-eclampsia or HELLP-syndrome, and her team have been advising more than 20.000 women during their high-risk pregnancies over the past 22 years.

They found that in most cases, additional salt helped within hours. More importantly, during all those years, they haven’t seen one case where salt supplementation has caused negative effects. The worst effect was no effect. (1) Support for this critical role of NaCl intake during pregnancy, was already provided by Robinson in 1958, who found a reduced incidence of pre-eclampsia in pregnant women on a high salt diet (3).

This study introduced substantial data for bias in other studies, of which all data suggest that salt restriction during pregnancy does not seem promising for the prevention of pre-eclampsia. Or, as the study of Mohaupt et.al concludes: pregnant women with even subtle signs of volume deficiency might benefit from salt supplementation in pregnancy.

Footnotes:
1. EUSALT Newsletter. Salt, blood pressure and pregnancy: a critical relationship? August 2006.
2. Markus G. MOHAUPT et.al . Blood pressure reduction in pregnancy by sodium chloride. Oxford University Press, 2006.
3. M. ROBINSON. Salt in Pregnancy. Lancet, 1958, 1: 178 – 181.

Source: 4th April 2007 12:23:26 / Femalefirst.co.uk

Placenta

As Figure 8 shows, it is also the action of your uterus that separates your placenta and expels it in the third stage of labor. This organ allows nutrients and oxygen to pass from your bloodstream into your baby's and also permits the removal of waste products from the baby's body. The placenta originated in cells from the fertilized egg. Enzymes on the surface of the ovum dissolved away a tiny portion of the surface of your uterine wall, opening a few arteries and veins in the process. With each beat of your heart, from that moment until your placenta comes away from the wall of your uterus, those arteries spurt jets of nutrient- and oxygen-rich blood against the surface of the placenta. This is the only blood supply to this most important organ, and only what is present in your bloodstream can nourish it and your developing baby.

The placenta is firmly anchored to the wall of your uterus by threads of collagen throughout and by a seal around its margin. Because of this, the blood that swirls up against the placenta stays in a "lake," continuously bathing the placental tissue. This blood does return to your heart after spending some time in the "lake," via the open veins that now function like the drain in you tub or shower stall: the pooled blood is pushed into the veins by the force of new blood coming into the "lake" from the open arteries. Technically, this sort of blood supply is termed an a-v (arterio-venous) shunt, meaning that the blood passes directly from arteries to veins without first passing through capillaries (the usual way things are done in the body).

Since the supply of blood encourages and supports placental growth, and a larger placenta requires more blood to keep it functioning optimally, ever-increasing amounts of blood are required as pregnancy advances to satisfy the needs of the placenta. If you are carrying a single baby, your blood volume will expand approximately 60 percent (if you eat well enough) to service your placenta. If you have twins (and therefore a double placenta or two separat placentas), your blood volume must expand by 100 percent or more to stay even with the demand. A falling blood volume or a blood volume that is below the needs of your pregnancy is recognized as a major cause of premature labor, underweight babies, and high blood pressure during pregnancy. When you recognize the importance of keeping your blood volume up and your placenta healthy (even though you can't see it or feel it), you will have a strong inducement to stay on your excellent pregnancy diet every day.

See here to better understand the evolution of the mainstream medical perspective on nutrition and salt in pregnancy

Nine Months, Nine Lessons available here

Perinatal Support Services: pregnancydiet@mindspring.com