The cause of pre-eclampsia was discovered in the 1950's and 1960's, by an obstetrician by the name of Dr. Tom Brewer. In the process of his medical education, and researching the work of Hamlin, Strauss, Burke, and Ferguson, doctors who had worked on this problem in the 40 years previously, he discovered that the cause of pre-eclampsia was an abnormal blood volume, caused by malnutrition, or food deficiency.

Here is an excerpt from an article that I have written on the Brewer Pregnancy Diet....

One of the main functions of the pregnant body is to preserve the pregnancy and nourish the baby. The body's ability to do this well depends a great deal on its ability to increase the mother's blood volume. Normally, this blood volume is expected to increase by 50-60%, over the course of the pregnancy.[4] For a woman with a pre-pregnant weight of 130 pounds, this would be a increase of about 2.1 quarts of blood (from about 3.5 quarts at the beginning of the pregnancy to about 5.6 quarts at the end of the pregnancy).

The liver makes albumin to facilitate this blood volume expansion. Albumin is similar to egg white. When it is in the mother's bloodstream, it creates osmotic pressure, which pulls extra fluid out of her tissues and back into the blood circulating in her blood vessels. The only way that the liver can make this albumin is from protein which the mother eats.

However, if the mother is trying to restrict her weight gain to someone's "ideal" number, by going on a high protein, but low calorie diet, much of the protein that she eats will get burned up for calories. Brewer has found that when a woman eats 1/3 less calories than the 2600 calories that he suggests, or about 1700 calories, half of the protein that she eats will get burned for calories.[5] In that case, only 60 of her 120 grams of protein would get used to make albumin (and baby cells, and uterine muscle cells), and she will probably have trouble expanding her blood volume adequately.

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

Salt also has osmotic pressure which helps to pull extra fluid out of the tissues and into circulation. While salt restriction may be helpful for pregnant women who have unhealthy hearts or kidneys, it is dangerous in healthy women. A healthy woman's taste buds are usually the most accurate indicator of the amount of salt that she needs, and studies have shown that it is not possible for a healthy pregnant woman to eat too much salt. Her kidneys simply excrete whatever extra salt that she eats.[6] In fact, it has also been shown that after just 2 weeks of "salt in moderation", the mother's blood volume begins to drop.

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

When the blood volume stops increasing, or drops, the body has no way of knowing that the mother is just eating less. All it knows is that the blood volume is less than it's supposed to be. So it starts the same processes that it uses when the blood volume is dropping due to hemorrhage. The internal organs must be preserved, at the expense of the limbs, if necessary. So the kidneys produce an enzyme called renin, which causes the blood vessels to constrict.[7] During hemorrhage, this response is a very helpful stop-gap measure, decreasing the amount of blood in the limbs, to send more blood to the internal organs, while help is on the way. During pregnancy, however, when no hemorrhage is occurring, this blood vessel constriction causes a rise in blood pressure. Attempting to treat this rising blood pressure with salt restriction, or weight restriction, only causes the blood volume to drop even more, leading to further formation of renin and more blood vessel constriction. And the blood pressure continues to rise.

Meanwhile, the kidneys are desperately trying to increase the blood volume by reabsorbing as much water and salt as they can, from the fluid that they have filtered out of the blood. They return this reabsorbed fluid and salt to the circulation. However, since there isn't enough albumin and salt in the circulation to hold this reabsorbed water, much of it leaks out into the tissues. The kidneys keep reabsorbing water at one end of the process, the water keeps leaking out of the capillaries at the other end, and the mother sees rapid swelling in her ankles, and rapid weight gain (from the extra water in her tissues).

The mother presents herself to her birth attendant (doctor or midwife), who tells her that she is developing pre-eclampsia. If her nutrition is not improved quickly, or if diuretics are prescribed (in medications or herb teas), her blood volume will continue to drop, and she will develop eclampsia (toxemia). Toxemia can culminate in convulsions, coma, and death. Many sources maintain that there is no known cause of toxemia, and therefore many practitioners continue to try to manage the situation by treating the symptoms alone, but they do so without success.[8] The symptoms not only persist, but the mother also continues to experience one complication after another.

Note from Joy: Please note that the use of diuretics and amphetamines 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 and amphetamines 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

Treating Pre-eclampsia

One way to treat pre-eclampsia is to educate the mother about the cause of her illness, and strongly encourage her to eat according to the Brewer Diet plan, and suggest that she eat something every hour that has protein in it. When the problem seems to need a more immediate response, the birth attendant can give the mother albumin intravenously,[9] and sometimes put her on antibiotics (to lessen the load on the liver by aromatic toxins from the intestines).[10] Dr. Brewer would often tell of one woman who, unable to find a doctor who would give her IV albumin, brought her blood pressure down by eating 52 eggs and drinking 6 quarts of milk, over a period of 3 days. *

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 the end of this page for the footnotes for this article.

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

See "Physiology" page here

See "Elevated Blood Pressure" page here

See an overview of the history of Brewer's perspective on pre-eclampsia here

See "Mistaken Diagnosis" here

The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer [Krebs], with Thomas Brewer, M.D., 1983.

"Metabolic Toxemia of Late Pregnancy (MTLP)" (p. 219)

Metabolic toxemia of late pregnancy is a specific disease entity characterized by a history of malnutrition, nausea, and vomiting; low blood proteins, especially low serum albumin; and low blood volume, which causes a marked reduction in blood flow to the placenta, kidneys, and other organs. It is a nutritional-metabolic-liver disease that occurs in the last half of pregnancy, more often in the seventh to ninth months, and disappears a few days after delivery.

As a result of the low blood volume and liver malfunction, the mother's blood pressure rises as the disease progresses, water and salt are retained abnormally, and protein appears in the urine as a result of damage to the capillaries of the kidney glomeruli or filters. In the most severe cases, hemorrhages develop in the mother's liver, brain, and other organs; convulsions, coma, and maternal and fetal deaths occur. This disease was previously termed "toxemia of late pregnancy" or "pre-eclampsia/eclampsia." Eclampsia comes from a Greek word meaning a flash of light; the term was used for the most severe form of the disease when the mother had convulsions and/or coma. Pre-eclampsia was used for the nonconvulsive stage characterized by excess water retention (edema), high blood pressure, and protein in the urine. Pre-eclampsia as used by most doctors and nurses in the United States today is an outdated term because edema, high blood pressure, and protein in the urine occur commonly in human pregnancy from many other causes than MTLP. The causes for these conditions need to be carefully investigated before any diagnosis is made.

The most important message about MTLP for the pregnant woman and her family is that it is now totally preventable. The dietary plan presented in this book will protect mother and baby from the ravages of this disorder, which is still responsible for some 30,000 infant deaths and several dozen maternal deaths each year in the United States alone. The role of good nutrition in the primary prevention of MTLP was recognized by many research workers in various nations in the the late 1920s and early 1930s. It is a paradox that the traditional prenatal care practices for the prevention of MTLP--blind weight control aiming at arbitrary numbers of pounds or "patterns of weight gain" and using low-salt, low-calorie diets as well as salt diuretics, sodium substitutes, and drugs like amphetamines to control appetite--have in fact caused MTLP in large numbers of pregnant women who carefully followed such recommendations without question. A detailed book about MTLP to share with your doctor or midwife is Tom's Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition (New Canaan, CT: Keats, second edition, 1982). For additional literature, contact the Toxemia of Pregnancy Foundation, P.O. Box 124, Bedford Hills, N.Y., 10507. This nonprofit organization sponsors an information line from nine to five (Eastern time) on weekdays, or for medical consultation in emergencies, twenty-four hours a day: (914) 666-5199.

Note from Joy: Unfortunately, this address and phone number are no longer a way that you can contact the Brewers.

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

The following is reprinted from Medikon International no. 4 - 30-5-1974.

"Iatrogenic Starvation in Human Pregnancy", by Tom Brewer, M.D., County Physician, Contra Costa County Medical Services, Richmond, California, U.S.A.

Frank Hytten tells us in his pregnancy physiology textbook of two pioneers in the field of iatrogenic starvation in human pregnancy.(1) A certain Professor Brunninghausen of Wurzburg decided, for reasons unstated, that it was better for women to eat less food during pregnancy; this was in 1803. A century later Prochownick is given credit in 1899 for introducing the idea that caloric and fluid restrictions during human pregnancy could produce an infant who weighed less at birth.(2) The intention of Prochownick was to minimize the cephalopelvic disproportion in a woman with a borderline contracted pelvis and thus reduce the incidence of surgical intervention in such patients. As surgical techniques developed with the practices of asepsis and improved anesthesia established, Western European obstetricians lost all fear of operative delivery. Prochownick's valuable clinical observation that caloric and fluid restrictions do in fact lower the birth weight of the newborn human infant was forgotten. Thus a very important clue to the mystery of "low birth weight for dates" newborns was buried.

Unfortunately, this still universal misconception became established as a dogma in clinical obstetrical teachings in Western medical culture: the human fetus is a parasite, will grow according to its "genetic code" to a given weight and length before birth, and that this growth and development are in no concrete, material sense influenced by the foods and fluids the pregnant woman is taking in during the course of her gestation.(3,4) Scientific obstetrics still suffers today from what I term "nutritional nonchalance" related to this false belief.

In 1972 officially in the United States the cause of eclampsia, the disease I term convulsive metabolic toxemia of late pregnancy (MTLP), was "unknown."(5,6) [This official assertion continues into 2008] Since this dread disease remains a common cause of maternal, fetal and newborn morbidity and mortality throughout the world, speculations about its etiology continue. It has been long believed that the Nutrition of the pregnant woman during gestation does in fact influence her development of MTLP. Women who develop MTLP are still accused of eating too many calories and too much salt (NaCl). That such an idea remains popular in 1973 stems from the fact taht very few Western-trained OB/GYN surgeons have ever taken time or interest to ask these poor women what foods and how much they have been eating and drinking during pregnancy.

When I began to work in the Tulane Service's prenatal clinics at Charity Hospital, New Orleans, Louisiana, as a third year medical student, pregnant patients were being told to restrict their caloric intake and to restrict their dietary salt intake: "So you won't have fits....so you and your baby won't die from toxemia." It is difficult for me to learn what is happening there now since no members of the Tulane faculty will communicate with me, but unofficial sources informed me not long ago that "...nothing has changed in this field since you were here over 20 years ago." I studied this problem for four years in another city-county hospital in our deep south. Jackson Memorial Hospital, Miami, Florida, from 1958 to 1962. A reliable communication from an established ostetrician in Miami in March, 1973 informed me that "...nothing has changed in this field since you left here over ten years ago." The common practices of weight control and dietary salt restriction seem eternal.

Since it is now clear that the sudden, rapid weight gain observed in patients with severe MTLP is a result of malnutrition with a falling serum albumin concentration, hemoconcentration, a falling blood volume with increasing interstitial fluid, we no longer need to blindly "control weight" with starvation type diets. However, fear of the unknown drives the most rational and "scientific" people to irrational actions; millions of pregnant women in Western European medical culture still suffer from iatrogenic starvation diets in the vague hope that caloric and salt restriction will in some way protect them and their unborn from the "ancient enigma of obstetrics," eclampsia.

Iatrogenic starvation in human pregnancy has a long and ignoble history in the United States: its traditions run strong and deep in one of our oldest and most respectable journals of obstetrics, the American Journal of Obstetrics and Gynecology. In its second volume published in 1921 we find this account by Rucker:

"On August 2nd, two weeks after her first visit, her blood pressure was 120/80, the urine was free from albumin and sugar. On August 17 her weight had increased 6 pounds and her legs were swollen up to her knees. She had no headache. Blood pressure was 180/90. Urine was free from albumin and sugar. She was placed upon a bread and water diet." (emphasis added)

"A week later, August 24, in spite of her rigid diet, she had gained 8 3/4 pounds more. (emphasis added) Her blood pressure was 205/110 and she was having pains in the back of her head and was seeing specks before her eyes. The urine showed a trace of albumin. No casts were found."(7)

Subsequently this poor woman had 11 convulsions. It is now clear that a "bread and water diet" is not effective prophylaxis for MTLP!

In the very first volume of The American Journal of Obstetrics and Gynecology published 53 years ago [as of1974], Ehrenfest reviewed "Recent Literature on Eclampsia," and found that venesection was still in common use for this dread disease: "For the purpose of reducing the blood pressure and of eliminating toxins...."

He reported another then widespread approach: "Diuretics should be accompanied by a total or partial restriction of salt. No meat shall be allowed." (emphasis added) Ehrenfest also noted the beginning of a scientific rejection of blood-letting in the management of eclampsia: "Cragin says: Eclampsia patients after convulsions resemble so closely patients in shock, that venesection seems illogical. They seem to need all the blood they have and more too."(8)

Here was the obvious clinical recognition of the hypovolemic shock which so commonly causes maternal and fetal deaths in severe metabolic toxemia of late pregnancy.(9) The illogical use of salt diuretics in this disease may be viewed now as a "modern" form of blood-letting in which electrolytes and water of the blood are forced out of the patient's body via her kidneys, a kind of cell-free venesection!

In April, 1969, I presented a paper to an international meeting on "toxemia of pregnancy" in Basel, Switzerland, by invitation of Dr. E.T. Ripperman, Secretary of the Organization Gestose.(10) Here I learned these interesting facts:

1. Eclampsia has virtually disappeared from Switzerland; there had been no maternal death from this disease in Basel for almost two decades.
   
   
2. Some Swiss OB/GYN professors were still teaching that the pregnant woman must avoid red meat as prophylaxis against eclampsia; for the Swiss this prescription seems to be working.
   
   
3. The incidence of low birth weight babies born in the University Hospital, Basel, in the year 1967, from some 3,000 deliveries was 3.0%.

It soon became apparent here from my discussions with many European OB/GYN authorities that the general nutritional status of the peoples of Central Europe was exceptionally good, and that this adequate nutrition was the basic cause for the elimination of severe MTLP and for the relatively low incidence of low birth weight infants.

My own paper presented in Basel was received with the utmost skepticism: the European obstetricians almost to the man responded: "Surely there is no severe malnutrition in rich America." Surely? The incidence of low birth weight in our nation has risen from 7.0% in 1950 to 10.0% now [1974] with much higher figures for all our poverty areas; MTLP continues to cause maternal-fetal and newborn morbidity and mortality. Iatrogenic starvation during human pregnancy is still widely practiced throughout our nation today because none of our medical or "public health" institutions have taken concrete actions to stop it.

A review of the unbound issues of The American Journal of Obstetrics and Gynecology reveals that for most of the 1950's and 1960's amphetamines and other "diet pills" were widely advertised for "weight control" in human pregnancy. Salt diuretics, long recognized to be lethal to the severely toxemic patient and to her fetus, were promoted by this journal form 1958 to 1972. Professor Leon Chesley finally recognized their harmful effects on the maternal plasma volume.(11) The advertisements for these water pills were then stopped but not their widespread use.

Today in 1973 the problems of rising prices for essential foods like lean meats, chicken, eggs, vegetables and fruits, and the continuing poverty and economic depression in many areas of our nation can not be solved by the nation's physicians. However, do not humane physicians today have a special and moral responsibility to stop the blind errors of iatrogenic starvation in human pregnancy? Do not obstetricians, especially, in charge of human antenatal care in public clinics and private offices, have a responsibility to their pregnant patients to give them scientific nutrition information? The protective effects of applied, scientific nutrition in human antenatal care have recently been dramatically documented by Mrs. Agnes Higgins of the Montreal Diet Dispensary.(12) The rationale for blind weight control to any "magic number" of pounds in human pregnancy has been completely destroyed.(13) What then must the obstetricians of our nation do? What actions must they take to insure maternal-fetal and newborn health for each woman who wants to produce a normal, full term child and remain in good health herself?

1. Recognize the complications of human pregnancy caused by malnutrition.(14)
   
   
2. Teach each pregnant woman as a routine part of modern, scientific prenatal care, the basic principles of applied scientific nutrition.
   
   
3. Insure that she actually eats an adequate, balanced diet all through gestation.
   
   
4. Encourage her to salt her food "to taste." (with rare exception)
   
   
5. Stop "weight control" to any number of pounds. (when nutrition is adequate and balanced, the weight gain takes care of itself with an average gain in healthy pregnancy of about 35 pounds)
   
   
6. Protect each pregnant woman and her unborn from all harmful drugs, especially salt diuretics and appetite depressants.
   
   
7. On the postpartum wards educate all pregnant patients who have suffered nutritional complications during pregnancy--so that those complications will not recur in subsequent pregnancies.(15)
   
   
8. Stop iatrogenic starvation in human pregnancy.

These measures will begin to open a new era in preventive obstetrics in our nation and dramatically reduce the numbers of low birth weight and brain-damaged and mentally retarded children now being born.

REFERENCES

1. Hytten, F.E. and Leitch, I. The Physiology of Human Pregnancy. 2nd edition, Oxford, Blackwell Scientific Publications, 1970.
   
   
2. Prochownick, L. "Ein Versuch zum Ersatz der Kunstlichen Fruhgeburt" (An attempt towards the replacement of induced premature birth. Zbl. Gynak. 30:577, 1889.
   
   
3. Williams, Sue Rodwell. Nutrition and Diet Therapy, 2nd Edition. St. Louis, Mosby, 1973, Chapter 17.
   
   
4. Brewer, T.H. "Human Pregnancy Nutrition: an examination of traditional assumptions" Aust. N.Z. J. Obstet. Gynaecol. 10:87, 1970.
   
   
5. Pitkin, Roy M., Kaminetzky, Harold A., Newton, Michael, and Pritchard, Jack A. "Maternal nutrition: a selective review of clinical topics" Obstet. Gynecol. 40:773-785, 1972.
   
   
6. Brewer, T.H. "Human maternal-fetal nutrition". Obstet. Gynecol. 40:868-870, 1972.
   
   
7. Rucker, M. Pierce. "The Behavior of the uterus in eclampsia" Amer. J. Obstet. Gynecol. 2:179-183, 1921.
   
   
8. Ehrenfest, Hugo. "Collective review: recent literature on eclampsia". Amer. J. Obstet. Gynecol. 1:214-218, 1920.
   
   
9. Brewer, T.H. "Limitations of diuretic therapy in the management of severe toxemia of pregnancy: the significance of hypoalbuminemia" Amer. J. Obstet. Gynecol. 83:1352, 1962.
   
   
10. Brewer, T.H. "Metabolic toxemia of late pregnancy: a disease entity" Gynaecologia 167: 1-8, 1969. (Basel)
    
    
11. Chesley, Leon C. "Plasma and red cell volumes during pregnancy" Amer. J. Obstet. Gynecol. 112:440-450, 1972.
    
    
12. Primrose, T. and Higgins, A. "A study in human antepartum nutrition" J. Reproduct. Med. 7:257-264, 1971.
    
    
13. Pomerance, J. "Weight gain in pregnancy: how much is enough?" Clin. Pediat. 11:554-556, 1972.
    
    
14. Brewer, T. "Metabolic toxemia: the mysterious affliction." J. Applied Nutrition 24:56-63, 1972.
    
    
15. Brewer, T.H. "A case of recurrant abruptio placentae." Delaware Med. J. 41:325-331, 1969.

The following is reprinted from Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition, by Thomas H. Brewer, M.D., 1982.

"Metabolic Toxemia of Late Pregnancy in the Third World" (p. 170)

As U.S. Americans we have a fundamental responsibility to our own people in this field, but we also recognize the worldwide nature of the role of malnutrition during pregnancy in a vast spectrum of preventable human suffering and diseases and deaths of women and babies. That this role can be so distorted, repressed, denied, ignored is one of the modern enigmas of obstetrics in the 1980's [and continuing in the 2000's]. We have received personal communications from physicians who live in Mexico and other Latin American nations, in South Africa and other African nations, in India, in Thailand, in Iran, in Iraq, in Egypt, etc. all of whom have observed a high incidence of MTLP among women in poverty in those nations. Wherever the Western low calorie, low salt diets for blind weight control and use of salt diuretics become popular, MTLP appears with increasing frequency among the upper classes, a result of iatrogenic maternal malnutrition and hypovolemia.

Here are a few recent references from the literature:

AFRICA................Lancet 1;146, 1978, Jan. 21
THAILAND..............Obstet. Gynecol. 54:26, 1979
INDIA.................Am. J. Clin. Nutri. 34:775, 1981
MEXICO................Am. J. Obstet. Gynecol. 142:28, 1982, Jan. 1

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

To Be Continued....

4. Gail Brewer, The Brewer Medical Diet for Normal and High Risk Pregnancy, p 7.

5. Ibid., p 39.

6. Ibid., pp 46-51.

7. Gail Brewer and Janice Presser Greene, Right from the Start (Emmaus, PA: Rodale Press, 1981), p 7.

8. Gail Brewer, BMD, p 220.

9. Thomas Brewer, Metabolic Toxemia of Late Pregnancy pp 15-21, 80.

10. Ibid., pp 27, 33-35.

Perinatal Support Services: pregnancydiet@mindspring.com