"Intra-uterine growth retardation" is the termed used when the baby is not growing as much as it should be. Babies who are smaller than they should be at this stage of the pregnancy are called "small for gestational age" (SGA).

If you are going to a midwife, she has been measuring your belly every visit, from your pubic bone to the top of your uterus (the top is called the "fundus"). The measurement is taken in centimeters (cm), and the number of cm of your measurement should equal the number of weeks of pregnancy (gestation) that your baby is, plus or minus 1-2 cm.

When a baby is smaller than s/he should be for her/his gestational age, one of the first things that a midwife looks for is whether you have been eating enough of the right kinds of foods, because the only way the baby can grow is by taking in nutrients that come to her/him through the umbilical cord, and those nutrients can only come from foods that you eat. Contrary to the beliefs of some, the baby cannot create the nutrients that s/he needs from the mother's body fat.

See here for a diet adjustment that can help turn an IUGR situation around

You can also refer to the "Bad Placenta?" story on the "Stories" page of this website for a dramatic account of how a SGA baby was rescued by her mother's use of the Brewer Diet.

See here for the "Bad Placenta?" story

See here for more information on how the over-medicalization of normal childbirth can cause low birth weight

The following questions and answers regarding IUGR are from The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer (Krebs) and Tom Brewer, MD.

But if I salt my food to taste for nine months, won't that cause a lot of swelling from excess water retention? Many women cut out all added salt during the last few days of their menstrual cycles, anyway, because it helps get rid of that bloated feeling. Aside from the discomfort, isn't swelling a danger sign in pregnancy? (p. 48)

Note from Joy: See paragraph #6 for explanation of IUGR.

It certainly can be a danger sign--but only when the swelling is caused by not eating enough of the right foods (including sodium-rich ones) or by a medical condition that would cause swelling in a non-pregnant woman or a man as well, such as heart failure or kidney disease.

The swelling that accompanies the normal course of pregnancy while you are on the Brewer Medical Diet is attributable to an entirely different cause--your healthy, well-functioning placenta. The same hormones that you've noticed make you swell up somewhat just before your period (some women hold an extra 5 to 7 pounds of water) are made in ever-increasing amounts by your placenta as pregnancy goes along. By the eighth month, in the well-nourished mother, the placenta makes--every day--the equivalent of the hormones in a hundred birth control pills! This swelling is not hazardous to you or to your baby. In fact, it's a natural way for your body to prepare for labor and breastfeeding by storing fluids you may need to avoid dehydration if your labor lasts a long time and to establish and maintain quality milk production.

Though all swelling may look the same, the situation inside your body is critically different when you are swelling on a good diet. On a nutritionally sound diet your liver has all the building blocks it needs to manufacture adquate amounts of a protein, albumin, that holds water in your circulation--the primary means by which your increased blood volume needs are met during pregancy. The larger volume of nutrient-rich blood servicing your placenta results in the larger production of female hormones and, so, more water retention than in a mother with average nutrition. It is possible for your tissues to hold 10 to 15 pounds of fluid for this reason without causing much change in your appearance--perhaps the fine lines in your face disappear and your rings feel somewhat tighter.

This "hidden" water retention in the well-fed pregnant woman (plus the increased size of her baby) has seldom been accounted for in the charts that break down the components of average weight gain in pregnancy, so they typically show a total of 24 to 28 pounds, whereas women on the Brewer Medical Diet gain, on the average, 35 to 45 pounds. Of course, many women gain less and many gain more based on their prepregnancy weights, metabolism, and activity level. We do not use the average as a rule (either a floor or a ceiling) for weight adjustment in pregnancy; it only demonstrates that the average figure you see elsewhere fails to consider the additional, beneficial water retention that comes with a good diet.

When your diet is not meeting your nutritional needs, the internal events are exactly the opposite. If the liver is undersupplied with the nutrients needed to produce albumin (and this is one of the most complicated functions the liver performs, so it's one of the first to go when nutrients are scarce), it cuts back. This decrease in production is detectable by analyzing a sample of blood: anything below 3 grams per 100 cubic centimeters of serum indicates a problem. With less albumin circulating and drawing water into the circulation, water that should be held inside your blood vessels cannot stay there. Instead, it leaks out into your tissues. Voila! You're swelling up, and the scales tell you about the water you're retaining--but they don't tell you where it is. Nor do they tell you that your blood volume is falling below the needs of a healthy pregnancy and that your placenta is starting to malfunction because of the reduced amount of blood flowing through it.

The pregnant woman on a poor diet (or even one on a basically nutritious diet who is not eating enough to meet her calorie needs) is not swelling from the influence of an increase in female hormones generated by a generous, healthy placenta. She is experiencing a shift of essential body fluids out of her circulation and into her tissues. If the situation continues, her other critical body organs, like the kidneys, liver, heart, lungs, and brain, become adversely affected by the dwindling blood supply (the kidneys respond, for example, by raising the blood pressure), and her baby begins to suffer intrauterine malnutrition. Most commonly this situation is diagnosed after a few weeks when the baby's failure to grow is noted at subsequent prenatal appointments. The medical terminology for this condition is intrauterine growth retardation (IUGR). If caught early enough, the situation can be reversed with appropriate nutritional intervention--by getting the mother on a diet suitable for her pregnancy needs and keeping her on it for the rest of her pregnancy. This includes salting to taste.

This interconnection between the foods you eat, how your liver works to keep your blood volume expanded, and the transfer of nutrients to your baby via the placenta is central to every successful pregnancy. It is impossible for anyone to evaluate what's happening internally from looking at your swelling or pressing your shinbone to see if you have water retention. Laboratory work measuring your blood proteins and hematocrit reading must be done before any diagnosis is made.

Swelling on a good diet is a sign of health in pregnancy. So salt to taste as an integral part of your pregnancy nutrition program. Do not restrict salt. Do not take diuretics or appetite suppressants to control your weight. Any of these actions is a direct attack on the expansion of your blood volume and places you and your baby in jeopardy for the most serious pregnancy complications.

Note from Joy: While the use of amphetamines and diuretics may no longer be considered the mainstream treatment of choice for the symptoms of toxemia, other methods of weight control in pregnancy and treatments for toxemia are currently in vogue which are equally hazardous to both the baby and the mother. And unfortunately, the hazards of these current treatments are no more recognized by the mainstream practitioners of today than were the hazards of the earlier use of amphetamines and diuretics by the practitioners of yesterday. I have been witness to some of the current hazardous treatments, just within the past 5-10 years.

I worked for a homebirth midwifery practice for several years. For most of that time, all the midwives were supportive of the use of the Brewer Diet by the clients of the practice. The last year of my time there, we got a new midwife on staff who was very opposed to the use of the Brewer Diet. Whenever we got a new client who was the least little bit on the plump side, she would apparently tell her to get a little more exercise and eat a little less carbohydrates. When her blood pressure would start to creep up, she would tell her to cut back on her salt a little bit. No amount of my trying to explain the Brewer insights to her made any headway. As a result, within the first six months of her being on staff, we had 2-3 clients who had to be hospitalized with blood pressure problems and premature labor, as I recall, which was very uncharacteristic of our practice.

So it is very important that we not dismiss the historical accounts that Brewer has documented for us. We need not look down our noses at his reports of the starvation-amphetamine-diuretic practices of the physicians around him in his early days, and his efforts to stop those practices. We have our own faulty treatments in our own time, which are based on the same faulty thinking, and are just as hazardous as the treatments that he witnessed.

In addition, unfortunately, some areas of the "alternative medicine" community have apparently 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 on the hazards of using herbal diuretics in pregnancy

"Forty Weeks, Forty Problems" (pp 162-163)

I had ultrasound scans at twenty-four and twenty-eight weeks because my family doctor was having trouble deciding whether my baby was growing normally.

There didn't seem to be much change in the size of my uterus from twenty weeks to twenty-four weeks. The scan done at twenty-eight weeks shows that my baby is only the size of a twenty-three week pregnancy. My doctor wants me to travel a hundred miles to a high-risk pregnancy unit at our state medical school hospital and be admitted for tests. I just found out about your diet and I know I haven't been eating anywhere near that amount of food. If I start eating better now, will my baby catch up, or is it too late?

You still have the last twelve weeks of pregnancy to go--the time when your baby puts on weight most rapidly--so yes, catching up is possible, assuming you haven't been severely limiting your food intake up until now. In some cases where the growth of the placenta has been impaired because of very poor diet, the recovery period for the baby is not so successful--no matter how well you eat toward the end of your pregnancy. There is less placental mass and a reduced capacity to transfer the nutrients you are suddenly providing from the foods that you eat.

We are always optimistic about efforts to improve the feeding of pregnant women, though, based on the work of Leela Iyengar, M.D., of India published in this country in 1968. She brought women diagnosed as malnourished into the hospital and fed them over the last four weeks of pregnancy. The birth weights of babies born to these mothers were a full pound more, on the average, than those of babies whose mothers were also identified as malnourished but were not provided supplemental feeding. Placental function, measured by excretion of estrogens in the urine, also improved dramatically following the improvement of the mothers' nutritional status.

So don't despair. Chances are good that you can do a great deal for your baby during these next three months, especially since this is the critical period of time for the development of your baby's brain. It used to be thought that everything of significance in organ formation happened in the first three months of gestation, but much work now points to the last eight to ten weeks of pregnancy as another time when even mild degrees of maternal undernutrition can prevent the brain from developing normally.

There are some nonnutritional causes for intrauterine growth retardation that your doctor probably would like to rule out as being of signigicance in your case (hence, the tests in the regional high-risk center). Infections your baby may have acquired in utero, abnormalities of the placenta and/or cord, and abnormalities of the baby's chromosomes or heart can also cause your baby to be small for gestational age (SGA). However, before you enter the hospital for the series of tests, give improved nutrition a try for two or three weeks and then ask for a reappraisal of your situation. Explain to the doctor that you don't think you've been eating well enough and you'd like to see if a trial of improved nutrition will bring about increased growth. Since there is nothing to be done for the nonnutritional causes for SGA babies, you have nothing to lose by waiting.

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

The series of tests at the high-risk unit would probably also include an evaluation of your kidneys, cardiovascular system, any nonnutritional anemias, and the presence of any other medical diseases that might require treatment. You will also be asked about your smoking, drinking, and hard drug habits, all of which can be associated with a slower rate of fetal growth primarily because they substitute for eating.

There is one last factor to be considered. Are you sure of when you conceived? If you became pregnant while breastfeeding and hadn't truly resumed normal periods, or if you became pregnant immediately after stopping birth control pills, you may not be as far along as your chart says. In either case, all you can do now is to start eating correctly every day to see if you can bring your baby at least up to appropriate weight for weeks of gestation.

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

From a previous question regarding dates, ultrasound scans, and nutrition (pp 155-156).......

A repeat scan will detect any failure of your baby to grow (intrauterine growth retardation, or IUGR). However, measuring the height of your uterus, a time-honored way of appraising fetal growth, can also sound the alert. Any time it is suspected, of course, the treatment for IUGR must include a complete nutritional workup and correction of any deficiencies. All too often, the mother is just assigned to a high-risk category, shifted to the care of a high-risk specialist until her underweight and sickly infant is born, and her nutrition fades into the background as a battery of tests are ordered many times over.

The Brewer Medical Diet for Normal and High-Risk Pregnancy available here

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

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.

Perinatal Support Services: pregnancydiet@mindspring.com