An editorial published in the Journal of the American Heart Association highlights the significance of diet as a lifestyle intervention to reduce the risk of preeclampsia.
Study: Diet as a Lifestyle Intervention to Lower Preeclampsia Risk. Image Credit: SUKJAI PHOTO / Shutterstock
Background
The prevalence of hypertensive disorders of pregnancy, including preeclampsia and gestational hypertension, is increasing worldwide, affecting up to 10% of all pregnant women. These disorders are associated with high maternal and fetal morbidity and mortality and significantly increase the long-term risk of cardiovascular disease in mothers.
Lifestyle factors, including diet, are vital in maintaining heart health and reducing cardiovascular disease risk. Diets rich in vegetables, fruits, whole grains, and high-quality lean proteins, such as the Mediterranean diet and the Dietary Approaches to Stop Hypertension and the Mediterranean diet (DASH), have been found to significantly reduce the risk of serious cardiovascular events, including cardiovascular infarction, stroke, and death due to cardiovascular complications.
Given the overlap between hypertensive disorders of pregnancy and cardiovascular disease, it might be expected that healthy dietary patterns may similarly reduce the risk of hypertensive disorders of pregnancy.
In this context, recent evidence indicates that pregnant women with higher adherence to the Mediterranean diet are at lower risk of adverse pregnancy outcomes, including hypertensive disorders of pregnancy. In contrast, a study conducted on women with pre-pregnancy risk factors could not find any beneficial effects of the Mediterranean diet on preeclampsia risk reduction.
To more conclusively understand the impact of healthy diets on hypertensive disorders of pregnancy risk, scientists at the University of Southern California, Los Angeles, have analyzed data from the MADRES (Maternal And Developmental Risks from Environmental and Social stressors) study, which is an ongoing study predominantly involving low-income Hispanic/Latin women from Los Angeles, California.
About the study
The study population included 451 adult women who completed up to two 24-hour dietary recalls (Solid Fats, Refined Grains, and Cheese; and Vegetables, Oils, and Fruit; VOF diet) in the third trimester of pregnancy. Information on hypertensive disorders of pregnancy was derived from participants’ medical records.
The scientists used multivariable logistic regression to evaluate the association of participants’ dietary patterns and the Healthy Eating Index 2015 (a diet quality index according to the Dietary Guidelines for Americans) with preeclampsia, gestational hypertension, and any hypertensive disorder of pregnancy. In addition, they determined the associations with participants’ body mass index (BMI).
Study findings
The study found that a higher adherence to solid fats, refined grains, and cheese is associated with the risk of development of preeclampsia and any hypertensive disorders of pregnancy. In contrast, a higher adherence to the VOF diet was found to reduce the risk of preeclampsia. No significant association between the Healthy Eating Index-2015 and the risk of hypertensive disorders during pregnancy was found in the analysis.
A subgroup analysis based on pre-pregnancy BMI revealed that the VOF diet could reduce the risk of preeclampsia in overweight women but not in obese, underweight, or normal-weight women.
Further analysis conducted after excluding women with pre-pregnancy hypertension could not find any beneficial impact of the VOF diet on preeclampsia risk reduction. This could be because of wider confidence intervals caused by a smaller sample size.
However, there remains a possibility that a healthy diet like VOF can become less effective in reducing the risk of preeclampsia among women with pre-pregnancy cardiometabolic risk factors, including hypertension and obesity. These observations highlight the need for optimizing pre-pregnancy cardiometabolic health to reduce adverse pregnancy outcomes.
Study significance
The study shows that consumption of solid fats, refined grains, and cheese can increase the risk of preeclampsia during pregnancy. In contrast, dietary consumption of vegetables, oils, and fruits can be effective in preventing preeclampsia development among low-income Hispanic/Latic women.
Existing evidence indicates that consumption of fats and processed meat is associated with increased systemic inflammation and endothelial dysfunction, which are major hallmarks of pre-pregnancy hypertension and obesity. These factors could be responsible for the development of preeclampsia and other hypertensive disorders during pregnancy.
Lesser availability and affordability of healthy foods to low-income women highlight the impact of socioeconomic disparities on adverse pregnancy outcomes.
Future studies should include women of various racial and ethnic backgrounds and those with pre-pregnancy cardiometabolic risk factors to more conclusively determine the impact of healthy dietary patterns on the risk of hypertensive disorders of pregnancy.
