Is there a connection between diet and the risk of being diagnosed with preeclampsia?

Diet and Preeclampsia: Evidence-Based Connections

Dietary factors play a significant role in preeclampsia risk, with calcium supplementation and healthy dietary patterns showing the strongest evidence for prevention in women with low calcium intake. 1

Key Dietary Factors Affecting Preeclampsia Risk

Calcium Intake

• Calcium supplementation (1.5-2.0 g/day) is strongly recommended for pregnant women with low calcium intake to prevent preeclampsia 1
• The WHO guidelines specifically recommend calcium supplementation as part of antenatal care, particularly for women at higher risk of hypertension 1
• Calcium carbonate is the most cost-effective formulation, ideally administered in divided doses of ≤500 mg elemental calcium per dose 1
• Calcium supplementation (≥1 g/day) is recommended for pregnant patients with essential hypertension if dietary intake is likely low (<600 mg/day) 2

Healthy Dietary Patterns

• Diets focusing on fruits, vegetables, whole grains, and limiting foods high in fat, sugar, and salt are associated with reduced preeclampsia risk 3
• Studies that focused on diet interventions have been effective in reducing preeclampsia risk 1
• A high-fiber diet (25-30 g/day) may help reduce blood pressure, inflammation, and attenuate dyslipidemia 3
• Healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood, and monounsaturated vegetable oils show strong consistency and biological plausibility for preeclampsia prevention 4

Weight Management

• Body mass index is proportionally correlated with preeclampsia risk 3
• Women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational weight gain 3
• Excessive gestational weight gain is associated with preeclampsia risk 1
• Weight reduction during pregnancy is not recommended despite its potential benefits in reducing blood pressure 1

Other Nutritional Factors

• Vitamin D status should be adequate, with supplementation considered alongside calcium 3, 4
• Milk-based probiotics may be beneficial for pregnant women at risk of preeclampsia 3
• Foods high in added sugar, particularly sugary drinks, are associated with increased preeclampsia risk 4
• For those with low selenium intake (such as those living in Europe), increased fish/seafood consumption or selenium supplementation may be beneficial 3

Ineffective Dietary Interventions

Several nutrients previously believed to affect preeclampsia risk have been shown to have no significant effect:

• Vitamins C and E supplementation 3, 5
• Magnesium supplementation alone 3
• Salt restriction 3
• Omega-3 long-chain polyunsaturated fatty acids (fish oils) 3
• Zinc supplementation 3, 5

Clinical Implementation

1. Assess calcium intake at first prenatal visit

   • If intake is likely low (<600 mg/day), recommend calcium supplementation (1.5-2.0 g/day) 1, 2
   • Begin supplementation early in pregnancy and continue until delivery 1

2. Evaluate dietary patterns and recommend:

   • Increased consumption of fruits and vegetables (≥400 g/day) 3
   • Plant-based foods and vegetable oils 3
   • Limited intake of foods high in fat, sugar, and salt 3
   • High-fiber diet (25-30 g/day) 3

3. Address weight management:

   • Counsel on appropriate gestational weight gain based on pre-pregnancy BMI 1, 3
   • Recommend physical activity appropriate for pregnancy 1

4. Consider additional supplementation:

   • Daily multivitamin/mineral supplement 3
   • Vitamin D assessment and supplementation if deficient 3, 4
   • Low-dose aspirin (100-150 mg daily) from 12 weeks until 36-37 weeks gestation for women at high risk 2

Pitfalls and Caveats

• Calcium and iron supplements should ideally be separated by several hours to minimize the inhibitory effect of calcium on iron absorption, though clinical impact appears minimal 1
• Focusing on single nutrients may obscure the complexity of interactions that affect preeclampsia risk 6
• The pathophysiology of preeclampsia is multifactorial, so dietary interventions alone may not prevent all cases 7
• Weight reduction during pregnancy is not recommended despite its potential benefits in reducing blood pressure 1
• The timing of nutritional interventions is important - ideally beginning before or early in pregnancy for maximum benefit 1

By implementing these evidence-based dietary recommendations, particularly calcium supplementation for those with low intake and promoting healthy dietary patterns, healthcare providers can help reduce the risk of preeclampsia in pregnant women.