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Preeclampsia: 5 ways nutrition supports blood pressure in pregnancy

If you’re pregnant or trying to conceive, your OB/GYN or other practitioners may have warned you about preeclampsia, a common pregnancy complication. Preeclampsia is a gestational hypertensive disorder that is more severe than gestational high blood pressure, but not as severe as eclampsia (seizures in pregnancy). It involves dysfunction in your blood vessels and in some instances can lead to organ failure. High blood pressure in pregnancy is incredibly common, occurring in 10% of all pregnancies!

To diagnose preeclampsia your doctor will look for high blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg, or both) plus evidence of protein in your urine (proteinuria). Most preeclampsia resolves once the baby is delivered, but sometimes it can persist after birth in a condition termed postpartum preeclampsia. Postpartum preeclampsia is one of the most common causes of readmission to the hospital following birth, affecting ~1% of all deliveries. The American Journal of Obstetrics and Gynecology recommends screening for it starting 48 hours after delivery and up to 6 weeks after delivery.

Researchers aren’t exactly sure what causes preeclampsia, but there is evidence that it starts with abnormal placental development in the first and second trimesters. Genetic factors, comorbidities, an altered immune response, and an increase in oxidative stress are all possible contributors to this altered placentation. From there, this lays the groundwork for preeclampsia to develop in the third trimester, when symptoms of high blood pressure and protein in the urine become evident. 

So the big question is… can you avoid preeclampsia? Well, yes and no. Some cases of high blood pressure and preeclampsia can be managed with lifestyle choices, but this is not true for all cases. There are many risk factors for preeclampsia including:

  • Family history of pre-eclampsia / genetics
  • First pregnancy
  • Multiples (twins, triplets, etc.)
  • Maternal age >35 years old
  • Previous placental abruption, IUGR, or molar pregnancy
  • Trisomy 13
  • Autoimmune disease
  • Gestational diabetes or preexisting diabetes
  • Chronic hypertension
  • Obesity
  • Chronic kidney disease
  • In vitro fertilization

You can see that there are a significant number of influences that are completely out of our control. We don’t know exactly what recipe of risk factors can trigger preeclampsia, but in this blog post, I want to share research on five nutrition factors that may reduce the risk of preeclampsia development. 

 

Preeclampsia: 5 ways nutrition supports blood pressure in pregnancy

1. Adequate protein may help to prevent preeclampsia

If you’re already familiar with my work, you know that I am a proponent of higher protein intakes during pregnancy than what is currently recommended by most practitioners. For preeclampsia specifically, low protein intake (<65 g/day) has been associated with increased risk for preeclampsia and eclampsia. If you’re familiar with the Brewer’s diet for supporting healthy blood pressure in pregnancy, high protein intake was one of the most important parts of this eating plan. 

Aside from total protein intake, your intake of specific amino acids is also important. Preeclampsia is a disorder that impacts the blood vessels, so having adequate ability for blood vessels to expand and contract is important for blood pressure regulation. The amino acid glycine helps in the production of elastin, which allows for this blood vessel flexibility. It also protects against oxidative stress by reducing free radicals, allowing for an increased availability of nitric oxide, further supporting blood vessels. Foods rich in glycine are outlined in chapter 3 of Real Food for Pregnancy and featured prominently in the meal plans in the book.

Be sure to check out my other article on protein and pregnancy for more on why protein needs are higher than previously thought and the role of specific amino acids in prenatal health.

2. Minerals matter for preeclampsia prevention and treatment

Sodium
Minerals like sodium (found in salt), calcium, magnesium, and potassium are all critical for preeclampsia mitigation, too. Studies show that a low-salt diet neither prevents nor treats preeclampsia. In fact, it can actually make it worse! 

Although conventional guidelines recommend reducing salt intake to lower blood pressure in general, pregnancy-induced high blood pressure seems especially non-responsive to salt restriction. A Cochrane systematic review concluded that lowering salt intake during pregnancy is not recommended. And in fact, recent studies have found that more salt rather than less actually lessens the severity of preeclampsia. But before you load up on salty, processed foods, be sure to consider potassium as well.

Potassium
While adequate sodium is important in pregnancy, it should be consumed hand-in-hand with potassium. A study that assessed urine analysis of sodium and potassium levels in pregnant women at the beginning of the third trimester found that women with preeclampsia had a higher ratio of sodium to potassium. This suggests that a diet rich in sodium without enough potassium (such as diets comprised primarily of ultra-processed foods) may lead to poor pregnancy outcomes. In other words, a diet of whole foods (with ample potassium) that is salted to taste is a good idea, but a diet of processed foods that’s very salty (but lacking in potassium) isn’t a wise choice. If you’re unsure how to meet the potassium needs in pregnancy, know that the meal plans in Real Food for Pregnancy are all plentiful in potassium.

Calcium
Women with preeclampsia also tend to have lower intakes of calcium and magnesium. To mitigate this, calcium supplements are often recommended to women with preeclampsia. A Cochrane review in 2018 suggested that a high-dose supplement of calcium (>1000 mg/day) reduces the risk of high blood pressure and preeclampsia in pregnancy, especially in women with a low-calcium diet. I am personally a proponent of food first, so ensure you read the calcium section of chapter 6 of Real Food for Pregnancy and consult with your practitioner before embarking on high-dose calcium supplementation.

Magnesium
Low serum magnesium status has been associated with a significantly higher risk of preeclampsia at both mid-pregnancy and term. A meta-analysis of seven randomized controlled trials with over 2600 total participants concluded that oral magnesium supplementation significantly reduced the risk of preeclampsia.

Because adequate mineral consumption may reduce the risk of preeclampsia, it is important to consume real foods during pregnancy that are nutrient-dense. Supplementation may be necessary sometimes, but focusing on nutrient-dense sources of sodium, potassium, calcium, and magnesium may help prevent preeclampsia. See my article on minerals and electrolytes in pregnancy to learn more about the best food sources.

3. Reduce oxidative stress in preeclampsia with colorful produce

Vegetables and fruit are some of our best sources of potassium, namely: green leafy vegetables, tomatoes, bananas, Brussels sprouts, mushrooms, winter squash, avocados, citrus fruit, and broccoli. In addition, fresh produce — especially colorful fruits and vegetables — are rich in antioxidants. Since preeclampsia likely stems from an increase in oxidative stress, antioxidants help to counterbalance this.

While all produce provides some level of antioxidants, berries are especially high in them. Studies suggest consuming berries may help to lower your blood pressure. Plus, the fiber in berries and other produce (especially non-starchy vegetables) can help keep blood sugar in a healthy range by slowing the absorption of carbohydrates from your digestive system (see why this is important in point 5 below).

4. Choline supports the placenta in preeclampsia 

An overall eating pattern of adequate protein, minerals, and colorful produce is important, but I want to highlight a specific nutrient that may protect against preeclampsia: choline. 

Choline is a micronutrient found in greatest concentrations in organ meats, egg yolks, and meats and seafood that plays a big role in placental function. Choline is significant because it may actually enhance the transfer of nutrients to your baby, a process that can be disrupted in preeclampsia. 

Studies that supplemented choline during pregnancy resulted in prevention of preeclampsia, reduced placental inflammation, and improved vascular placental function. In fact, up to 930 mg of choline per day may be beneficial – which is more than DOUBLE that of the current recommendations. You can learn more about choline and pregnancy here.

5. Balance your blood sugar for healthy blood pressure in pregnancy

I can’t underscore this enough – I am a huge proponent of eating for balanced blood sugar. While eating balanced meals has many glycemic benefits, did you know that high blood sugar and high blood pressure actually go hand in hand?

When a woman has insulin resistance (a hallmark sign of blood sugar imbalance) in the first trimester, this may actually predict preeclampsia later in the pregnancy. This may be one reason the development of preeclampsia is more common among women with blood sugar imbalances, such as gestational diabetes.

Even without any diagnosable blood sugar issues, high intake of refined carbohydrates in pregnancy is a risk factor for preeclampsia. A study of nearly 33,000 pregnant women found those who ate the most added sugars (i.e. ultra-processed foods) were more likely to develop preeclampsia. Worryingly, a recent study found that 58% of calories consumed on the average American diet are from ultra-processed foods — yikes!

The good news is you can offset this risk by eating an amount of carbohydrates that’s right for your body (i.e. some can tolerate more, some need less) as well as choosing higher quality carbohydrates (i.e. less processed). In addition, what you combine with your carbohydrates at meals and snacks can influence how much they raise your blood sugar. For the most stable blood sugar levels, combine your carbohydrates with foods that contain protein, fat, and fiber. For example, if you’re having a piece of bread, combine it with a source of protein, such as an egg, some turkey, cheese, or nut butter for more stable blood sugar levels. I discuss this in more detail in my continuous glucose monitor experiments (CGM experiment part 1 and part 2).

 

Summary

Preeclampsia may not be a pregnancy outcome we can avoid altogether, but you can incorporate these nutrition suggestions to help potentially reduce the risk of developing it (or lessen the severity of preeclampsia, if you do develop it). 

  • Focus on eating real, whole foods during pregnancy
  • Choose colorful fruits and vegetables high in antioxidants to reduce oxidative stress
  • Prioritize protein intake, especially foods with glycine, to support blood vessel flexibility
  • Incorporate liver, eggs, or other sources high in choline to support placental transfer of nutrients to baby
  • Maintain your minerals by getting enough sodium, calcium, magnesium, and potassium
  • Choose high-quality carbohydrates and reduce your intake of refined carbohydrates and added sugar

Nutrition is just one piece of the lifestyle puzzle, and I know other influences like stress, sleep, and toxins can impact preeclampsia risk, too. For more on preeclampsia, there’s a detailed section in Ch 7 of Real Food for Pregnancy covering additional strategies for reducing the risk/severity of high blood pressure and preeclampsia in pregnancy. 

Until next time,
Lily

P.S. If you have experienced high blood pressure or preeclampsia, I’d love to hear about your experience below. Was there anything you did nutrition or lifestyle-wise that improved your blood pressure?

Also, if you had any blood pressure abnormalities in one pregnancy and then avoided them in a subsequent pregnancy, tell us about it. I’ve received dozens of such stories to my inbox and social media messages and those stories deserve to be shared!

P.P.S. Once you start looking at the data on nutrition for preeclampsia, it’s easy to get overwhelmed! I know this is a very brief article and sometimes it’s hard for me to rein in the compulsion of writing a thesis paper on a topic (IYKYK, lookin’ at you, article on folate!). 

If there’s enough interest, I may put together a practitioner webinar that dives even deeper into the research on nutrition and preeclampsia for the Women’s Health Nutrition Academy. If you’re a practitioner interested in this topic, leave a comment below and let me know! 

 

References

  • American College of Obstetricians and Gynecologists. “Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ task force on hypertension in pregnancy.” Obstet Gynecol 122.5 (2013): 1122-1131.
  • American College of Obstetricians and Gynecologists. “Gestational hypertension and preeclampsia: ACOG Practice Bulletin, number 222.” Obstet Gynecol 135.6 (2020): e237-e260.
  • Wellcome, Jody L., et al. “Factors Associated with Postpartum Preeclampsia Readmissions.” American Journal of Obstetrics & Gynecology 226.1 (2022): S439.
  • Hauspurg, Alisse, and Arun Jeyabalan. “Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy.” American Journal of Obstetrics and Gynecology (2021).
  • Benetos, Athanase, Mirko Petrovic, and Timo Strandberg. “Compendium on the Pathophysiology and Treatment of Hypertension.” (2019).
  • Phipps, Elizabeth A., et al. “Pre-eclampsia: pathogenesis, novel diagnostics and therapies.” Nature Reviews Nephrology 15.5 (2019): 275-289.
  • Bej, Punyatoya, et al. “Role of nutrition in pre-eclampsia and eclampsia cases, a case control study.” Indian Journal of Community Health 26.Supp 2 (2014): 233-236.
  • El Hafidi, Mohammed, Israel Pérez, and Guadalupe Baños. “Is glycine effective against elevated blood pressure?.” Current Opinion in Clinical Nutrition & Metabolic Care 9.1 (2006): 26-31.
  • Schoenaker, Danielle AJM, Sabita S. Soedamah-Muthu, and Gita D. Mishra. “The association between dietary factors and gestational hypertension and pre-eclampsia: a systematic review and meta-analysis of observational studies.” BMC medicine 12.1 (2014): 1-18.
  • Duley, Lelia, and David J. Henderson‐Smart. “Reduced salt intake compared to normal dietary salt, or high intake, in pregnancy.” Cochrane Database of Systematic Reviews 3 (1999).
  • Gennari-Moser, Carine, et al. “Normotensive blood pressure in pregnancy: the role of salt and aldosterone.” Hypertension 63.2 (2014): 362-368.
  • Scaife, Paula Juliet, and Markus Georg Mohaupt. “Salt, aldosterone and extrarenal Na+-sensitive responses in pregnancy.” Placenta 56 (2017): 53-58.
  • Birukov, A., et al.. “Aldosterone, Salt, and Potassium Intakes as Predictors of Pregnancy Outcome, Including Preeclampsia”. Hypertension, vol. 74, no. 2, Hypertension, 2019, pp. 391–398.
  • Hofmeyr, G. Justus, et al. “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.” Cochrane database of systematic reviews 10 (2018).
  • Porri, Debora, et al. “Effect of magnesium supplementation on women’s health and well-being.” NFS Journal 23 (2021): 30-36.
  • Yuan, Jing, et al. “Oral Magnesium Supplementation for the Prevention of Preeclampsia: a Meta-analysis or Randomized Controlled Trials.” Biological Trace Element Research 200.8 (2022): 3572-3581.
  • Galleano, Monica, Olga Pechanova, and Cesar G Fraga. “Hypertension, nitric oxide, oxidants, and dietary plant polyphenols.” Current pharmaceutical biotechnology 11.8 (2010): 837-848.
  • Kwan, Sze Ting Cecilia, et al. “Maternal choline supplementation during pregnancy improves placental vascularization and modulates placental nutrient supply in a sexually dimorphic manner.” Placenta 100.45 (2016): 130.
  • Jiang, Xinyin, et al. “A higher maternal choline intake among third‐trimester pregnant women lowers placental and circulating concentrations of the antiangiogenic factor fms‐like tyrosine kinase‐1 (sFLT1).” The FASEB Journal 27.3 (2013): 1245-1253.
  • Bahado-Singh, Ray O., et al. “Metabolomic determination of pathogenesis of late-onset preeclampsia.” The Journal of Maternal-Fetal & Neonatal Medicine 30.6 (2017): 658-664.
  • Borgen, I., et al. “Maternal sugar consumption and risk of preeclampsia in nulliparous Norwegian women.” European journal of clinical nutrition 66.8 (2012): 920-925.

 

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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes.

47 Comments

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  1. In my first pregnancy, I was working full time and eating mostly carbs and definitely not enough protein. I never developed preeclampsia, but did have high blood pressure in my third trimester that led to induction. I read your book, Real Food for Pregnancy, that talks about these same points in this post, and implemented them into my lifestyle while TTC. I’m 33 weeks into my second pregnancy now and so far my blood pressure readings have been great! Adding in extra minerals, way more protein, and balancing my blood sugar has been a game changer this time around! I’ve felt so much better in each trimester.

    • Amazing work! Keep it up!

  2. My wife had to go to the hospital for observation for a night in the last week of her pregnancy because her blood pressure got to borderline preeclampsia levels. They recommended induction, but agreed to release her and have her monitor levels at home. We were hesitant to raise her sodium intake just because we didn’t want her to see a short term spike over allowable levels. But, we knew we had to get her levels down low enough that they wouldn’t spike too high at the beginning of labor. We always have LMNT on hand, so I mixed one up and she drunk the whole thing in just a few minutes. I didn’t know how quickly it would have an effect, but we checked it in 15 minute intervals for about an hour after she drank it. Her BP dropped close to 10 points in the first 15 minutes and stayed down. It stayed low until she went into labor and didn’t get any higher until near the end of her over 24 hours of labor.

  3. I’m not a practitioner but I’ve enjoyed your webinars. I’d love to see one!

  4. I don’t have a pre-eclampsia story, but I have a question/comment. Is it intentional not to date your articles? It would be really helpful to know the publication dates for including in references for assignments. Universities do allow URLs with date of access, but articles that are less that five years old are required.

    I love this article, and the food-first principles of pregnancy nutrition. Thank you.

  5. Thank you so much for this write-up! I developed pre-e during my pregnancy in 2018. By all accounts, my risk factors were minimal. I started developing symptoms at 20 weeks when I started developing floaters in my eyes while on vacation. At 28(?) weeks I had gained an abnormal amount of weight and my blood pressure was severely high so I was moved from a midwife to an OB. At 30 weeks I was having severe heartburn and went to urgent care, where my BP was as high as 190/120 and was almost induced. I was able to be on bedrest until about 35 weeks when they induced me due to high protein in my urine and my liver enzymes were increasing. The induction took 3 days and I was kept 3 days after. My blood pressure just wouldn’t drop back down. I was bp meds until my 6 week appt, which my OB was very reluctant to take me off. It did eventually drop to normal levels (but still trended on the high end). I tried exercising, eating “clean”, fasting, etc. The major change that got me down to healthy normal levels was incorporating meditation. Maybe it would have happened anyways, but after a few weeks of daily practice, my BP has been normal. It is sensitive to things like alcohol and processed foods still but I keep those at a minimum.

    While I ate “healthy” during my pregnancy, I did indulge more. I still made sure I had a green smoothie everyday, but I would also have French fries. Looking back, I’m pretty certain my protein intake was low.

    Overall, it was frightening for my husband and I and as you research, it really feels hopeless when it comes to prevention. There are definitely some things I’ll do different if I get pregnant again. I’ve seen that it often skips a pregnancy. I tried to research while I was in school but only found a few epidemiological studies so thank you for bringing more studies to light! I’m a newer functional nutrition provider and your webinars and posts have been incredibly helpful. I literally google-searched “Lily Nichols and preeclampsia” last night and nothing came up. Then I saw the email for this blog post this morning. Wild. Thank you for the work you do.

  6. I just went to the doctor for my 9 week pregnancy check-up. She suggested that I take a baby aspirin once a day starting at week 12 – because I am high risk for preeclampsia- due to my age; I am 43. She said that studies show that baby aspirin can really help prevent the risk of preeclampsia at my age. I am not sure how I feel about this. I don’t like taking any medication while pregnant. In the past they said Tylenol was safe in pregnancy and now that study came out and said it is not safe. I am wondering your thoughts on baby aspirin.

    • Same thing happened to me, I am 36 and have an IVF pregnancy but normal bp and was still advised to take 2 baby aspirin daily. I have had further screening for pre eclampsia and was told I am not at risk but my OB wants me to stay on the aspirin just incase. I don’t want to take anything if I don’t need to. Would also love to know to your take on baby aspirin. Thx!

      • I would LOVE some more comments on the baby asprin. I had pre-e with my 1st baby, did not take baby asprin (was also not super on top of my diet but overall I ate “well” just not taking into account all of the deficiencies in certain vitamins and minerals. Nothing ultimately came of the pre-e, but it was scary. SECOND pregnancy I took baby asprin the whole time, developed SEVERE pre-e at 34 weeks, then got HELLP syndrome, hemorrhaged severely, nearly went into liver failure. And though I’m sure there were other factors… I attribute some of it to the asprin because it can cause blood clotting issues which is exactly what caused me to hemorrhage. Now in 3rd pregnancy and will not take the baby asprin when it I know the OB will recommend it.

  7. I’d love to enter this conversation because I had so many questions during my two pregnancies that either weren’t or couldn’t be answered. With my first, my blood pressure was in normal range until I had a stressful disagreement with my midwife about an intervention I opposed. After that, my blood pressure was elevated 140ish/90ish when I was at the birth center. The midwives agreed that it was likely stress and had me take my own BP at home every morning and it was lower so they never stressed it very much after that. They said if it was high in labor they’d reassess and it wasn’t so no issues.

    My second pregnancy was during Covid, got pregnant Jan 2020 and also moved cross country during (many stressors). My homebirth midwife wasn’t comfy with my borderline high BP so she would make me take it in her office. I had a few near panic attacks, masked, and feeling unsupported so my BP became an issue. Did all the things I needed to do to rule out possible pre eclampsia with my doctor. Midwife eventually said if it’s high in labor we would go to the hospital. In labor it wasn’t. What am I to make of these situations. I’d like to have one more and don’t know how to get answers and choose a supportive environment to birth the way I prefer as long as everyone is healthy.

    My second midwife is the one who told me about you so I can thank her for that at least❤️

    • Stress definitely affects blood pressure and some have “white coat syndrome” where anxiety/stress over interactions with medical staff/fear of interventions or diagnoses can temporarily cause blood pressure to rise. Certainly something to factor in!

    • I’m so sorry to hear you had this stressful response after a disagreement with your midwife. I can relate all too well. I had to find new providers and am so thankful now for the disagreement bc I felt empowered in pregnancy and motherhood. I hope you feel similarly and see the silver lining!

  8. I had high BP readings in the hospital towards the end of my pregnancy, was monitored twice and it came down on its own, and I monitored it at home also. No pre-eclampsia indications. I put it down to fear of being induced, as I would get very stressed before hospital appointments and needed to listen to meditation music beforehand to try and stay calm! I was following your diet throughout mostly, with some random cereal cravings towards the end which may have also contributed. I cut down my solo date consumption, combined with cheese or other fat/protein, cut out cereal and protein bars, walked for longer daily and prioritised natural protein even more. Had no issues during labour or afterwards. I’d had a great pregnancy until the last few weeks. But I was super stressed about being forced to induce. They really tried it on me but I held out!

  9. I developed mild pre eclampsia in my first pregnancy at 38 weeks – which was disappointing because I felt like I really took my nutrition seriously (read your book in the first trimester). What I think was a big contributor to mine was stress, which I underestimated at the time. I was pregnant in the beginning of the pandemic which caused a lot of anxiety, worked crazy hours from home isolated with my husband, and we moved when I was 32 weeks out of San Francisco. Not say nutrition wasn’t important…probably would’ve been worse! I’d be curious about any research on the stress and nervous system that play a role.

  10. Yes! I did this for my second pregnancy. I did ivf for both of my pregnancies and I had chronic high bp in my first pregnancy, so was medicated with labetalol. Historically, rises in estrogen made my bp go up (so never was never on bc.) Thankfully, it never progressed to preeclampsia, but I did earn myself multiple visits to triage bc of random elevated bp. Fast forward to my second pregnancy, I joined a fertility program (Tasha Blasi’s program) and the first thing she sent me was your book! I changed from a mostly vegetarian diet to a whole food, grain, gluten, dairy and added sugar free diet, focused on sleep and hydration. I am certain that my body needed high quality animal protein and more anti-inflammatory foods. I had an extremely successful ivf cycle and the first transfer worked at nearly 39. I was taken off labetalol in week 11 bc my bp dipped so low, I almost passed out one day. And my bp was stable throughout the remainder of my pregnancy, unmedicated so my dr let me go a couple extra days before induction! Your diet recommendations have and continue to benefit my overall health. Thank you!!!!

    • Amazing testimony!

  11. I’ve been pregnant once, and I read your real good for pregnancy book..my OB said I was the ideal pregnant patient for her… ate Whole Foods, super clean, worked out till the day of my delivery, etc. come to the day of delivery and I had high blood pressure and a small amount of protein in my urine. They dubbed me pre-eclamptic. I was so upset. I’m curious to see if you or anyone reading this knows about my next pregnancy…even if I do not have high blood pressure my dr. Told me I’d still have to have a baby aspirin daily after 12 weeks!? Not happy about that and tbh makes me not want to get pregnant again 🙁

  12. In my pregnancy I had been following your diet and was eating lower carb, non processed foods salted to taste. My blood pressure was borderline problematic at about 138/84 for most of the last two months of pregnancy. I threw every trick in the book at it and was only able to keep it from getting worse. After pregnancy I started a different magnesium supplement and started getting horrible tension headaches multiple times a week. Switching back to my original magnesium helped for a while but then the headaches came back. I then learned about how many people are actually not getting enough potassium. Through really intentionally increasing my potassium intake, I have been able to make my headaches almost non existent. I am very curious to see if it will have any effect on my blood pressure in future pregnancies. I am so glad you are putting this information out there because in all my searching while pregnant, I mostly saw information about sodium, protein, and calcium, but no one was talking about potassium at all.

    • Hello! What are your favourite potassium sources? I’m trying to add more potatoes and bananas. Thanks!

  13. Excellent article, Lily.

    As histamine is increasing in awareness these days, I wanted to point out that elevated histamine is associated with nearly every pregnancy complication.

    Now, is high histamine the underlying issue? I don’t think so. I think it’s a response to low choline, low antioxidants, low folate and the other factors you mentioned here.

    That said, there are numerous genetic variations which increase susceptibility to higher histamine levels during pregnancy – like MTHFR, PEMT, DAO, ALDH and other cytokine related variants.

    “Preeclampsia has been linked to maternal endothelial damage and increased oxidative stress (Poston and Chappell, 2001, Sacks et al., 1998). Endothelial damage and oxidative stress are both linked to histamine production (Sahnoun et al., 1998), so a further link between histamine and preeclampsia could be expected. In preeclampsia, mean blood histamine levels increase with the severity of the disease”

    I love your work. It’s refreshing to see real research done in this area.

    • Would you recommend histamine block in pregnancy or is it not safe?

  14. Oh Lily, so grateful for all your work. I found you prior to my second pregnancy. Currently pregnant with my 4th. I have stories you’d probably love. My first, I delivered at 26 weeks due to HELLP (showed signs of high BP at 10 weeks, growth restriction was evident at 20 weeks – now that I know more). I was at deaths door for a week just trying to get baby girl to grow. She was born at 1lb 1oz. My placenta was dying when she was born and watching blood flow the last week, it was non existent. Made changes for #2 but low protein now that I look back. My providers had PTSD from us for sure. They got nervous when I spiked and delivered at 28+5. Worked with an MFM w/#3, supplemented progesterone, finally tested for GD and was positive — likely was with the other two but wasn’t far along to test. Ate more raw eggs this time and tried hard to eat more protein. Spiked at 33+4 and started spilling protein. Common factor, I got worse after betamethasone shots for baby each time. Not that we won’t do them but makes me wonder correlation with the blood sugar and steroid and BP. I was also low carb with 3rd. Currently 18 weeks, and focused on pro metabolic lifestyle. Drink lots of raw milk and daily focus is mineral intake. I can tell when I’m lacking sodium. Loosely following brewers diet. Protein is still hard, even just eating enough but eating more dairy to compensate (I was no dairy with the last 3 other than ice cream on occasion). Also high progesterone supplementation (following Pope John Paul). Anxious to see where we land this time.
    Happy to share more if you’re interested. your work has been so helpful to me, thank you!!

  15. I am currently pregnant (week 39!) and multiple OBs since the first trimester have told me that since Im “high risk”- over 35 and first pregnancy- I should take 2 baby tylenols per day to avoid preeclampsia. I took it a few times, but stopped.. 2 per day for 9+ months seemed so excessive! i checked with some physician friends outside of this specific hospital system and they never heard of this recommendation. I then bought “Real Food for Pregnancy” in the 2nd tri and read about the nutrition guidelines specific to preeclampsia and have followed that instead. My last prenatal w an OB, he was not pleased when I told him im not doing the baby tylenols and instead eating real, whole foods etc. My most recent prenatal visits are w a midwife and she has not mentioned the baby tylenols at all.

  16. I was diagnosed with pre-eclampsia right when I got to the hospital and was in labor. I had no HBP readings throughout my pregnancy, ate lots of eggs, added LMNT to my beverages and had berries every single day. I would imagine it was brought on more from stress, it was my first pregnancy, I’m over 35 and considered obese.

  17. Very interested in a practitioner webinar!

  18. I have no risk factors whatsoever. I had two normal pregnancies, then in 2020 I was overdue with my 3rd and started having higher BP than my usual (but still lower than the danger threshold) and migraines. Was admitted to triage to get checked out and was all clear except for critically low sodium. Was transported to a bigger hospital and put in ICU; they normalized my sodium, but were completely perplexed with the situation. I ended up having a precipitous labor & delivery in the ICU, was kept for a few days and released. Then 5 or 6 days later my BP spiked, had crazy headaches despite postpartum heavy pain meds, and trouble breathing. Back to the hospital for mag treatment and BP meds for a few more weeks. While my diet was probably very protein deficient there at the end, I second what others have said about the correlation between Pre-E & stress. Anyways, I’m pregnant with number 4, and would do nearly anything to avoid the Pre-E experience again. On baby aspirin (which I have no problem with) and doing research re:diet to mitigate the risk!

  19. Seeing all the aspirin comments so thought I would jump in and clarify. There is really good evidence on low dose aspirin therapy for the prevention/delay of onset of preeclampsia. Here’s a link to the standard ACOG guidance.

    https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2021/12/low-dose-aspirin-use-for-the-prevention-of-preeclampsia-and-related-morbidity-and-mortality

    It’s not a bad thing if you’re recommended to take low dose aspirin. I did this in my second pregnancy after having developed preeclampsia in labor with my first. I did not develop pre-e the second time around. I ate healthfully during both pregnancies but tried to up protein and limit carbs a bit during the second.

  20. I am a wellness coach and herbalist that is a huge fan of your book. As a mother who suffered several conditions during and after pregnancy that could have been avoided or addressed through diet, I tend to attract clients who deal with similar conditions. I hope that you hold a webinar on this topic. Learning how nutrition affects pre-eclampsia is something I am deeply interested in.

  21. During my first pregnancy, my baby was small and I had to be induced at 39 weeks. I ask my OB how I could get the baby to go bigger but he didn’t know. When I went in for the induction I had some elevated BPs and a small amount of protein in my urine. I thought I was a healthy person and that’s what got me researching. I found your book! For my second pregnancy, I switched up my vitamins and supplements. Drank electrolyte drinks and increased my protein. The whole pregnancy went well, with no elevated BPs and my second baby was much bigger!

    • Amazing!

  22. I had preeclampsia with my first child that went into eclampsia when I was I labor. With my second and third pregnancies I took a baby aspirin every day after the first trimester. This was prescribed by my OBGYN and they said studies show it prevents preeclampsia in subsequent pregnancies. Definitely something to ask your OB about if you had preE before!

  23. I’d love to hear your thoughts on sulphoraphane for preeclampsia treatment and prevention. I tried the suggestions you outlined without much improvement and my midwife agreed to me trying sulphoraphane even though there were only a couple of studies on it. It worked really well for me!

  24. Practitioner her and YES would love an even more detailed WHNA webinar on all things prenatal blood pressure! It’s a murky topic and I find that the conventional medicine world is especially fear-mongering in this area. Anyone else? Have had several clients just recently get sent straight to L&D for early induction with ONE high blood pressure reading. Thankfully many worked their way out of it and went on several more weeks to deliver healthy babies…but there was so much fear along the way.

  25. Thank you for covering this topic. I am definitely interested in a practitioner webinar, both personally and professionally.

  26. I am a HCP and would love to hear more about prevention of pre-eclampsia. It is one of our top 5 reasons for induction in pregnancy in my community!

  27. Currently 4 weeks pp. My BP pre-pregnancy was excellent. Interestingly, my blood pressure shot up to over 170 systolic while doing the glucose tolerance test. My blood sugars always remained stable, but my blood pressure would creep up to the higher side. I definitely saw a correlation with carby foods.

    Pre-pregnancy weight was also wnl, but I gained close to 90 pounds! Was very swollen. In two weeks, close to 40 of that came off without trying anything to lose weight. When I brought up rapid weight gain with the provider, she stated it was “probably due to something going on pre-pregnancy”.

    Postpartum, I was unable to breastfeed due to low supply, despite trying everything and seeing two lactation consultants. They were suspecting undiagnosed PCOS and/or IGT. I am not sure how to try to have a conversation with my OB to ask for an investigation into the root causes.

    I think it is interesting that my BP was impacted, but my sugars remained stable. I had an extensive functional medicine panel 6 months before conception, and all thyroid, insulin, and A1C were excellent. However, it took us 4 years to conceive, so I am wondering if something was undiagnosed prior to pregnancy.

  28. I had preeclampsia and was put on bed rest at 26weeks with my first pregnancy. I had to go to my doc two times a week and get blood work done once a week. Every other week I saw a specialist.
    I would go in to my apts and toward the end be sent to the birthing center for observation/ more labs because BP was still too high.
    At my 36 week apt, same thing but due to a significant los of amniotic fluid (water had not broke). But this time I had an emergency c-section due to my blood work being out of wack.
    A couple days previous to this apt I was experiencing body aches almost flu like symptoms but no fever or vomiting.

    Baby girl was in the NICU for a month but she is almost 5 now and thriving!

    I am currently 25 weeks pregnant with my second and have been really focusing on food and nutrition to hopefully prevent it this time.
    I have always been physically active and a healthy eater, but really honing in on my protein, minerals, and eating as nutrient dense meals as I can as well as staying physically active (yoga, strength training, Pilates)
    I take my BP at home multiple times a day and they are beautiful! But I have always had anxiety when I go to the doctor so my BP is always high when I’m in for my apts.
    I just take my at home BP log and my doctor does Sonos every time to check growth of baby. So far so good. She doesnt feel the need to take other actions at this time but is keeping a close eye on me.

    I’ve always been a huge believer that food is medicine so I always knew the next time i was pregnant I would really focus on nutrition to hopefully combat preeclampsia.
    I love your book!

  29. I had sudden preeclampsia in my first and only pregnancy.
    I was doing high intensity (pregnancy adjusted) workouts 4 days a week, eating quite healthy and clean, but also going for the desserts when i really wanted to.
    I was actually able to self-diagnose thanks to your book.
    My case was hard to diagnose because my blood pressure did not really go high and the protein in urine was very low. I was at the hospital purely because i was sure it was pree and asked to spend the night. Within 24 hours it went from a potential mild pree to emergency csection due to liver and kidney failure and i gave birth at 30 weeks.
    Though my weight was high compared to ‘conventional norms’ i was in the healthiest and fittest state of my life.

  30. yes, interested in more research on how protein intake can prevent pre eclampsia.
    Thank you !
    Mischa Orbons, CPM, LDM

  31. I would definitely be interested in a webinar on pre-eclampsia/high blood pressure prevention from a nutritional perspective. I am a community based midwife and personally experienced pre-eclampsia with my first pregnancy and was induced at almost 32 weeks, my BP crept up through pregnancy and then spiked and almost immediately after that I had protein in my urine. I had low appetite throughout my pregnancy and living an on call life-style I know I didn’t eat enough protein, but otherwise followed a Weston A Price foundation diet as far as types of food, I knew of the Brewer diet but my personal midwife didn’t think there was a lot of validity to it other than growing big babies. I also probably was unintentionally eating low salt as my husband at the time wasn’t using any added salt, and my CMP showed low sodium on the day I was admitted to the hospital. Pregnancy #2, I still had a low appetite, but was very conscious about eating a lot of protein – didn’t exactly follow the Brewer diet as I couldn’t get in that much food in one day, especially trying to get in all the carbohydrate servings after the protein and vegetables. I did choose to take Asprin after much internal debate. I made it to 39 weeks and had a beautiful 6 hour home birth, although in the last week of pregnancy my blood pressure did get mildly hypertensive and had been creeping up for 4 weeks before that which brought up a lot of PTSD from the last birth. So would be super thrilled about.a webinar on this topic for both my personal and professional development. Thank you for what you do, you have become one of my favorite resources.

  32. I didn’t find your books until I was diagnosed with gestational diabetes after my blood glucose test during my most recent pregnancy. I made dietary changes to help manage the GD; I admittedly had not prioritized the recommend way of eating during my previous pregnancies. (Lots of junk food! Eating whatever I wanted! Etc)

    Even so, I’ve had normal BP throughout my 4 pregnancies, most of the time it was even quite low.

    But for the past two pregnancies, I developed postpartum pre-eclampsia at about a week postpartum. These ended in multi night hospital stays in which I was monitored, given mag sulfate and sent on my way…only to return later that day or night with high BP again. The first time this happened I was put on BP medication for about a month; the second time my OB insisted it wasn’t necessary but I advocated for myself and was allowed to take it after all. Nothing like being home with a newborn when your blood pressure spikes and you’re far from the hospital or doctors office.

    My blood pressure always returned to normal within a week of the hospital stays. But both times, my doctors would kind of shrug and said it wouldn’t happen again so I shouldn’t worry.

    If we have more children, this situation is one of my top concerns. I really hope making dietary improvements as early on in the pregnancy as I can would help. I’d love to hear your thoughts on this situation!

  33. Yes Lily! A deep dive into nutrition as it relates to hypertensive disorders in pregnancy who be fantastic for clinicians. For all of my home birth clients with a prior history of a pregnancy effected by hypertension (this of course does not include those with chronic hypertension, as they are not appropriate candidates for home birth) are advised to either drink 8oz of hibiscus tea or 8oz of beetroot juice daily starting 2-3 weeks prior to when they became hypertensive in the prior pregnancy. The hibiscus my act as a mild diuretic and is high in antioxidants. Beetroot lower BP by 5-8mmHg as it has compounds that convert to nitric acid in the blood after consumption. I also ask that anyone w/a history of HTN in a prior pregnancy buy an automated bicep cuff that is the appropriate size. I have them take their own BP at home the week of their appointment and send me a screenshot of their reading. This prevents misdiagnosing white coat HTN for gestational HTN. Women are generally honest when it comes to the health and safety of their pregnancy. This approach has only bit me in the butt once when a mom was cherry picking her readings, and the kiddo was born growth restricted. I already recommend an oral magnesium glycinate supplement for so many people nightly (leg cramps, restless legs, migraines, insomnia, an overwhelming number of Braxton Hicks, anxiety) that it will be easy to recommend daily supplementing instead if their oral micronutrient intake is not up to par.

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