An evidence review and nutritional conceptual framework for pre-eclampsia prevention

Abstract

Pre-eclampsia is a serious complication of pregnancy, and maternal nutritional factors may play protective roles or exacerbate risk. The tendency to focus on single nutrients as a risk factor obscures the complexity of possible interactions, which may be important given the complex nature of pre-eclampsia. An evidence review was conducted to compile definite, probable, possible and indirect nutritional determinants of pre-eclampsia to map a nutritional conceptual framework for pre-eclampsia prevention. Determinants of pre-eclampsia were first compiled through an initial consultation with experts. Secondly, an expanded literature review was conducted to confirm associations, elicit additional indicators and evaluate evidence. The strength of association was evaluated as definite RR<0.40 or ≥3.00, probable RR 0.40-0.69 or 1.50-2.99, possible RR 0.70-0.89 or 1.10-1.49 or not discernible RR 0.90-1.09. The quality of evidence was evaluated using GRADE. Twenty-five nutritional factors were reported in two umbrella reviews and 22 meta-analyses. Of these, 14 were significantly associated with pre-eclampsia incidence. Maternal vitamin D deficiency and higher serum iron emerged as definite nutritional risk factors for pre-eclampsia incidence across populations, while low serum zinc was a risk factor in Asia and Africa. Calcium and/or vitamin D supplementation were probable protective nutritional factors. Healthy maternal dietary patterns were possibly associated with lower risk of developing pre-eclampsia. Potential indirect pathways of maternal nutritional factors and pre-eclampsia may exist through obesity, maternal anaemia and gestational diabetes mellitus. Research gaps remain on the influence of household capacities and sociocultural, economic and political contexts, as well as interactions with medical conditions.

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

“…Long-term longitudinal studies have shown that higher ultra-processed food intake in women is associated with increased cardiovascular risk and hypertension [ 59 ], as can occur in women with a history of PE [ 60 ]. These data support the recommendations of other expert reviews and the World Health Organization regarding promoting healthy maternal diets [ 55 , 61 , 62 ].…”

“…More recent observational and intervention studies provide contemporary evidence to support the role of nutritional factors in PE [ 54 ]. Evidence-based summaries from systematic reviews, meta-analyses, and representative PE expert groups (such as PRECISE) recommend healthy maternal dietary patterns to reduce the risk of PE [ 54 , 55 , 56 , 57 ].…”

“…One recent comprehensive evidence-based expert review of nutritional factors that may protect or exacerbate the risk of PE by the PRECISE Conceptual Framework Working Group highlighted the importance of focusing on research related to healthy dietary patterns rather than single nutrients [ 55 ]. Nevertheless, they identified 25 nutritional factors in two umbrella reviews and twenty-two meta-analyses.…”

Longitudinal Assessment of Serum 25-Hydroxyvitamin D Levels during Pregnancy and Postpartum—Are the Current Recommendations for Supplementation Sufficient?

“…There has been evidence of an association of vitamin D deficiency with different pregnancy-related disorders, such as hypertensive disorders of pregnancy, gestational diabetes, fetal growth restriction, and preterm birth, as well as common complications of the neonatal period [ 8 , 12 , 36 , 37 , 38 ]. Kinshella et al recently presented evidence that maternal vitamin D deficiency poses a nutritional risk factor for preeclampsia.…”

“…Kinshella et al recently presented evidence that maternal vitamin D deficiency poses a nutritional risk factor for preeclampsia. Vitamin D supplementation and healthy maternal diet were identified as protective nutritional factors associated with a lower risk of developing preeclampsia [ 37 ]. In line with these findings, the FEPED Study, assessing the effects of the maternal vitamin D status in the first trimester of pregnancy on the risks of preeclampsia, GDM, preterm birth, and SGA at birth, found a significantly decreased risk of preeclampsia associated with maternal serum 25(OH)D levels of ≥30 ng/mL in the first and third trimesters, while no significant linear relationship was identified for GDM, preterm birth, and SGA [ 39 ].…”