Sunday, April 3, 2022

Pregnancy Hypertension and Preeclampsia

Disclaimer: Please remember, I am not a medical doctor, or any sort of medical professional. This blog post is intended to provide food for thought, not to diagnose or treat anyone. The opinions expressed below are mine, gleaned from 11 natural pregnancies and deliveries (including 9 midwife-assisted home births), as well as my current 12th pregnancy at age 43.

I have had five babies in my 20s, five babies in my 30s, and am currently on my second pregnancy in my 40s. While I was a lot younger and more energetic two decades ago when my oldest were babies, the benefits now are that I a) have older helpers and better resources, and b) have learned a lot about pregnancy and childbirth throughout the years. 

One of the things I have thankfully never struggled with is high blood pressure, during pregnancy or otherwise. However, due to a congenital defect with my right ureter, I have a tendency to develop kidney pain and kidney infections if I am not very diligent in preventing them, especially during pregnancy when baby cramps my organs. Thankfully, I have always successfully treated these issues with alternative remedies, without them getting to the point where they negatively impacted my blood pressure. This post is to sum up what I have learned, and what I believe has helped me keep my blood pressure in the low normal range all these years, even as my "advanced maternal age" puts me at increased risk of developing gestational hypertension (and in spite of having teenagers - ha!). 

According to the CDC, in the United States, high blood pressure happens in 1 in every 12 to 17 pregnancies among women ages 20 to 44, and high blood pressure in pregnancy has become more common.

Officially, there is no known cause of preeclampsia, and no known cure except delivery of the baby in extreme cases, no matter how premature the infant might be. The main symptoms are high blood pressure, protein in the urine, persistent headache (may or may not be accompanied by changes in vision such as seeing spots), and swelling of the hands and feet. Please note: some swelling can be normal, or a sign of less dangerous conditions such as dehydration. Swelling in the face is often a sign of an extreme case of preeclampsia, a medical emergency. 

No doubt about it, preeclampsia (pre-e) is a very dangerous condition that cannot be left unaddressed. Where I diverge from the mainstream medical opinion is that there is no known cause, or cure. Nothing happens for no reason. And if we find out the reason, we can then counteract it.

It is widely accepted in the medical community that kidney disease can cause high blood pressure. I am convinced that high blood pressure in pregnancy likewise comes down to diet and the kidneys, and how well they are able to function. The kidneys are tasked with filtering waste products from the blood stream and retaining nutrients. When they are unable to do so (or do so fully) due to being overtaxed, blood pressure goes up. 

In particular, I believe the three main culprits that negatively affect blood pressure during pregnancy to be: 1. dehydration, 2. not consuming enough protein, and 3. undiagnosed urinary tract/kidney problems


1. Dehydration


This is pretty common in pregnancy, especially in warmer climates, or during the summer. Hence the common swelling of legs and feet, without it being a medical concern. Dehydration itself is unlikely to cause pre-e, but it can be a contributing factor if your diet is off, or if you are already having UT/kidney issues. 

Having lived in Arizona for 16+ years, where we typically have 6 months or more of temps above 100 degrees F, I can assure you that a) water is not enough to hydrate the human body and b) salt is NOT the enemy, and is actually vitally important in maintaining electrolyte balance and hydration. 

Mainstream medical advice for moms with swelling or pre-e is to cut back on salt. If we were talking about the sodium found in pre-packaged and junk foods, or snow-white (i.e. nutritionally empty) table salt, this might be true. However, a quality high-mineral salt is essential for maintaining electrolyte balance and hydration. 

To combat dehydration, you should:

- Stay away from any caffeinated beverages, since they have a dehydrating effect by increasing urine output. Every one cup of caffeinated beverage must be offset by at least two cups that aren't. Caffeine also raises blood pressure. 

- Drink plenty of herbal teas that are hydrating AND safe during pregnancy. If you don't care for the flavor of these, they can be greatly diluted and still remain effective. My favorites are rooibos, pregnancy tea, and special tea blends for UTI health (more on this later). You can also try drinking coconut water (blergh), or eating high-water, alkalizing foods such as melons and cucumbers. 



- When drinking water, always add something to make it more hydrating, such as: sliced cucumber, fresh mint, berries, lemon slices, ginger, a splash or apple cider vinegar or juice, or whatever else sounds good. I literally go nine months without ever drinking just plain water.

- Salt food to taste with a high-mineral salt. If the salt is white, it's worthless (even if its labeled "sea salt" or something like it). My personal favorite for many years has been Redmond's Real Salt. "To taste" looks different based on individual factors. Here in Arizona, we salt our food to crazy levels. When we first moved here, it blew my mind how much salt the locals were using, but we have since acclimated. Many out-of-state visitors become heat sick when visiting here and going out during the heat of the day, if they don't start using considerably more salt than they are used to. Do reduce sodium from ready foods such as frozen meals and fast food. 


- There are commercial electrolyte solutions on the market. Many of these contain zero-calorie sweeteners that I personally avoid, but organic Gatorade (both powdered and ready-bottled) can be very helpful. 

- Take an epsom salt bath after a particularly hot day, or if you weren't able to stay as hydrated as you would have liked to be. 

- If your ankles do swell, rest lying on your left side while increasing fluids / electrolytes. If all else fails, this trick is sure to get your ankles back: Add a shredded zucchini to a medium-sized saucepan, add water to cover, and steam on low-medium heat for 15 to 20 minutes. Strain out the zucchini, and drink the zucchini water. Not very tasty (THAT'S an understatement!), but super effective at reversing any swelling of your ankles or hands. 

- If the dehydration is due to an acute medical event such as food poisoning, which prevents you from taking in fluids by mouth, you may need to have IV hydration therapy. Thankfully, there are now many services available where a medic will come to your home and do this, no need to go the hospital. I recently had to do this after getting norovirus while already dealing with first trimester morning sickness. Fun times!



2. Not consuming enough protein


I would consider this one of the two biggest culprits behind pregnancy hypertension and pre-e. Ironically, one of the warning signs of pre-e is having protein in the urine, which might lead one to believe that the expectant mom is getting an excess of protein, but quite the opposite is actually true. It means that the pregnant mom's body is cannibalizing her own protein stores (muscle tissue) to provide the baby with protein, which is then excreted in the urine because the kidneys are overtaxed.

Research in recent times is confirming what the Brewer Pregnancy Diet, developed several decades ago by Dr. Tom Brewer, has been saying all along: a diet high in protein (at least 80-100g of protein per day for a singleton baby) greatly reduces the chances of developing pre-e, by providing the expectant mother with this vital nutrient, and preventing the cannibalization of her muscle tissue and overexertion of the kidneys. 

Please note: high protein does NOT equal low-carb. The Brewer Diet also focuses on healthy carbs and other nutrients in the correct balance. Since this approach to pregnancy nutrition has an excellent track record spanning many decades, I will not go into detail here, but all the information is available on their website and countless other online sources. 

If you have never actually added up how many grams of protein you are consuming in a day, chances are, you are not getting the recommended 80-100 grams daily. By contrast, the mainstream recommendation for "sedentary" adult women who are not expecting is just 46g of protein per day! Of course, such protein deficiency is often made up for with excess carbs, which increases the other major culprit behind pre-e (discussed in point 3 below). 

In a nutshell, according to the Brewer Diet, a pregnant mom should be consuming the following each day:

4 servings of milk or milk products

2 eggs any style

6-8 servings (about 1 oz each) protein sources

2 servings fresh, dark green vegetables

5 servings of grains

2 servings of vitamin C foods

3 servings of healthy fats

1 serving of vitamin A foods

at least weekly: liver

salt to taste

unlimited water


Their website gives ideas for foods in each of these categories. Please note also how the Brewer Diet is very much in support of salt being vitally important, and advises against restricting salt intake. 

If lack of protein is the culprit, then a high-protein diet of even just a few days if often able to reverse symptoms of pre-e. Sadly, when moms are hospitalized for monitoring due to high blood pressure, they are often fed hospital food that exacerbates their symptoms, due to the lack of high-quality proteins (what hospital serves steak?!), a focus on cheap carbs (such as the ubiquitous cup of jell-o), and likely a restriction on salt intake. If you do have to go to the hospital, always have your own food brought in. 

Important caveat: If you have run the numbers, and are confident that you are already getting the recommended 80-100 grams or more of protein each day, please do not increase your protein consumption, and instead read on below. In the case of point 3 being the culprit, increasing protein could actually further diminish kidney function. 


3. Undiagnosed urinary tract / kidney problems

Urinary tract infections (UTI) are very common during pregnancy. If left untreated, the bad bacteria can work its way all the way up to the kidneys, and lead to reduced kidney function, or kidney infection. While any OB or midwife will regularly check the urine for such bacteria, they might not address the issue unless the patient complains of symptoms, since some amount of bacteria is fairly normal, and the standard treatment approach (antibiotics) should be avoided whenever possible, especially during pregnancy. Many moms might ascribe the symptoms of a UTI to pregnancy discomforts such as ligament pain or a tender cervix, or might in fact not experience any symptoms at all in spite of having quite a high bacterial load. In any case, regular preventative maintenance in this area is always a great idea for women, but even more so during pregnancy, when the kidneys need and deserve extra attention.

Compromised kidney function is very likely a major contributing factor to developing pre-e. Increasingly, even mainstream medicine is acknowledging the possible connection between UTIs and pre-e. The kidneys are filters that clean the blood. When they are unable to do so, or do so sufficiently, blood pressure goes up. 



If you have run the numbers and are confident that you are getting at least 80-100 g of protein per day (with a singleton), and yet your blood pressure is high, or you have excessive swelling, or there is protein in your urine, ask your doctor or midwife about checking your urine for bacteria indicating a UTI. Even if the levels are low, start by addressing the urinary system. 

Start with the least invasive / aggressive measures, and work your way up if your symptoms are not improving, or worsening. Chances are, if your UTI were severe or you had an actual kidney infection, you would be well aware of it, and your doctor or midwife would have noticed. Thus, if your only symptom is high blood pressure and the presence of some bacteria, then the milder treatment approach will prove effective enough. 


As a preventative maintenance:

- Stay well hydrated (see point 1 above).

- Avoid sugary drinks, which feed bad bacteria, especially in combination with caffeine. 

- Wear only cotton or other natural fiber underwear, and avoid synthetic fabrics such as nylons, spandex leggings, etc. that create a moist, warm environment in which bacteria thrive. Avoid any clothing that is tight/restrictive in the area between the rib cage and the pelvis (i.e. waist, lower back). 

- Always empty your bladder before and after intercourse. The reason behind this is that many men carry bacteria without experiencing a UTI, because their urethra is longer than that of women, and the bacteria may never make it to the bladder. However, this bacteria does come out along with semen during intercourse, and can then make its way into the woman's urethra, from where it is only a short distance to the bladder. Hence the tongue-in-cheek term of "honeymoon disease" for cystitis/UTI. Moms, please be sure to teach your daughters about this prior to marriage. It is amazing how many young brides go into marriage clueless in this area, and suffer needlessly. 

- Always wipe front to back, and teach this to your daughters when they are potty training. 

- Consider making herbal teas formulated specifically for urinary tract health part of your daily beverage intake if you tend to get dehydrated, or easily develop UTIs or kidney problems. One common culprit during pregnancy is that the growing baby puts pressure on the ureters (the "tubes" taking urine from the kidneys to the bladder). Urine backs up into the kidneys, where the swelling causes pain that often persists (like a bruise) even after the kidneys have had a chance to drain. There are also congenital factors that can make these tubes less efficient at carrying urine from the kidneys to the bladder. 

- Sleep in a side-lying position at night, alternating sides each time you wake up, to make sure both kidneys get a chance to drain well even if a baby is cramping the urinary system. Take 10-15 minutes per side in the daytime to lie down, put your legs up, and relieve the pressure on your kidneys. 

As treatment for UTI, do all of the above, plus:

- Instead of taking antibiotics, consider using natural remedies, such as D-mannose (the active ingredient in cranberries) and/or drinking water with 1/2 to 1 tsp of baking soda added, several times throughout the day. Both of these change the pH of the urine, making a hostile environment for the bacteria, which is then flushed out of the system (hence the importance of staying hydrated). D-mannose powder is flavorless if not a tad bit sweet. It dissolves easily in cold water, and is therefore a perfect remedy even for young children that may be unable to swallow capsules, or balk at taking medicines with off-putting flavors. My trick for taking baking soda without having to drink baking soda water is to fill empty size 00 gelatin capsules with baking soda, and take them with water like any other capsule. They will dissolve in the stomach within minutes, and be just as effective without having to drink nasty baking soda water. 

- Take a bath with baking soda added to the water (plus Epsom salt for hydration if you like). The baking soda will give instant relief. Depending on the size of the tub, add about 1/2 to 1 cup baking soda to a full bath.  

- Cut out sugar and refined carbs as much as possible, and add foods rich in vitamin C. You can also add a good vitamin C supplement. 

- Always check with your doctor or midwife before starting supplements if you are expecting, to make sure they are safe during pregnancy. One supplement I always keep in stock is Solaray brand Kidney Blend. It is extremely effective and fast-acting both for UTIs as well as kidney infections. 

- Drink large quantities of teas specifically formulated for kidney/urinary health. These will typically contain uva ursi, cornsilk, marshmallow root, and other herbs known for being helpful in this area. One very inexpensive, highly effective remedy is to steep cornsilk (the "hair" on a cob of corn) and steep it in hot water just like tea, and then drink it. 

- Add a high-quality probiotic supplement. Probiotics are living cultures. Consequently, most probiotics sold at room temperature are dead and ineffective. Some brands use more reliable freeze-dry methods, but still don't come close in effectiveness to fresh, refrigerated probiotics. Thus, this is not an item you want to purchase on Amazon, or a big box store, but rather at your local health food store, which will typically have a small refrigerator in the supplements section where they keep such probiotics. My favorite brand is Bio-K plus drinkable probiotics. A half bottle per day is plenty for most acute urinary issues. If taking antibiotics, a full bottle per day (split into two portions off-set from the antibiotics) is an appropriate dosage to prevent many of the negative side effects associated with antibiotics. 

- Continue the above treatments for several days after symptoms subside, to make sure all bad bacteria has been sufficiently eliminated, to prevent a relapse. 

As treatment for severe UTI or kidney infection, do all of the above, plus:

- Cut out all foods except proteins (meat, eggs) and non-starchy vegetables. 

- Every two hours, drink one quart of uva ursi tea, alternating with one quart of filtered water every two hours (so one quart of either tea or water every hour). To steep the uva ursi tea, drop 4 teabags into a quart of freshly boiled water. Cover, and steep for 10 minutes. Remove the tea bags, and drink as hot as you are able to. 

- You will likely see great improvement of your symptoms (kidney pain, lower back pain, pain while urinating, limited urine output, cloudy urine, etc) within 24 hours. Continue treatment for at least three days to make sure the bacteria has been sufficiently eradicated, before scaling back to the less aggressive methods in the previous point. Continue some form of treatment for several days after symptoms subside to prevent a recurrence. 

- As bad bacteria die off, they release toxins that cause headaches. Expect these to start within 24 hours of this aggressive treatment, and persist for the first 72 hours. With your midwife's or doctor's approval, Tylenol is considered safe during pregnancy and can help if the headaches are severe. 

Side note: Once-daily, low-dose aspirin has proven very effective at preventing pre-e, because it thins the blood and keeps things moving along (again, helping the kidneys do their job more effectively). Overall, the long track record of aspirin makes this a very low-risk drug to take regularly, even during pregnancy. In fact, moms over age 35 are almost universally advised by their doctors to start daily low-dose aspirin as they enter the second trimester, just as an effective prevention of pre-e. This treatment approach might be especially advisable for moms with a history of pre-e. Also, a more current issue is contracting COVID during pregnancy, which increases the risk of blood clots, the chances of which are also reduced by taking aspirin with its blood-thinning properties. Please speak to your doctor or midwife if any of these scenarios (previous case of pre-e, advanced maternal age, COVID during pregnancy) apply to you, and ask if daily low-dose aspirin would be right for you. 

Once kidney function is fully restored, and the kidneys are given the extra care they need during pregnancy, combined with an overall healthy diet (including plenty of protein as well as mineral-rich salt) and proper hydration, you can expect your blood pressure to return to and remain in the normal range.