The following is reprinted from The Brewer Medical Diet for Normal and High-Risk Pregnancy, by Gail Sforza Brewer with Thomas Brewer, M.D., Medical Consultant, 1983.

"Research Background: A Bibliography for Parents and Health Professionals" (p. 225)

There are very few original ideas in the world, and the ones we've written about here are no exception. Were it not for the dogged work, most of it unappreciated in its time, of many thousands of researchers who thought nutrition held promise for improving the health of mothers and babies, this book and many others in this field could never have been published. Moreover, many clinics and private offices now using this material in daily prenatal care would not be in operation, or would be operating in ways that are less helpful to childbearing women.

When asked about research into the subject, we are always gratified to be able to point to a distinguised line of research, both clinical and experimental, that reaches back more than fifty years [as of 1983], all of it supporting the point of view and the practices we've described in this book. From the thousands of published studies here and abroad dealing with maternal and child nutrition, we have culled those that particularly influenced us over the years.

Anyone who wants to make a complete study of prenatal nutrition and its effects on the health of mother and baby or looking for a set of references to offer an interested doctor of midwife or public official will also find this bibliography suitable.

See here for more research on the link between premature labor and low birth weight, and inadequate prenatal nutrition

This perspective comes from an article by Amy Hass, in Midwifery Today Issue 67, Autumn 2003.

"The fact is that research has been done on this subject, but with the exception of folic acid, it stopped somewhere around the 1980s when the focus shifted to drugs as the answer to curing all ills. The research that was done was not widely accepted due to the fact that it could not include clinically controlled studies. It would not show common sense or ethics to starve a group of pregnant women in order to supply a control group. The researchers did the logical thing and used the women's previous diet and circumstances as the control (Brewer 1982). The results were amazing. Dr. Tom Brewer totally eradicated preeclampsia in specific populations where the former rates were upwards of 40 percent. He had the women eat a healthy, varied, well-balanced diet that included high quality foods, adequate protein and complex carbohydrates. He also had them drink water to thirst, salt to taste and avoid drugs. Unfortunately, the National Institutes of Health refused to publish the results because he couldn't do a clinically controlled study.

So what's the problem with pregnancy nutrition? The standard medical community does not believe that women need to eat this way. Doctors keep saying that they don't know the cause of preeclampsia, but they are madly searching for a 'magic pill' or single cause to shed some light on the mystery..."

"...This attitude means that the majority of women receive no education on nutrition in pregnancy. Desperate treatments of preeclampsia, such as diuretics, elimination of salt intake and calorie and weight gain restriction, only exacerbate the problem by further reducing and restricting much-needed blood volume (called hypovolemia) and reducing the blood supply to the placenta and fetus."

See here for the rest of "Preventing Complications with Nutrition", by Amy Haas

In September of this year (2008) a study came out from Denmark which seems to emphatically support something which the Brewers and their supporters have been saying for over 30 years. That is that pregnant women who lose extra salt, or burn extra calories, through extra exercise NEED to compensate for those losses by adding extra salt and calories to their diets. When they do not make special allowances for their unique needs in this way, their blood volume will drop, and they will develop rising BPs, pathological edema, pre-eclampsia, HELLP, IUGR, premature labor, underweight babies, and other complications associated with low blood volume. This particular study was looking at only pre-eclampsia, and only at recreational exercise, but those of us who understand the Brewer principles understand that the same principles do apply to all of these other complications, and to any source of salt/fluid/calorie loss, as well.

"Pregnant exercise 'unsafe'"

Read more.......

"Women who exercise during pregnancy face risk of pre-eclampsia, researchers warn"

Read more.......

"Exercise in pregnancy linked to fatal raised blood pressure condition"

Read more.......

Anne Frye, CPM
Portland, Oregon
www.LabrysPress.com
www.AnneFrye.com
www.midwiferybooks.com
503-255-3378
(Pacific time--three hours earlier than EST)
afryemdwf@gmail.com

Anne provided full maternity care for women seeking homebirths for 14 years. When she studied to be a midwife, she was trained to use the Brewer diet as a primary means of optimizing each woman's chance of achieving a healthy pregnancy. In working with a poor immigrant population on the Texas/Mexican border she saw first-hand what a powerful tool diet can be to make this possible. Since that time she stopped actively practicing and focused on teaching as well as authoring professional-level textbooks with an emphasis on preventive care, including the nutritional management of pregnancy. Her textbooks include Understanding Diagnostic Tests in the Childbearing Year, Holistic Midwifery, A Comprehensive Textbook for Midwives in Homebirth Practice, Vol I Care during Pregnancy and Vol II Care of the Mother and Baby during Labor and Birth and Healing Passge: A Midwife's Guide to the Care and Repair of the Tissues Involved in Birth. These texts are available through her website. She also regularly offers consultations to care providers of all kinds as well as mothers who have questions about diet in pregnancy, troubleshooting preeclampsia, nutritional support for multiple gestation, interpretation of laboratory results, as well as other issues. Feel free to call her if you would like to talk to someone who has first-hand experience regarding the value of nutrition in ensuring a healthy pregnancy.

Note from Joy: There are some now in 2008 who would trivialize these documents simply because they are "too old." Let us stand with grace and compassion and dignity, unashamed of the hard work that has gone before us and which has laid the foundation for and supported the findings of Dr. Brewer and others. Let us stand in honor of those whose deaths are chronicled in these writings, and not allow them to have died in vain.

Let us not be blind to the fact that much of the current research on pre-eclampsia and related complications is colored by its roots in the unfortunate misguided turn taken in the 1950s by the standard-makers of the day--the turn towards weight-control, low-salt diets, and other efforts to treat elevated blood pressure, edema, and pre-eclampsia with treatments that would keep the pregnant woman's blood volume woefully depleted.

Let us read the current research with eyes that are open and truly see where their presuppositions are defeating their quest for the truth. Let us forever be on the lookout for new researchers who accurately understand the Brewer perspective and know how to investigate the complications of pregnancy without compromising the health of the pregnant woman and her child with "antihypertensive treatments" and the other "standards of care" which compromise her blood volume. Let us learn from the courageous researchers who have gone before, and let us be persistent and enduring in our search for more proof of the nutritional foundation for pre-eclampsia and other complications of pregnancy which are related to an inadequate blood volume. Let us persist in spite of the defamation and ridicule and ostracism that is likely to follow us.

And above all let us remain steadfast in our insistence that no research should be done that includes a control group of women who are put on the low-salt, low-calorie diets which we know to be life-threatening, both to them and to their unborn children.

See here for "Preventing Toxemia of Pregnancy", by Bob Filice, MD

See here for more information about research supporting Dr. Brewer's views & methods

See here for a timeline of the Brewer Diet development

See here for a description of the parallel evolutions of Dr. Brewer's prespective, and that of mainstream medicine

See here for more details from many of the following studies, including tables and graphs

Acosta-Sison, Honora. "Relation between state of nutrition of the mother and the birthweight of the fetus: a preliminary study." J. Philippine Islands Med. Assn. 9 (1929):174.

_______. "A clinicopathologic study of eclampsia based on thirty-eight autopsied cases." Amer. J. Obstet. Gyne. 22 (1936):35.

Ahokas, R.A., et al. "Maternal dietary restriction and repletion: effects on cardiac output and placental blood flow in the rat." Paper presented to Society of Perinatal Obstetricians, annual meeting, San Antonio, Tex., Feb. 1982.

American College of Obstetricians and Gynecologists. Standards for Ambulatory Obstetric Care. Chicago, 1977.

________. Assessment of Maternal Nutrition. Chicago, 1980.

Anatov, A.N. "Children born during the siege of Leningrad in 1942." J. Pediatrics 30 (1947):250.

Balfour, M.I. "Nutrition of expectant and nursing mothers. Interum report of the People's League for Health." Lancet 2:10, 1942.

Beerers, D.G., et al. "Salt and blood pressure in Scotland." Brit. Med. J. 281 (Sept. 6, 1980): 641.

Bletka, M., et al. "Volume of whole blood and absolute amount of serum proteins in the early stages of late toxemia of pregnancy." Am. J. Obstet. Gynecol. 106 (1970):10.

Brewer, Thomas H. "Limitations of diuretic therapy in management of severe toxemia: the significance of hypoalbuminemia." Am. J. Obstet. Gynecol. 83 (1962):1352.

________."Role of malnutrition, hepatic dysfunction and gastrointestinal bacteria in the pathogenesis of acute toxemia of pregnancy." Am. J. Obstet. Gynecol. 84 (1962):1253.

________. "Steroid metabolism in acute toxemia of pregnancy." Obstet. Gynecol. 21 (9163): 648.

________. "Administration of human serum albumin in severe acute toxemia of pregnancy." J. Obstet. Gynaecol. Brit. Cwlth. 70 (1963): 1001

________. "Toxemia of pregnancy." Am. J. Obstet. Gynecol. 89 (1964):838.

________."Serum albumin and pregnancy toxemia."--response to a question. Abstract #1093, Excerpta Med. Obstet. Gynaecol. (X) 18 (1965):232

________. "Interpretation of culdocentesis findings in the diagnosis of acute gynecologic problems." Pacific Med. & Surg. 72 (1964): 376.

________. "Serum albumin and pregnancy toxemia." Lancet 2 (Nov. 21, 1964): 1125.

________. "Tetracycline hepatotoxicity." Brit. Med. J. 1 (1965):995.

________. "Ectopic pregnancy." Lancet. 2 (1965):1132.

________. "Pregnancy hypertension." Ob-Gyn Collected Letters, Internatl. Correspond. Soc. Ob. Gyn. series VII, Jan. 15, 1966, p. 17.

________. "Good prenatal nutrition prevents toxemia of late pregnancy." Postgrad. Med. 39 (Feb. 1966): A 119 (Jean Mayer, ed.).

________. Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition. New Canaan, Conn: Keats Publishing, 1982, second edition.

________. "Human pregnancy nutrition: a clinical view." Obstet. Gynecol. 30 (1967):605.

________. "Perhaps I Am Wrong?" (poem) Obstet. Gynecol. 32 (1968): 519.

________. "Don't curse the darkness: light a candle!" J. Applied Nutrition 20 (1968):23.

________. "Scientific nutrition in clinical obstetrics." Medical Tribune, July 18, 1968, p. 11.

________. "Nutrition and pre-eclampsia." Obstet. Gynecol. 33 (1969):448

________. "Metabolic toxemia of late pregnancy:a disease entity." Gynaecologia 167 (1969):1 (Basel)

________. "A case of recurrent abruptio placentae." Delaware Med. J. 41 (1969):325.

________. "Human pregnancy nutrition: an examination of traditional assumptions." Aust. N.Z. J. Obstet. Gynaecol. 10 (1970): 87.

________. "Disease and Social Class." In Brown, Martin, ed. The Social Responsibility of the Scientist. New York: Free Press, 1971.

________. "Human maternal-fetal nutrition." Obstet. Gynecol. 40 (1972): 868

________. "Metabolic toxemia: the mysterious affliction." J. Applied Nutrition 24 (1972): 56.

________. "Nutrition and infant mortality." Pediatrics 51 (1973):1107.

________. "Pancreatitis in pregnancy." J. Reproduct. Med. 12 (1974):204.

________. "Metabolic toxemia of late pregnancy in a county prenatal nutrition education project: a preliminary report." J. Reproduct. Med. 13 (1974):175.

________. "Prenatal complications." In Pomeroy, Leon, ed., New Dynamics of Preventive Medicine, vol. 2. Miami, Symposia Specialists, 1974.

________. "Iatrogenic starvation in human pregnancy." Medikon 4 (1974): 14 (Ghent).

________. Book review (The Economics of Mental Retardation by Ronald W. Conley, Baltimore & London: Johns Hopkins University Press, 1973). J. Reproduct. Med. 14 (1975): 29.

________. "Consequences of malnutrition in human pregnancy." CIBA Review: Perinatal Medicine. Basel: Ciba-Geigy, 1975, p.5.

________. "Role of malnutrition in pre-eclampsia and eclampsia." Am. J. Obstet. Gynecol. 125 (1976):281.

________. "Etiology of eclampsia." Am. J. Obstet. Gynecol. 127 (1977):448.

________. "The No-risk Pregnancy Diet." In Brewer, Gail Sforza [Krebs], ed., The Pregnancy-After-30 Workbook. Emmaus, Pa.: Rodale Press, 1978.

________. "Maternal Malnutrition." Journ. Nutri. Educ. 14-5, 1982 (Jan.-Mar.).

________, & Brewer, Gail Sforza [Krebs]. "Pregnancy nutrition counseling for childbirth educators." In Stewart & Stewart, eds., Compulsory Hospitalization: Freedom of Choice in Childbirth? Marble Hill, Mo.: NAPSAC Publications, 1979.

________, & and Hodin, Jay. "Why women must meet the nutritional stress of pregnancy." In Stewart, D. & Stewart, L., eds., 21st Century Obstetrics Now! Marble Hill, Mo.:NAPSAC Publications, 1977.

________, & Miali, J.B. "Glucuronic acid conjugation of anisic acid in normal and toxemic pregnancy." Obstet. Gynecol. 20: (1962) 345.

________, & Nelson, Robert. "Toxemia of pregnancy at Jackson Memorial Hospital." Bulletin Univ. Miami Sch. Med. 12 (1958): 87.

________, & Wink, C.A.S. "Toxaemia--a disease of prejudice?" World Med. J. 21 (1974): 70 (London). Book review: Pathology of Toxaemia of Pregnancy by Sheehan & Lynch, 1973.

________, & Woessner, J.F. "Human uterine proteinase." Fed. Proc. 19 (1960): 335.

________, & Woessner, J.F. "Formation and breakdown of collagen and elastin in the human uterus during pregnancy and post-partum involution." Biochem. J. 89 (1963): 75.

Briend, A. and Carles, C. "Protein deficiency and pregnancy toxemia in Africa." Lancet, Jan. 21, 1978, p. 146.

Burke, Bertha S., et al. "Nutrition studies during pregnancy." Am. J. Ostet. Gynecol. 46 (1943):38.

Call, M., & Lorentzen, D. "Rupture of the liver associated with toxemia." Obstet. Gynec. 25 (1965): 466.

Cameron, C.S., & Graham, S. "Antenatal diet and its influence on stillbirths and prematurity." Glasgow Med. J. 24 (1944):1.

Chesley, Leon C. "Plasma volume and red cell volume in pregnancy." Am. J. Obstet. Gynecol. 112 (1972): 440.

________. Testimony to the U.S. Food and Drug Administration, Bureau of Drugs, OB-GYN Advisory Committee Hearing. "Certain thiazides: their use in pregnancy." Rockville, Md., July 17, 1975. For transcript, write FDA Bureau of Drugs, 5600 Fishers Lane, Rockville MD 20852.

Cloeren, Stella et al. "Effect of plasma expanders in toxemia of pregnancy." New Eng. J. Med. 287 (1972):1356

________, S.E. et al. "Hypovolemia in toxemia of pregnancy: plasma expander therapy with surveillance of central venous pressure." Arch. Gynak. 215 (1973):123

Crout, Richard J. "Certain thiazides." F.D.A. Notice. Federal Register. vol. 41, no. 115, June 14, 1976, pp. 23989-23992.

Dobbing, John. "The later growth of the brain and its vulnerability." Pediatrics 53 (1974): 2.

Dodge, Eva, & Frost, T. "Relation between blood plasma proteins and toxemias of pregnancy." JAMA 111 (1938): 1898.

Drillien, C.M. "School disposal and perfomance for children of different birthweight born 1953-1960." Arch. Dis. Child. 44 (1969):562.

Duffus, G.M., et al. "The relationship between baby weight and changes in maternal weight, total body water, plasma volume, electrolytes, and proteins and urinary oestrial excretion." J. Obstet. Gynaecol. Brit. Cwlth. 78 (1971):97.

Ebbs, John, et al. "The influence of prenatal diet on the mother and child." J. Nutr. 22 (1941) 515.

Ferguson, James Henry. "Maternal death in the rural South: a study of forty-seven consecutive cases." JAMA. 146 (1951): 1388.

______, & Keaton, A.G. "Studies of diets of pregnant women in Mississippi: ingestion of clay and laundry starch." New Orleans Med. Sci. J. 102 (1950):460.

Foote, R.G., et al. "The use of liberal salt diet in pre-eclamptic toxemia and essential hypertension with pregnancy." New Zealand Med. J. 77 (1973):242.

Fort, A.T. "Adequate prenatal nutrition." Obstet. Gynecol. 37 (1971):286.

Frisch, Rose E. "Fatness, puberty, and fertility." Natural History, Oct. 1980, pp. 16-27.

Gabbe, Steven C. "Diabetes in pregnancy: clinical controversies." Clin. Obstet. Gynecol. 21 no. 2 (1978): 443-453.

Gormican, Annette, et al. "Relationships of maternal weight gain, pre-pregnancy weight, and infant birthweight." J. Amer. Diet. Assn. 77 (1980):662.

Gray, Mary Jane et al. "Regulation of sodium and total body water metabolism in pregnancy." Am. J. Obstet. Gynecol. 89 (1964): 760.

Green, G.H. "Maternal mortality in the toxaemias of pregnancy." Aust. N.Z. J. Obstet. Gynaecol. 2 (1962)"145.

Grieve, J.F.K. "Prevention of gestational failure by high protein diet." J. Reprod. Med. 13 (1974): 170.

Habicht, J.P., et al. "Relation of maternal supplementary feeding during pregnancy to birthweight and other sociobiological factors." In Winick, M., ed., Nutrition and Fetal Development, New York:John Wiley & Sons, 1974.

Hamlin, Reginald H.J. "The prevention of eclampsia and pre-eclampsia." Lancet 1 (1952):64.

________. "Prophylaxis against toxemia." Clin. Obstet. Gynecol. 1 (1958):369.

Hibbard, Lester. "Maternal mortality due to acute toxemia." Obstet. Gynecol. 42 (1973):263.

Higgins, Agnes C. "Nutritional status and the outcomes of pregnancy." J. Canadian Dietet. Assoc. 37 (1976):17.

________. "The Higgins Intervention Method for Nutritional Rehabilitation During Pregnancy: procedure for estimation of caloric and protein requirements" (reprint). Montreal Diet Dispensary, 2182 Lincoln Avenue, Montreal H3h 1J3, Quebec, Canada.

Howard, Peggy. "Albumin concentrate can be used for pre-eclampsia." OB/GYN News, Oct. 1, 1974.

Hytten, F.E., & Thomas, A.M. "Maternal physiological adjustments." In Maternal Nutrition and the Course of Pregnancy. Washington, D.C.: Committee on Maternal Nutrition, Food and Nutrition Board, National Research Council-National Academy of Sciences, 170.

Iyengar, Leela. "Urinary estrogen excretion in undernourished pregnant Indian women: effect of dietary supplementation on urinary estrogens and birth weights of infants." Am. J. Obstet. Gynecol. 102 (1968):834.

Jeans, P.C., et al. "Incidence of prematurity in relation to maternal nutrition." J. Am. Deit. Assn. 31 (1955):576.

Jones, K.L., et al. "Pattern of malformation in offspring of chronic alcoholic mothers." Lancet 1 (1973): 1267-1271.

Kelman, L., et al. "Effects of dietary protein restriction on albumin synthesis, albumin catabolism, and the plasma aminogram." Am. J. Clin. Nutr. 25 (1972):1174.

Knobloch, Hilda, et al. "Neuropsychiatric sequelae of prematurity: a longitudinal study." JAMA 161 (1956):581.

Laurence, K.M., et al. "Increased risk of recurrence of pregnancies complicated by fetal neural tube defects in mothers receiving poor diets, and possible benefit of dietary counseling." Br. Med. J. 281 (1980):1592.

Lawrence, Ruth. Breastfeeding: A Guide for the Medical Profession. St. Louis: C.V. Mosby, 1980.

Lechtig, A., et al. "Effect of moderate maternal malnutrition on the placenta." Am. J. Ostet. Gynecol. 123 (1975):191.

Liley, A.W. "Clinical and laboratory significance of variation in maternal plasma volume in pregnancy." Int. J. Gynaec. Obstet. 8 (1970):358.

Lindberg, Bo. "Salt, diuretics and pregnancy." Gynecol. Obstet. Invest. 10 (1979): 145-156.

Lowe, C.U. "Research in infant nutrition: the untapped well." Am. J. Clin. Nutr. 25 (1972):245.

Lubic, Ruth Watson. "Evaluation of an out-of-hospital maternity center for low-risk patients." In Aiken, Linda H., ed., Health and Policy and Nursing Practice. New York: McGraw-Hill, 1980.

Maqueo, Manuel, et al. "Nutritional status and liver function in toxemia of pregnancy." Obstet. Gyne. 23 (1964):222.

Mathews, D.D., et al. "Modern trends in management of non-albuminuric hypertension in late pregnancy." Br. Med. J. 2 (1978):623.

McCance, R.A., & Widdowson, Elsie M. Calorie Deficiencies and Protein Deficiencies. Boston: Little, Brown, 1968.

Mellanby, Edward. "Nutrition and childbearing." Lancet 2 (1933):1131.

Mitchell, J., et al. "Dietary habits of a group of severe pre-eclamptics in Alabama." J. Natl. Med. Assn. 41 (1949):122.

Pasamanick, B., et al. "Pregnancy experience and the development of behavior disorder in children." Amer. J. Psychiat. 112 (1956):613.

Pike, R.L., & Smicklas, H.A. "A reappraisal of sodium restriction during pregnancy." Internatl. J. Gynaecol. Obstet. 10 (1972):1.

________, & Gursky, D.S. "Further evidence of deleterious effects produced by sodium restriction during pregnancy." Am. J. Clin. Nutr. 23 (1970):883.

Platt, B.S., & Stewart, R.J. "Reversible and irreversible effects of protein-calorie deficiency on the central nervous system of animals and man." World Rev. Nutr. Deitet. 13 (1971):43.

Porapakkham, Saroj. "An epidemiological study of eclampsia." Obstet. Gynecol. 54 (1979):26.

Pritchard, Jack S., ed. Williams Obstetrics, 16th ed. New York: Appletom-Century-Crofts, 1980.
"Prenatal nutritional counseling substantially reduces low birth weight deliveries." Group Health News, March 1980.

Ramsey, Elizabeth, et al. "Serial and cineradiographic visualization of maternal circulation in the primate (hemochorial) placenta." Amer. J. Obstet, Gynecol. 86 (1963): 213.

Robinson, M. "Salt in pregnancy." Lancet 1 (1958): 178.

Ross, Robert A. "Relation of vitamin deficiency to the toxemias of pregnancy." Amer. J. Med. Sci. 190 (1935):811.

_______. "Late toxemias of pregnancy: The number one obstetrical problem of the South." Am. J. Obstet. Gynecol. 54 (1947): 723.

Rosso, Pedro. "Nutrition and maternal-fetal exchange." Am. J. Clin. Nutr. 34 (Apr. 1981):744-755.

________, & Streeter,M.R. "Effect of food or protein restriction on plasma volume expansion in pregnant rats." J. Nutr. 11 (1979):1887.

________., et al. "Effects of maternal undernutrition on placental metabolism and function." In Young, D.S., and Hicks, J.M., eds., The Neonate. New York: John Wiley & Sons, 1976.

Saugstad, L. Fegersten. "Weight of all births and infant mortality." J. Epid. and Comm. Health 35 (1981): 185-191.

Schewitz, Lionel. "Hypertension and renal disease in pregnancy." Med. Clin. N. Amer. 55 (1971):47.

Schneider, Jan. "Low birth weight infants." Obstet. Gynecol. 31 (1968):283.

Scrimshaw, N.S., et al. Interactions of Nutrition and Infection. Geneva: World Health Organization Monograph Series no. 57, 1968.

Shank, R.E. "A chink in our armor." Nutrition Today 5, no.2 (1970):2.

Shanklin, Douglas, & Hodin, Jay. Maternal Nutrition and Child Health. Springfield, Ill.: Charles C. Thomas, 1979.

Shearer, Madeleine H. "Malnutrition in middle-class pregnant women." Birth and the Family Journal 7 (Spring 1980):1.

Sheehan, H.L., & Lynch, J.B. Pathology of Toxaemia of Pregnancy. Edinburgh and London: Churchill Livingston, 1973.

Shoemaker, E.S., & Gant, N.F. "The effect of thiazide diuretics on placental function." Tex. Med. 69 (1973):109-115.

Sibai, Baha M., et al. "Plasma volume determination in pregnancies complicated by chronic hypertension." Paper presented to Society of Perinatal Obstetricians, annual meeting, San Antonio, Tex., Feb. 1982. Obstet. Gynecol. 60 (1982):174.

Springer, Ninfa Saturnino, et al. "Nutritional indexes of clients in a maternity and infant care project." J. Amer. Dietet. Assoc. 71 (1977):613.

Steinfeld, Jesse L. "Differences in daily albumin synthesis between normal men and women as measured with I131-labeled albumin." J. Lab. Clin. Med. 55 (1960): 904.

Strauss, M.B. "Observations on the etiology of the toxemias of pregnancy: the relation of nutritional deficiency, hypoproteinemia, and elevated venous pressure to water retention during pregnancy." Am. J. Med. Sci. 190 (1935):811.

Tatum, J.H., & Mule, J. "Puerperal vasomotor collapse in patients with toxemia of pregnancy." Am. J. Obstet. Gynecol. 71 (1956):492.

Taylor, E. Stuart. Editorial Comment on "Maternal Nutrition in Pregnancy, Part I, A Review" by Arthur Leader, et al. Ostet. Gynecol. Survey. 34 (Apr. 1982):230-231.

Theobald, G.W. "Discussion on diet in pregnancy." Proc. R. Soc. Med. 28 (1935): 1388.

Tompkins, W.T., et al. "The underweight patient as an increased obstetrical hazard." Am. J. Obstet. Gynecol. 69 (1955):114.

________, & Wiehl, D. "Nutrition and nutritional deficiencies as related to the premature." Pediatric Clin. No. Amer. 1 (1954):687.

Toverud, Guttorm. "The influence of nutrition on the course of pregnancy." Milbank Mem. Fund. Qtr. 28 (1950):7.

Walker, Elizabeth Cabell. "Sodium and calorie restriction during pregnancy: the knowledge and practices of New York State obstetricians." Master's thesis, Cornell University Graduate School, Dept. of Nutrition, Ithaca, N.Y., 1980.

Williams, Phyllis S. "Timeline for good prenatal nutrition" (reprint). Associated Health Professionals, Box 2087, Hampden Highlands, ME 04444.

Williams, Sue Rodwell. Nutrition and Diet Therapy, 4th ed. St. Louis: C.V. Mosby, 1981.

2006--At the Salt & Pregnancy Forum of May 2006 (1), organized by EuSalt, Prof. Dr. Markus G. Mohaupt already underlined that pregnancy is no time to reduce salt intake and that additional salt may benefit women suffering from pre-eclampsia.

Recently, Prof. Dr. Mohaupt published a case study (2) showing that an additional salt intake of 20g stopped hypertension during pregnancy… In this case, a 33-year-old woman with normal renin activity was diagnosed with essential arterial hypertension 15 years ago. During the 6 month period before conception, her blood pressure was well-controllable by dual antihypertensive treatment. Throughout pregnancy, blood pressure recordings were collected daily, and at five weeks of gestation in her first pregnancy, she stopped all antihypertensive drugs. As a result, the average blood pressure increased, whereas the expected increase in aldosterone synthase activity in pregnancy did not show. Given this hypoaldosteronism, sodium supplementation aiming at 20g total NaCl intake per day was initiated, and pursued throughout pregnancy, and resulted in a decrease of the blood pressure during pregnancy.

After delivery, maternal blood pressure rose again, NaCl supplementation was terminated and antihypertensive treatment was reinstalled. The observation that blood pressure was responsive to NaCl supplementation is in line with the hypothesis that intravascular volume decrease causes increased blood pressure in pregnancy. The absence of the expected increase in aldosterone synthesis was associated with a mutation of the aldosterone synthase gene, similar to earlier findings in pre-eclamptic women. This persistenthypoaldosteronism together with earlier findings on NaCl supplementation led the researchers to supplement salt in this woman. This salt supplementation was associated with a reduced blood pressure throughout pregnancy. In addition to this case, Mrs Sabine Kuse, founder of a support group (1984) for women in acute state and after pregnancy with pre-eclampsia or HELLP-syndrome, and her team have been advising more than 20.000 women during their high-risk pregnancies over the past 22 years.

They found that in most cases, additional salt helped within hours. More importantly, during all those years, they haven’t seen one case where salt supplementation has caused negative effects. The worst effect was no effect. (1) Support for this critical role of NaCl intake during pregnancy, was already provided by Robinson in 1958, who found a reduced incidence of pre-eclampsia in pregnant women on a high salt diet (3).

This study introduced substantial data for bias in other studies, of which all data suggest that salt restriction during pregnancy does not seem promising for the prevention of pre-eclampsia. Or, as the study of Mohaupt et.al concludes: pregnant women with even subtle signs of volume deficiency might benefit from salt supplementation in pregnancy.

Footnotes:
1. EUSALT Newsletter. Salt, blood pressure and pregnancy: a critical relationship? August 2006.
2. Markus G. MOHAUPT et.al . Blood pressure reduction in pregnancy by sodium chloride. Oxford University Press, 2006.
3. M. ROBINSON. Salt in Pregnancy. Lancet, 1958, 1: 178 – 181.

Source: 4th April 2007 12:23:26 / Femalefirst.co.uk

Salt in Pregnancy

	High Salt Diet	Low-Salt Diet
Toxemia	37/1000	97/1000
Perinatal deaths	27/1000	50/1000
C-section	9/1000	14/1000
Abruptio placenta	17/1000	32/1000

To Be Continued....

Perinatal Support Services: pregnancydiet@mindspring.com