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Health Condition

Preeclampsia

  • Calcium

    An analysis of double-blind trials found calcium supplementation to be highly effective in preventing preeclampsia.

    Dose:

    1,200 to 1,500 mg daily
    Calcium
    ×

    Calcium deficiency has been associated with preeclampsia.20 In numerous controlled trials, oral calcium supplementation has been studied as a possible preventive measure.21 22 2324 While most trials have found a significant reduction in the incidence of preeclampsia with calcium supplementation,212227282430 One study reported that calcium supplementation reduced both the severity of preeclampsia and the mortality rate in the infants.23

    An analysis of double-blind trials46 found calcium supplementation to be highly effective in preventing preeclampsia. However, a large and well-designed double-blind trial and a critical analysis of six double-blind trials concluded that calcium supplementation did not reduce the risk of preeclampsia in healthy women at low risk for preeclampsia.32 For healthy, high-risk (in other words, calcium deficient) women, however, the data show a clear and statistically significant beneficial effect of calcium supplementation in reducing the risk of preeclampsia.3228233623383940242443 44 4546

    The National Institutes of Health recommends an intake of 1,200 to 1,500 mg of elemental calcium daily during normal pregnancy.47 In women at risk of preeclampsia, most trials showing reduced incidence have used 2,000 mg of supplemental calcium per day.22 Nonetheless, many doctors continue to suggest amounts no higher than 1,500 mg per day.

  • Arginine

    In one study in which pregnant women at an increased risk of developing preeclampsia received either arginine or a placebo, the arginine group had a significantly lower incidence of preeclampsia compared with the placebo group.

    Dose:

    Refer to label instructions
    Arginine
    ×
    In a double-blind study, 100 pregnant women at increased risk of developing preeclampsia received 3 grams of arginine once a day or a placebo, starting in the 20th week of gestation and continuing until delivery. The incidence of preeclampsia was significantly lower by 74% in the arginine group than in the placebo group (6.1% vs. 23.4%).38
  • Coenzyme Q10

    In a double-blind study at women who were at high risk of developing preeclampsia, supplementing with coenzyme Q10 reduced the incidence of preeclampsia by 44%.

    Dose:

    200 mg per day
    Coenzyme Q10
    ×

    Pregnant women with preeclampsia have significantly lower plasma coenzyme Q10 levels, when compared with women with healthy pregnancies. In a double-blind study at women who were at high risk of developing preeclampsia, supplementing with coenzyme Q10 reduced the incidence of preeclampsia by 44%. The amount used was 200 mg per day; treatment was begun during the twentieth week of pregnancy and continued until delivery.39

  • Folic Acid

    Supplementing with folic acid and vitamin B6 may lower homocysteine levels. Elevated homocysteine damages the lining of blood vessels and can lead to preeclamptic symptoms.

    Dose:

    5 mg daily
    Folic Acid
    ×
     

    Women with preeclampsia have been shown to have elevated blood levels of homocysteine.40,41,42,43 Research indicates elevated homocysteine occurs prior to the onset of preeclampsia.44 Elevated homocysteine damages the lining of blood vessels,41,46,44,48,49,50,51 which can lead to the preeclamptic signs of elevated blood pressure, swelling, and protein in the urine.52

    In one preliminary trial, women with a previous pregnancy complicated by preeclampsia and high homocysteine supplemented with 5 mg of folic acid and 250 mg of vitamin B6 per day, successfully lowering homocysteine levels.40 In another trial studying the effect of vitamin B6 on preeclampsia incidence, supplementation with 5 mg of vitamin B6 twice per day significantly reduced the incidence of preeclampsia. Women in that study were not, however, evaluated for homocysteine levels.54 In fact, no studies have yet determined whether lowering elevated homocysteine reduces the incidence or severity of preeclampsia. Nevertheless, despite a lack of proof that elevated homocysteine levels cause preeclampsia, many doctors believe that pregnant women with elevated homocysteine should attempt to reduce those levels to normal.

  • Fish Oil

    Fish oil supplementation may lower the incidence of preeclampsia.

    Dose:

    Refer to label instructions
    Fish Oil
    ×
     

    Fish oil supplementation has been proposed to lower the incidence of preeclampsia.52,53 However, controlled clinical trials suggest that fish oil does not reduce symptoms54 or protect against preeclampsia.55,56

  • Magnesium

    Magnesium supplementation has been shown to reduce the incidence of preeclampsia in high-risk women in one trial.

    Dose:

    Refer to label instructions
    Magnesium
    ×
     

    Magnesium deficiency has been implicated as a possible cause of preeclampsia.57,58,59,60,61 Magnesium supplementation has been shown to reduce the incidence of preeclampsia in high-risk women in one trial,62 but not in another double-blind trial.58

  • Vitamin B2

    Women who are deficient in vitamin B2 (riboflavin) are more likely to develop preeclampsia than women with normal levels. Supplementation may correct a deficiency.

    Dose:

    Refer to label instructions
    Vitamin B2
    ×
     

    Women who are deficient in vitamin B2 (riboflavin) are more likely to develop preeclampsia than women with normal vitamin B2 levels.63 These results were observed in a developing country, where vitamin B2 deficiencies are more common than in the United States. Nevertheless, insufficient vitamin B2 may contribute to the abnormalities underlying the disease process.

  • Vitamin B6

    Supplementing with vitamin B6 and folic acid may lower homocysteine levels. Elevated homocysteine damages the lining of blood vessels and can lead to the preeclamptic symptoms.

    Dose:

    Refer to label instructions
    Vitamin B6
    ×
      

    Women with preeclampsia have been shown to have elevated blood levels of homocysteine.64,65,66,67 Research indicates elevated homocysteine occurs prior to the onset of preeclampsia.68 Elevated homocysteine damages the lining of blood vessels,65,70,68,72,73,74,75 which can lead to the preeclamptic signs of elevated blood pressure, swelling, and protein in the urine.76

    In one preliminary trial, women with a previous pregnancy complicated by preeclampsia and high homocysteine supplemented with 5 mg of folic acid and 250 mg of vitamin B6 per day, successfully lowering homocysteine levels.64 In another trial studying the effect of vitamin B6 on preeclampsia incidence, supplementation with 5 mg of vitamin B6 twice per day significantly reduced the incidence of preeclampsia. Women in that study were not, however, evaluated for homocysteine levels.78 In fact, no studies have yet determined whether lowering elevated homocysteine reduces the incidence or severity of preeclampsia. Nevertheless, despite a lack of proof that elevated homocysteine levels cause preeclampsia, many doctors believe that pregnant women with elevated homocysteine should attempt to reduce those levels to normal.

What Are Star Ratings
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

References

1. Myatt L, Miodovnik M. Prediction of preeclampsia. Semin Perinatol 1999;23:45-57.

2. Smith GN, Walker M, Tessier JL, Millar KG. Increased incidence of preeclampsia in women conceiving by intrauterine insemination with donor versus partner sperm for treatment of primary infertility. Am J Obstet Gynecol 1997;177:455-8.

3. Rey E, LeLorier J, Burgess E, et al. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997;157:1245-54.

4. Rath W Z. Treatment of hypertensive diseases in pregnancy—general recommendations and long-term oral therapy. Geburtshilfe Neonatol 1997;201:240-6 [in German].

5. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

6. Mounier-Vehier C, Equine O, Valat-Rigot AS, et al. Hypertensive syndromes in pregnancy. Physiopathology, definition and fetomaternal complications. Presse Med 1999;28:880-5 [in French].

7. Sibai BM, Ewell M, Levine RJ, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1997;177:1003-10.

8. Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 1998;Suppl 2:B79-84.

9. Saudan P, Brown MA, Buddle ML, Jones M. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol 1998;105:1177-84.

10. Hojo M, August P. Calcium Metabolism in Preeclampsia: Supplementation may help. Medscape Womens Health 1997;2:5.

11. Mikhail MS, Anyaegbunam A, Garfinkel D, et al. Preeclampsia and antioxidant nutrients: decreased plasma levels of reduced ascorbic acid, alpha-tocopherol and beta carotene in women with preeclampsia. Am J Obstet Gynecol 1994;171:150-7.

12. Gulmezoglu AM, Hofmeyr GJ, Oosthuisen MM. Antioxidants in the treatment of severe pre-eclampsia: an explanatory randomised controlled trial. Br J Obstet Gynaecol 1997;104:689-96.

13. Valsecchi L, Fausto A, Grazioli V. Severe preeclampsia and antioxidant nutrients. Am J Obstet Gynecol 1995;173:673 [letter].

14. Bianco A, Stone J, Lynch L, et al. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996;87:917-22.

15. Marcoux S, Berube S, Brisson C, Mondor M. Job strain and pregnancy-induced hypertension. Epidemiology 1999;10:376-82.

16. Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health 1998;24:206-12.

17. Rath W Z. Treatment of hypertensive diseases in pregnancy—general recommendations and long-term oral therapy. Geburtshilfe Neonatol 1997;201:240-6 [in German].

18. Rey E, LeLorier J, Burgess E, et al. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of hypertensive disorders in pregnancy. CMAJ 1997;157:1245-54.

19. Sibai BM, Frangieh AY. Management of severe preeclampsia. Curr Opin Obstet Gynecol 1996;8(2):110-3.

20. 33. Hojo M, August P. Calcium metabolism in normal and hypertensive pregnancy. Semin Nephrol 1995;15:504-11 [review].

21. Hojo M, August P. Calcium Metabolism in Preeclampsia: Supplementation may help. Medscape Womens Health 1997;2:5.

22. Moutquin JM, Garner PR, Burrows RF, et al. Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. CMAJ 1997;157:907-19.

23. Levine RJ, Hauth JC, Curet LB, et al. Trial of calcium to prevent preeclampsia. N Engl J Med 1997;337:69-76.

24. Belizan JM, Villar J, Gonzalez L. Calcium supplementation to prevent hypertensive disorders of pregnancy. N Engl J Med 1991;325:1399-405.

25. Crowther CA, Hiller JE, Pridmore B, et al. Calcium supplementation in nulliparous women for the prevention of pregnancy-induced hypertension, preeclampsia, and preterm birth: an Australian randomized trial. FRACOG and the ACT study group. Aust N Z J Obstet Gynaecol 1999;39:12-8.

26. Bucher HC, Guyatt GH, Cook RJ, et al. Effect of calcium supplementation on pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized controlled trials. JAMA 1996;275:1113-7.

27. Herrera JA, Arevalo-Herrera M, Herrera S. Prevention of preeclampsia by linoleic acid and calcium supplementation: a randomized controlled trial. Obstet Gynecol 1998;91:585-90.

28. Villar J, Abdel-Aleem H, Merialdi M, et al. World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Am J Obstet Gyneco 2006;194:639-49.

29. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

30. Lopez-Jaramillo P, Narvaez M, Weigle RM, Yepez R. Calcium supplementation reduces the risk of pregnancy-induced hypertension in an Andes population. Br J Obstet Gynaecol 1989;96:648-55.

31. Lopez-Jaramillo P, Narvaez M, Felix C, Lopez A. Dietary calcium supplementation and prevention of pregnancy hypertension. Lancet 1990;335:293. [letter]

32. Villar J, Repke JT. Calcium supplementation during pregnancy may reduce preterm delivery in high-risk populations. Am J Obstet Gynecol 1990;163:1124-31.

33. Sanchez-Ramos L, Briones DK, Kaunitz AM, et al. Prevention of pregnancy-induced hypertension by calcium supplementation in angiotensin II-sensitive patients. Obstet Gynecol 1994;84:349-53.

34. DerSimonian R, Levine RJ. Resolving discrepancies between a meta-analysis and a subsequent large controlled trial. JAMA 1999;282:664-70 [review].

35. Ritchie LD, King JC. Dietary calcium and pregnancy-induced hypertension: is there a relation? Am J Clin Nutr 2000;71(5 Suppl):1371S-4S [review].

36. Villar J, Belizan JM. Same nutrient, different hypotheses: disparities in trials of calcium supplementation during pregnancy. Am J Clin Nutr 2000;71(5 Suppl):1375-9S [review].

37. Consensus Development Conference Panel. Optimal calcium intake: Consensus Development Conference statement. JAMA 1994;272:1942-8.

38. Camarena Pulido EE, Garcia Benavides L, Panduro Baron JG, et al. Efficacy of L-arginine for preventing preeclampsia in high-risk pregnancies: A double-blind, randomized, clinical trial. Hypertens Pregnancy 2016;35:217–25.

39. Teran E, Hernandez I, Nieto B, et al. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet 2009;105:43-5.

40. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

41. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

42. Rajkovic A, Catalano PM, Malinow MR. Elevated homocyst(e)ine levels with preeclampsia. Obstet Gynecol 1997;90:168-71.

43. Laivuori H, Kaaja R, Turpeinen U, et al. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet Gynecol 1999;93:489-93.

44. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

45. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999;20:519-29 [review].

46. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:5-15.

47. Hayman R, Brockelsby J, Kenny L, Baker P. Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor. J Soc Gynecol Investig 1999;6:3-10.

48. Lyall F, Greer IA. The vascular endothelium in normal pregnancy and pre-eclampsia. Rev Reprod 1996;1:107-16.

49. Roberts JM, Redman CWG. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1994;341:1447-54.

50. Taylor RN, de Groot CJ, Cho YK, Lim KH. Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:17-31.

51. Wachstein M, Graffeo LW. Influence of Vitamin B6 on the incidence of preeclampsia. Obstet Gynecol 1956;8:177-80.

52. Sibai BM. Prevention of preeclampsia: A big disappointment. Am J Obstet Gynecol 1998;179:1275-8 [review].

53. Williams MA, Zingheim RW, King IB, Zebelman AM. Omega-3 fatty acids in maternal erythrocytes and risk for preeclampsia. Epidemiology 1995;6:232-7.

54. Laivuori H, Hovatta O, Viinikka L, Ylikorkala O. Dietary supplementation with primrose oil or fish oil does not change urinary excretion of prostacyclin and thromboxane metabolites in pre-eclamptic women. Prostaglandins Leukot Essent Fatty Acids 1993;49:691-4.

55. Onwude JL, Lilford RJ, Hjartardottier H, et. al. A randomised double blind placebo controlled trial of fish oil in high risk pregnancy. Br J Obstet Gynaecol 1995;109:95-100.

56. Salvig JD, Olsen SF, Secher NJ. Effects of fish oil supplementation in late pregnancy on blood pressure: a randomised controlled trial. Br J Obstet Gynaecol 1996;103:529-33.

57. Wynn A, Wynn M. Magnesium and other nutrient deficiencies as possible causes of hypertension and low birthweight. Nutr Health 1988;6:69-88.

58. Spatling L, Spatling G. Magnesium supplementation in pregnancy: a double-blind study. Br J Obstet Gynaecol 1988;950:120-5.

59. Sibai BM, Villar MA, Bray E. Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial. Am J Obstet Gynecol 1989;161:115-9.

60. Standley CA, Whitty JE, Mason BA, Cotton DB. Serum ionized magnesium levels in normal and preeclamptic gestation. Obstet Gynecol 1997;89:24-7.

61. Handwerker SM, Altura BT, Altura BM. Ionized serum magnesium and potassium levels in pregnant women with preeclampsia and eclampsia. J Reprod Med 1995;40:201-8.

62. Conradt A, Weidinger H, Algayer G. Magnesium deficiency, a possible cause of pre-eclampsia: reduction of frequency of premature rupture of membranes and premature or small-for-date deliveries after magnesium supplementation. J Am Coll Nutr 1985;4:321.

63. Wacker J, Fruhauf J, Schulz M, et al. Riboflavin deficiency and preeclampsia. Obstet Gynecol 2000;96:38-44.

64. Leeda M, Riyazi N, de Vries JI, et al. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Am J Obstet Gynecol 1998;179:135-9.

65. Powers RW, Evans RW, Majors AK, et al. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation. Am J Obstet Gynecol 1998;179:1605-11.

66. Rajkovic A, Catalano PM, Malinow MR. Elevated homocyst(e)ine levels with preeclampsia. Obstet Gynecol 1997;90:168-71.

67. Laivuori H, Kaaja R, Turpeinen U, et al. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet Gynecol 1999;93:489-93.

68. Sorensen TK, Malinow MR, Williams MA, et al. Elevated second-trimester serum homocyst(e)ine levels and subsequent risk of preeclampsia. Gynecol Obstet Invest 1999;48:98-103.

69. Ray JG, Laskin CA. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: A systematic review. Placenta 1999;20:519-29 [review].

70. Roberts JM. Endothelial dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:5-15.

71. Hayman R, Brockelsby J, Kenny L, Baker P. Preeclampsia: the endothelium, circulating factor(s) and vascular endothelial growth factor. J Soc Gynecol Investig 1999;6:3-10.

72. Lyall F, Greer IA. The vascular endothelium in normal pregnancy and pre-eclampsia. Rev Reprod 1996;1:107-16.

73. Roberts JM, Redman CWG. Pre-eclampsia: more than pregnancy-induced hypertension. Lancet 1994;341:1447-54.

74. Taylor RN, de Groot CJ, Cho YK, Lim KH. Circulating factors as markers and mediators of endothelial cell dysfunction in preeclampsia. Semin Reprod Endocrinol 1998;16:17-31.

75. Wachstein M, Graffeo LW. Influence of Vitamin B6 on the incidence of preeclampsia. Obstet Gynecol 1956;8:177-80.

76. Franx A, Steegers EA, de Boo T, et al. Sodium-blood pressure interrelationship in pregnancy. J Hum Hypertens 1999;13:159-66.

77. Moutquin JM, Garner PR, Burrows RF, et al. Report of the Canadian Hypertension Society Consensus Conference: 2. Nonpharmacologic management and prevention of hypertensive disorders in pregnancy. CMAJ 1997;157:907-19.

78. Williams MA, King IB, Sorensen TK, et al. Risk of preeclampsia in relation to elaidic acid (trans fatty acid) in maternal erythrocytes. Gynecol Obstet Invest 1998;46:84-7.

79. Wergeland E, Strand K. Work pace control and pregnancy health in a population-based sample of employed women in Norway. Scand J Work Environ Health 1998;24:206-12.

80. Marcoux S, Berube S, Brisson C, Mondor M. Job strain and pregnancy-induced hypertension. Epidemiology 1999;10:376-82.

81. Katz VL, Ryder RM, Cefalo RC, et al. A comparison of bed rest and immersion for treating the edema of pregnancy. Obstet Gynecol 1990;75:147-51.

82. Allen C, Glasziou P, Del Mar C. Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 1999;354:1229-33 [review].

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2019.