Maternal nutritional risk factors for pre-eclampsia incidence: findings from a narrative scoping review
Mai‐Lei Woo Kinshella, Shazmeen Omar, Kerri Scherbinsky, Marianne Vidler, Laura A. Magee, Peter von Dadelszen, Sophie E. Moore, Rajavel Elango, The PRECISE Conceptual Framework Working Group, Peter von Dadelszen, Laura A. Magee, Lucilla Poston, Hiten D. Mistry, Marie‐Laure Volvert, Cristina Escalona Lopez, Sophie E. Moore, Rachel Tribe, Andrew Shennan, Tatiana Taylor Salisbury, Lucy C. Chappell, Rachel Craik, Marleen Temmerman, Angela Koech Etyang, Sikolia Wanyonyi, Geoffrey Omuse, Patricia Okiro, Grace Mwashigadi, Esperança Sevene, Helena Boene, Corssino Tchavana, Eusébio Macete, Carla Carillho, Lazaro Quimice, Sónia Maculuve, Donna Russell, Ben Baratt, Joy E Lawn, Hannah Blencowe, Véronique Filippi, Matt J. Silver, Prestige Tatenda Makanga, Liberty Makacha, Yolisa Prudence Dube, Newton Nyapwere, Reason Mlambo, Umberto D’Alessandro, Anna Roca, Melisa Martínez-Álvarez, Hawanatu Jah, Brahima A. Diallo, Abdul Karim Sesay, Fatima Touray, Abdoulie Sillah, J. Alison Noble, Aris T. Papageorghiou, Judith E. Cartwright, Guy Whitley, Sanjeev Krishna, Rosemarie Townsend, Asma Khalil, Marianne Vidler, Joel Singer, Jing Li, Jeffrey N. Bone, Mai‐Lei Woo Kinshella, Kelly Pickerill, Ash Sandhu, Tu Domena, Rajavel Elango, William Stones
Abstract
BACKGROUND: Pre-eclampsia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-eclampsia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-eclampsia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-eclampsia. METHODS: A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility. RESULTS: The review found evidence for associations between nutritional inadequacies and a greater risk of pre-eclampsia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-eclampsia. Maternal nutritional risk factors for pre-eclampsia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-eclampsia incidence. CONCLUSION: A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-eclampsia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary diversity and social, cultural contexts of food and meals.