Hypertension in Pregnancy: What Should I Do?

Firstly, it is important to remember that: do not restrict sodium intake in pregnant women with hypertensive disorders!

In cases of hypertension in normal people, sodium restriction is necessary to reduce blood pressure. However, the same strategy cannot be applied to pregnant women because sodium is required for normal fluid retention and blood volume expansion during pregnancy. Hence, a certain amount of sodium is still needed to give birth to a healthy baby. Therefore, the conclusion would be: consume sodium foods as recommended by Malaysia Dietary Guidelines (MDG) of not more than 2000mg per day, equivalent to 5 g of salt per day.

Calcium supplementation is also beneficial in treating hypertension in pregnancy. This is because calcium deficiency is one of the factors for preeclampsia. Studies have shown that calcium supplementation can reduce the severity of preeclampsia and also able to reduce the risk of getting preeclampsia. Calcium supplementation of 1500-2000 mg per day is recommended (WHO, 2011). 

According to menu planning guidelines by American Dietetic Association (ADA), pregnant women with hypertension should eat at least:

• 3 servings of whole grain products. Preferable with those fortified with iron to meet pregnancy needs
• 2-3 servings of vegetables. This includes at least 1 serving of dark green or orange vegetables that are rich in vitamin C content.
• 2 servings of fruits.
• 2-3 servings of lean meat, fish, or poultry.
• 3 servings of milk or dairy foods (low-fat or non-fat) to obtain adequate calcium and vitamin D.

What should pregnant women with hypertensive disorders avoid?

Pregnant women diagnosed with hypertension should avoid:

• Foods that are high in sodium especially processed meat, canned foods and salted foods.
• Alcohol. In fact, all pregnant women must not consume alcohol to prevent fetal alcohol syndrome in their infants.
• Excessive caffeine. Pregnant women should not take more than 4 cups of coffee per day.
• Raw or uncooked meat, fish, poultry, or eggs that can cause infections.
• Raw and unpasteurized milk and dairy products.
• Foods high in mercury such as shark and king mackerel that may lead to growth retardation in infant and even death. 
• Smoking.

Do You Know?

Fetal alcohol syndrome is a mental and physical defect in infant due to alcohol consumption by the mother during pregnancy. Baby with fetal alcohol syndrome may have the symptoms and complications such as:

• Retarded growth in womb and after birth
• Muscle weakness and poor coordination
• Mental retardation
• Heart defects
• Infant death

Facial characteristics of a child with fetal alcohol syndrome:

(Source: A.D.A.M. Medical Encyclopedia)

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DASH Diet and Hypertension

DASH diet is originally recommended by National Heart, Lung, and Blood Institute (NHLBI) for reducing and controlling blood pressure in those with hypertension. DASH stands for Dietary Approaches to Stop Hypertension. It is proven to be able to reduce blood pressure within 2 weeks time. However, many recent studies shown that DASH diet also give benefits to normal people for good health.

DASH diet encourages inclusion of regular physical activity program for a better blood pressure reducing effect. DASH diet provides almost 55% of carbohydrate, 18% protein and 27% fat from total daily calorie intake. The main characteristics of DASH diet are:

 The advantages of DASH diet:

• Able to lower blood pressure (best effect seen in people with moderately high / prehypertension)
• For people of severe hypertension, DASH diet can help to improve response to medication besides lowering the blood pressure.
• Weight loss

Table 1: The recommended intake for different food groups in DASH diet (according to a 2000 kcal diet per day).

Food group	Daily servings recommended	Portion size	Comments
Grains and grain product	6 -8	1 slice bread 1 oz dry cereal ½ cup cooked rice	Provide majority sources of energy and fiber Prefer whole grains / unrefined grains.
Vegetables	4 -5	1 cup raw leafy vegetables ½ cup cooked vegetables ½ cup 100% vegetable juice	Provide high potassium, magnesium, and fiber.
Fruits	4 -5	1 medium fruit (i.e. 1 whole apple) ½  cup canned fruit ½  cup 100% fruit juice	Significant sources of potassium, magnesium, and fiber.
Non-fat or low-fat milk and dairy products	2 -3	1 cup milk 1 cup yogurt 1 ½ oz cheese	Provide rich sources of calcium and protein.
Lean meats, poultry, and fish	≤ 6	1 oz cooked meats, poultry , or fish 1 whole egg	Provide sources of protein and magnesium. Egg yolk intake should not be more than 4 per week (high in cholesterol)
Nuts, seeds, and legumes	4 -5 per week	1/3 cup nuts 2 tablespoon peanut butter ½ cup cooked legumes	Provide high sources of energy, magnesium, protein, and fiber.
Fats and oils	2 -3	1 teaspoon soft margarine 1 teaspoon vegetable oil 1 tablespoon mayonnaise	27% fat from total calorie intake as recommended in the DASH study
Sweets and added sugar	≤ 5 per week	1 tablespoon sugar 1 tablespoon jam 1 cup lemonade	Sweets should be low in fat

*The daily servings recommended and their portion sizes are of U.S. references.1 oz is approximately equals to 30 g or 30 ml.

Sources: U.S. Department of Health and Human Sevices, 2006.Your Guide 

to Lowering Your Blood Pressure with DASH: DASH Eating Plan.

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