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• W2912641213 abstract "Hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia, are common complications occurring in 2–8% of pregnancies, and contribute significantly to long-lasting health consequences for both women and their children. There is some uncertainty around the precise cause(s) of HDP, which probably reflects its highly complex and multifactorial pathogenesis, and this has hindered the development of effective prevention strategies. Currently, only low-dose aspirin and calcium supplementation are recommended for the prevention of HDP in pregnant women at high risk (Duley et al. Cochrane Database Syst Rev 2007;18:CD004659; Hofmeyr et al. Cochrane Database Syst Rev 2018;10:CD001059). Ikem and colleagues (BJOG 2019; 126:663–73) evaluated the role of maternal diet in the prevention of HDP by examining associations between mid-pregnancy dietary patterns and the subsequent development of HDP in a prospective cohort study of over 55 000 Danish women. Consistent with findings from a limited number of previously reported prospective cohort studies, the results identify an association between a higher consumption of vegetables, nuts, and fish (seafood diet) and a lower risk of both gestational hypertension and pre-eclampsia. In contrast, higher dietary consumption of French fries, meat, white bread, and snacks (Western diet) was positively associated with both disorders. The authors conclude that there were no associations between dietary patterns and severe pre-eclampsia (OR 0.81, 95% CI 0.53–1.25 for high- versus low-seafood diet; OR 1.26, 95% CI 0.76–2.09 for high- versus low-Western diet), although the magnitude of the effect was comparable with those obtained for gestational hypertension (OR 0.86, 95% CI 0.77–0.95; OR 1.18, 95% CI 1.05–1.33) and pre-eclampsia (OR 0.79, 95% CI 0.65–0.97; OR 1.40, 95% CI 1.11–1.76). The findings did not reach statistical significance, probably reflecting the low occurrence of cases of severe pre-eclampsia. Interestingly, Ikem and colleagues propose that associations between maternal diet and HDP were evident only among women whose preconception body mass index (BMI) was within the normal range (18.5–24.9 kg/m2). It remains unclear if these differences reflect inherent limitations within the study design, including the reliance on the self-reporting of dietary intake and residual confounding, or if they reflect true physiological variation. Although interesting for forming a future hypothesis, the findings from Ikem and colleagues are in contrast to the large individual participant data meta-analysis conducted by the International Weight Management in Pregnancy (i-WIP) collaboration (BMJ 2017; 358:j3119), bringing together data from over 36 randomised dietary intervention trials and more than 12 500 women globally. Although antenatal dietary interventions were associated with a modest 0.7-kg difference in gestational weight gain, there was limited impact on maternal pregnancy outcomes, with no evidence of a differential effect of the intervention based on maternal preconception or early pregnancy BMI category. Clearly, the consumption of a healthy and varied diet during pregnancy is prudent advice; however, alternative strategies are required if significant improvements in maternal and child health are to be realised. This includes widespread population efforts to improve health generally, and weight specifically, of young people well before the time of conception. None declared. Completed disclosure of interest forms are available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
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• W2912641213 date "2019-02-06" @default.
• W2912641213 modified "2023-09-23" @default.
• W2912641213 title "Does preconception body mass index modify the effect of maternal diet on hypertensive disorders of pregnancy?" @default.
• W2912641213 doi "https://doi.org/10.1111/1471-0528.15596" @default.
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