Maternal Dietary Patterns and Pregnancy Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis

Abstract

Healthy maternal diets can lower the odds of developing pre-eclampsia, a direct and second leading cause of maternal death, globally. However, there is a research gap in low- and middle-income countries (LMIC), which bear a disproportionate burden of these deaths. The objectives of this systematic review were to: 1) evaluate the association between dietary patterns in pregnancy and hypertensive disorders, including pre-eclampsia for pregnant and postpartum women in LMIC, and 2) compile barriers and facilitators to an adequate maternal diet. A systematic search was performed on MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, Web of Science, Cochrane Central Register of Controlled Trials, African Journals Online, the WHO Regional Databases, 2 trial registries, Google Scholar, and reference lists. Included in the analysis were primary research studies of dietary patterns during pregnancy, with pregnancy hypertension outcome(s), and conducted in LMIC. Included studies were assessed using ROBINS-I risk of bias. Thirteen studies were included, of which 5 studies were included in a meta-analysis (Review Manager 5). Lower odds of pre-eclampsia were associated with adequate (compared with no or low) consumption of vegetables (OR: 0.38; 95% CI: 0.18, 0.80; I2 = 85%; P = 0.01) and adequate (compared with no or low) consumption of fruit (OR: 0.42; 95% CI: 0.24, 0.71; I2 = 79%; P = 0.008). No firm conclusions could be drawn about the impact on pre-eclampsia odds of any of the following during pregnancy: high consumption of meat or grains; a “Western” diet; or alcohol consumption. More LMIC-based research is needed to explore whether the apparent beneficial effects of fruits and vegetables on pre-eclampsia incidence might be enhanced when maternal malnutrition is prevalent, and/or whether other sociodemographic factors might contribute.

An evidence review and nutritional conceptual framework for pre-eclampsia prevention

“…The review consisted of four, large, HIC-based cohort studies: three from the Norwegian Mother and Child Cohort Study (MoBa) that assessed maternal diet in the second trimester (80)(81)(82) and the Generation R Cohort Study from the Netherland with assessment at a median 13.5 weeks (83). A subsequent meta-analysis of LMIC-based studies found that adequate (≥1-3 servings/week) vegetable consumption reduced the odds of developing pre-eclampsia by 62% (OR 0.38, 95% CI: 0.18 to 0.80, 4 studies, 1,391 participants, I 2 85%) and by 58% with adequate (≥1-3 servings/week) fruit consumption (OR 0.42, 95% CI: 0.24 to 0.71, 5 studies, 1,676 participants, I 2 79%) compared to women with low or no consumption (84). Conversely, maternal diets https://doi.org/10.1017/S0007114522003889 Published online by Cambridge University Press characterized by ultra-processed foods was associated with higher odds of developing preeclampsia, based on high quality evidence and no heterogeneity between study results (56).…”

Maternal nutritional risk factors for pre-eclampsia incidence: findings from a narrative scoping review

“…With the exception of calcium, where decades of intervention trials corroborate with early epidemiological observations and understandings of biological mechanisms on evidence of a protective effect against preeclampsia, many potential maternal dietary factors are not supported by results of supplementation trials [124]. For example, though maternal serum vitamin C [52], zinc [58] and iron [67] have strong associations with the development of pre-eclampsia and make biological sense, supplementation resulted in non-significant effects [124][125][126][127]. Findings from this scoping review may help to shed light on the discrepancy.…”

Identifying barriers, facilitators, and interventions to support healthy eating in pregnant women with or at risk for hypertensive disorders of pregnancy

“…As more evidence supports the positive benefits of healthy diet, such as lower risk of preeclampsia with DASH and higher vegetable and fruit consumption, this messaging needs to be disseminated. 31 …”