Associations of DASH Diet in Pregnancy With Blood Pressure Patterns, Placental Hemodynamics, and Gestational Hypertensive Disorders.

Background The Dietary Approaches to Stop Hypertension (DASH) diet improves blood pressure in nonpregnant populations. We hypothesized that adherence to the DASH diet during pregnancy improves hemodynamic adaptations, leading to a lower risk of gestational hypertensive disorders. Methods and Results We examined whether the DASH diet score was associated with blood pressure, placental hemodynamics, and gestational hypertensive disorders in a population-based cohort study among 3414 Dutch women. We assessed DASH score using food-frequency questionnaires. We measured blood pressure in early-, mid-, and late pregnancy (medians, 95% range: 12.9 [9.8-17.9], 20.4 [16.6-23.2], 30.2 [28.6-32.6] weeks gestation, respectively), and placental hemodynamics in mid- and late pregnancy (medians, 95% range: 20.5 [18.7-23.1], 30.4 [28.5-32.8] weeks gestation, respectively). Information on gestational hypertensive disorders was obtained from medical records. Lower DASH score quartiles were associated with a higher mid pregnancy diastolic blood pressure, compared with the highest quartile (P<0.05). No associations were present for early- and late pregnancy diastolic blood pressure and systolic blood pressure throughout pregnancy. Compared with the highest DASH score quartile, the lower DASH score quartiles were associated with a higher mid- and late pregnancy umbilical artery pulsatility index (P≤0.05) but not with uterine artery resistance index. No associations with gestational hypertensive disorders were present. Conclusions A higher DASH diet score is associated with lower mid pregnancy diastolic blood pressure and mid- and late pregnancy fetoplacental vascular function but not with uteroplacental vascular function or gestational hypertensive disorders within a low-risk population. Further studies need to assess whether the effects of the DASH diet on gestational hemodynamic adaptations are more pronounced among higher-risk populations.

Effects of dietary nitrate supplementation, from beetroot juice, on blood pressure in hypertensive pregnant women: A randomised, double-blind, placebo-controlled feasibility trial.

Chronic hypertension in pregnancy is associated with significant adverse pregnancy outcomes, increasing the risk of pre-eclampsia, fetal growth restriction and preterm birth. Dietary nitrate, abundant in green leafy vegetables and beetroot, is reduced in vivo to nitrite and subsequently nitric oxide, and has been demonstrated to lower blood pressure, improve vascular compliance and enhance blood flow in non-pregnant humans and animals. The primary aims of this study were to determine the acceptability and efficacy of dietary nitrate supplementation, in the form of beetroot juice, to lower blood pressure in hypertensive pregnant women. In this double-blind, placebo-controlled feasibility trial, 40 pregnant women received either daily nitrate supplementation (70 mL beetroot juice, n = 20) or placebo (70 mL nitrate-depleted beetroot juice, n = 20) for 8 days. Blood pressure, cardiovascular function and uteroplacental blood flow was assessed at baseline and following acute (3 h) and prolonged (8 days) supplementation. Plasma and salivary samples were collected for analysis of nitrate and nitrite concentrations and acceptability of this dietary intervention was assessed based on questionnaire feedback. Dietary nitrate significantly increased plasma and salivary nitrate/nitrite concentrations compared with placebo juice (p < 0.001), with marked variation between women. Compared with placebo, there was no overall reduction in blood pressure in the nitrate-treated group; however there was a highly significant correlation between changes in plasma nitrite concentrations and changes in diastolic blood pressure in the nitrate-treated arm only (r = -0.6481; p = 0.0042). Beetroot juice supplementation was an acceptable dietary intervention to 97% of women. This trial confirms acceptability and potential efficacy of dietary nitrate supplementation in pregnant women. Conversion of nitrate to nitrite critically involves oral bacterial nitrate reductase activities. We speculate that differences in efficacy of nitrate supplementation relate to differences in the oral microbiome, which will be investigated in future studies.

Associations of the dietary approaches to stop hypertension (DASH) diet with pregnancy complications in Project Viva.

BACKGROUND/OBJECTIVES: The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to improve cardiometabolic outcomes in non-pregnant populations. Little is known regarding the impact of this diet on health during pregnancy. The objective of this research is to examine associations of adherence to the DASH diet with hypertensive disorders of pregnancy (HDP) and other pregnancy outcomes. SUBJECTS/METHODS: We conducted analyses with data that came from 1760 women in Project Viva, a Boston-area longitudinal cohort recruited in early pregnancy 1999-2002. We derived a DASH score using data from a food frequency questionnaire (FFQ) administered at median 11.1 weeks gestation. Next, we used multivariable linear regression models that accounted for the woman's age at enrollment, pre-pregnancy body mass index (BMI), education, smoking habits, race/ethnicity, gestational weight gain (GWG) up until the time of the FFQ, and total energy intake to examine associations of the DASH score with HDP, gestational diabetes, preterm delivery (<37 weeks), birth size, and GWG from FFQ to delivery. Models for HDP and GDM were additionally mutually adjusted for each other. Because pre-pregnancy weight status may modify these relationships, we tested for interactions between pre-pregnancy BMI and the DASH score. RESULTS: Mean ± SD age of the women was 32.2 ± 4.9 years; 71.9% were white. Overall, the DASH diet score (mean: 24.0, SD: 5.0) was not associated with any of the pregnancy outcomes or complications. However, we found a positive association between the DASH diet and subsequent GWG among women who were obese before pregnancy (0.19 [95% CI: 0.05, 0.34], P ≤ 0.05 kg higher GWG per 1 unit DASH score). CONCLUSIONS: Adherence to DASH diet during early pregnancy does not appear to be protective against HDP or other adverse pregnancy outcomes.

Salt intake and the validity of a salt intake assessment system based on a 24-h dietary recall method in pregnant Japanese women.

BACKGROUND: Information regarding salt intake in pregnant women in Japan is limited. An electronic system for the assessment of salt intake using a 24-h dietary recall method has been developed in Japan. The objectives of the present study were to investigate salt intake in pregnant women and to compare the salt intake estimated by the electronic salt intake assessment system with that measured by 24-h urinary salt excretion (24-hUNaCl). METHODS: Data were collected on 24-hUNaCl and salt intake estimated by the salt intake assessment system for 35 pregnant Japanese women at approximately 20 weeks of gestation. The adjusted 24-hUNaCl (24-hUNaCl/[the number of urinations during the examination day--the number of missing urine collections] × the number of urinations during the examination day, g/day) was used as a standard. RESULTS: The mean adjusted 24-hUNaCl was 7.7 ± 2.5 g/day, and mean systolic/diastolic blood pressure values were 106.1 ± 8.6/62.8 ± 6.5 mmHg. The adjusted 24-hUNaCl was significantly correlated with the salt intake estimated by the salt intake assessment system (r = 0.47, p = 0.004). Bland-Altman analysis showed no significant mean difference (adjusted 24-hUNaCl--salt intake estimated by the assessment system = -0.36 g/day, p = 0.4) and no significant proportional bias (p = 0.1). CONCLUSION: These results suggest that pregnant women in Japan restrict their salt intake, at least when they are being examined for salt intake. They also suggest that repeated use of the described system may be useful in estimating salt intake in pregnant women.

Normotensive blood pressure in pregnancy: the role of salt and aldosterone.

A successful pregnancy requires an accommodating environment. Salt and water availability are critical for plasma volume expansion. Any changes in sodium intake would alter aldosterone, a hormone previously described beneficial in pregnancy. To date, it remains ambiguous whether high aldosterone or high salt intake is preferable. We hypothesized that increased aldosterone is a rescue mechanism and appropriate salt availability is equally effective in maintaining a normotensive blood pressure (BP) phenotype in pregnancy. We compared normotensive pregnant women (n=31) throughout pregnancy with young healthy female individuals (n=31-62) and performed salt sensitivity testing within the first trimester. Suppression of urinary tetrahydro-aldosterone levels by salt intake as measured by gas chromatography-mass spectrometry and urinary sodium excretion corrected for creatinine, respectively, was shifted toward a higher salt intake in pregnancy (P<0.0001). In pregnancy, neither high urinary tetrahydro-aldosterone nor sodium excretion was correlated with higher BP. In contrast, in nonpregnant women, systolic BP rose with aldosterone (P<0.05). Testing the impact of salt on BP, we performed salt sensitivity testing in a final cohort of 19 pregnant and 24 nonpregnant women. On salt loading, 24-hour mean arterial pressure rose by 3.6±1.5 and dropped by -2.8±1.5 mm Hg favoring pregnant women (P<0.01; χ(2)=6.04; P<0.02). Our data suggest first that salt responsiveness of aldosterone is alleviated in conditions of pregnancy without causing aldosterone-induced hypertension. Second, salt seems to aid in BP lowering in pregnancy for reasons incompletely elucidated, yet involving renin suppression and potentially placental sensing mechanisms. Further research should identify susceptible individuals and clarify effector mechanisms.

Utilización de mini implante en paciente con requerimiento de anclaje asimétrico. Presentación de caso / Use of mini implants in patients with requirements of asymmetric anchorage. Case presentation

Fundamento: el uso de los mini implantes como anclaje es una técnica novedosa en ortodoncia, aunque en Cuba su uso es reciente. Presentación de caso: paciente masculino de 13 años, raza blanca, balance neuromuscular, buena relación intermaxilar, discrepancia hueso diente negativa elevada, apiñamiento dentario y caninos ectópicos. Se realizaron extracciones de primeros premolares izquierdos y primeros molares derechos en ambos maxilares, lo que limitó el anclaje tradicional. Se colocaron mini implantes en ambos maxilares para el requerimiento de anclaje máximo asimétrico durante la primera etapa del tratamiento. No existió dolor, inflamación u otra lesión en la zona peri implantaria y se logró eliminar la discrepancia hueso diente negativa elevada inicial y sus manifestaciones. Se obtuvo relación de caninos de neutroclusión y guías caninas funcionales. Conclusiones: los mini implantes permitieron el anclaje máximo asimétrico para lograr una oclusión estética y funcional en el paciente.

Background: the use of mini implants as anchorage is a new technique used in orthodontics; although its use is very recent in Cuba. Case presentation: a 13 year old male white patient with neuromuscular balance, good intermaxillary relation and high negative discrepancy tooth bone, dental crowding and ectopic canines. Tooth extractions were made to align the upper and lower dental arches, which limited the traditional anchor. Mini implants were used in the molar zones for the maximum asymmetric anchorage requirement during the first stage of the treatment. There was no pain, swelling or other injury to the peri implant zone and managed to eliminate the discrepancy initial elevated negative tooth and its manifestations. It was obtained relationship of canines of neutroclusion and functional canine guides. Conclusions: the mini implants allowed the maximum asymmetrical anchorage to achieve a patient functional aesthetic occlusion.

[Micronutrients supplementation in women with hypertensive states in pregnancy]. / Suplementación de micronutrimentos en mujeres con estados hipertensivos del embarazo (EHE).

Pregnancy presents a large number of metabolic adaptations and requirements of micro and macronutrients could be increased, which are not always covered by the diet making necessary to supplement some of them. The micronutrients are an important part of metabolic reactions and both; their deficiency as their excess could participate in damage to organs and tissues of the mother and the fetus. Actually the hypertension pregnant states (HPS) participate in the leading causes of death during pregnancy, making necessary the search for interventions to prevent or reduce the consequences.The oxidative stress levels are linked with the risk to develop HPS, which has created assumptions about the use of micronutrients with antioxidant power and its possible role as protectors in these pathologies, however, the information is still uncertain and the metabolic action of the use of micronutrients supplementation is not precisely known because some micronutrients have shown a protective effect on the development of HPS. It is necessary to evaluate the nutritional status before and during pregnancy, as well to realize more studies about it and strengthen public policies about the use of micronutrients during the pregnancy.