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MoonDragon's Women's Health Pregnancy Information

(Pregnancy-Induced Hypertension; PIH; Toxemia of Pregnancy)

For "Informational Use Only".
For more detailed information, contact your health care provider
about options that may be available for your specific situation.

This page is dedicated to Thomas H. Brewer, M.D. (1925-2005) in recognition of his life-long work in improving prenatal nutrition and prevention of preeclampsia (toxemia of pregnancy). His work will go on through the thousands of practitioners, midwives and women he has educated over the decades.

  • Preeclampsia / Eclampsia Description
  • Preeclampsia / Eclampsia Frequent Signs & Symptoms
  • Preeclampsia / Eclampsia Causes
  • Preeclampsia / Eclampsia Risk Factors
  • Preeclampsia /Eclampsia Preventive Measures
  • Preeclampsia / Eclampsia Expected Outcome
  • Preeclampsia / Eclampsia Complications
  • Preeclampsia / Eclampsia Conventional Medical Treatment
  • Medication
  • Activity Recommendations & Restrictions
  • Diet & Nutrition
  • Notify Your Health Care Provider
  • Pregnancy Nutrition Supplements & Products


    Preeclampsia, also known as toxemia of pregnancy and pregnancy-induced hypertension (PIH), is a serious disturbance in blood pressure, kidney function and the central nervous system that may occur from the 20th week of pregnancy until seven days after delivery. Eclampsia is an extension of the preeclampsia process. This is one of the most serious and most easily prevented complications of pregnancy. The symptoms usually appear after the 30th week of pregnancy. Modern medical science does not know the cause of preeclampsia, but many practitioners and midwives have noticed a very strong connection between deficiencies in the mother's diet and the occurrence of preeclampsia to say that it is the result of malnutrition during pregnancy.

    preeclampsia symptoms


    Mild Preeclampsia (Mild PIH)

  • Protein in the urine.
  • Significant blood-pressure rise, even if still in the normal range.
  • Puffiness (edema) in the face, hands and feet that is worse in the morning.
  • Excessive weight gain (more than a pound a week during the last trimester).

  • Severe Preeclampsia (Severe PIH)

  • Continued blood pressure rise.
  • Continued swelling and puffiness.
  • Blurred vision.
  • Headache.
  • Irritability.
  • Abdominal pain.

  • Eclampsia

  • Worsening of above symptoms.
  • Muscle twitching.
  • Seizures.
  • Coma.


  • Modern medical science does not recognize a cause, believing it to be caused by a substance or toxin produced by the placenta. However, this condition is easily prevented or controlled in its early stages by good maternal nutrition and nutritional supplements and therapies recommended by your midwife or health care provider. Below are a few highly recommended books about toxemia of pregnancy prevention and nutritional information.



    Amazon: Metabolic Toxemia of Late Pregnancy, By Thomas H. Brewer
    Amazon: The Natural Way to a Trouble-Free Pregnancy: The Toxemia/Thiamine Connection, By John B. Irwin
    What Every Pregnant Woman Should Know, By Gail Storza Brewer
    The Brewer Medical Diet For Normal & High-Risk Pregnancy: An Obstetrician's Guide By Thomas H Brewer & Gail Storza Brewer


    These risk factors may increase the chances of complications associated with preeclampsia / eclampsia.

  • Poor nutrition during pregnancy. For helpful nutritional information see Nutrition Information & Guidelines to help set up a dietary plan for pregnancy.

  • Diabetes Mellitus.

  • Pre-pregnancy high blood pressure (hypertension).

  • Chronic kidney disease.

  • Obesity.

  • First pregnancy.

  • Preeclampsia during one pregnancy does not mean it will recur with subsequent pregnancies, but it does increase the risk of recurrence. Be sure to review your nutritional requirements for pregnancy.

  • Multiple gestation (twins). Nutritional requirements increase with a multiple gestation.

  • Family history of preeclampsia or eclampsia.



  • Obtain good prenatal care from your midwife or health care provider. Choose one that knows about nutritional requirements during pregnancy. Your midwife or health care provider may recommend Prenatal Multi-Nutrient Dietary Supplements. Try to use a supplement from whole food sources.

  • Do not use medications of any kind, including non-prescription drugs, without consulting with your midwife.

  • Eat a normal, well-balanced diet during pregnancy. Take natural Prenatal Vitamin & Mineral Supplements, if suggested by your midwife. It is important to eat 60 to 90 grams of Protein daily. Protein is needed to form the growing fetus, uterus, and placenta. Insufficient protein in a pregnancy diet may place a pregnant woman at risk for developing preeclampsia.

  • Eat Salt to taste. Extra Salt is required during pregnancy to help with the expanding blood volume that is needed to support the pregnancy. Without adequate salt, preeclampsia may result. However, do not overdo it either. Moderation in all things.

  • Eat foods high in Calcium. 1000 to 1200 mg of elemental Calcium should be taken in your diet daily as a minimum requirement.

  • Take in adequate calories. The minimum calorie requirement for pregnancy is 2400 calories a day. Make these calories count with good nutritious foods and a well balanced diet. Avoid a diet high in processed and empty calorie junk foods.

  • MoonDragon's Nutrition Information: Pregnancy Diet
    MoonDragon's Nutrition Information: Nutritional Guidelines

  • Drink a tea of Red Raspberry Leaves, Nettle and Dandelion Leaves throughout pregnancy to tone and nourish the body and the liver.


    2 parts Red Raspberry Leaf (dried)
    1 part Alfalfa Leaf (dried)
    1 part Nettle Leaf (dried)
    1 part Peppermint Leaf (dried)
    1 Part Dandelion Leaf (dried)

    Mix dried bulk herbs together until well blended and store in a glass quart, half-gallon, or gallon jar in a cool, dark place and use as needed. Light will deplete the nutrients in the leaves. The herbal blend can be placed loose in hot water and strained after brewing or in a tea strainer or tied up in gauze squares and dropped into hot water for brewing, depending upon quantity of tea being made. It can be made by the cupful or by the gallon. It can be consumed hot or cold as ice tea. It makes a great sun-tea that can be placed in a sunny window and allowed to steep until it has a rich color and then chilled in a refrigerator to be consumed throughout the day. It is very rich in vital nutrients helpful for pregnancy. This tea can be consumed throughout pregnancy and is helpful towards the end of pregnancy to prepare for the birth. It is a good base tea to add benefical labor tinctures or other remedies to during the labor and it can also be made into iced cubes and ice chips to be used by the mother during her labor. It makes a great sun tea and can be consumed cold or hot.I usually recommend about a quart a day of prepared tea. This gives the mom help with her fluids and her nutrition. It can be used unsweetened or with a little honey added for sweetener, if desired. Mountain Rose Herbs is a reliable herbal merchant that has quality bulk herbal products. Starwest Botanicals is a good second choice for bulk herbals. Tinctures and extracts can be added to the tea. Dandelion is added to the basic Pregnancy Tea recipe to help nourish the liver.


  • Increase the levels of Potassium in your body. Potassium relieves and stabilizes some symptoms of preeclampsia (high blood pressure & edema). It supports and vitalizes the stressed organs and systems (kidneys, liver, and nervous system) allowing them to function properly. Some natural foods containing high levels of potassium are potato peels and bananas. Mint, Chicory and Dandelion leaves are also extremely high in potassium. These may be added to the Pregnancy Tea of Red Raspberry Leaves, Nettle and Alfalfa.
  • To help balance the sodium/potassium levels in your body, raw Beet juice, up to 4 ounces a day, and is one of the fastest and most effective ways to increase available calcium in the body. If you do not have a juicer, grate one raw beet and one raw apple together for a snack. This is delicious and effective.


    1/2 cup Lemon juice
    1/3 cup Honey
    1/4 teaspoon Salt
    1 Calcium tablet, powdered (not bone meal of dolomite)

    Mix ingredients with enough water to make one quart of fluid. Have the woman take spoonfuls at regular intervals.

  • Electrolyte Replacement Supplement Products

  • If you have serious problems with morning sickness and/or you are becoming dehydrated, a hydrating enema is a treatment that was used before IVs and can be used in place of IV therapy. Any nourishing substance can be absorbed in the bowel. You may need to do a cleansing enema first to clean out the bowel before using a hydrating enema. Here are a few suggestions for a hydrating enema:
    • Pedialyte, a commercially made electolyte solution given orally to sick kids can be used via a hydrating enema.
    • A solution containing one tablespoon of Sugar to one teaspoon Salt dissolved in one quart of water.
    • A weak Red Raspberry Leaf Tea with a little Honey and a pinch of Salt.
    • Saline solution consisting of a heaped teaspoon of common salt in a pint of boiling water. Allow to cool to 100°F (which is near body temp and should feel warm but not hot). This should be given via an enema slowly into the rectum and repeated at intervals of three to four hours. This is a recommendation for shock and collapse due to hemorrhage or any other cause when the patient is in need of bodily fluid from severe fluid loss.

    • Enemas need to be given warm and very slowly. It is surprising how well solutions are absorbed and tolerated using this method. Helpful with severe morning sickness known as hyperemesis gravidarum when nausea and vomiting become pathologically a severe problem.

    MoonDragon's Health Therapy: Enemas Information & Recipes
    MoonDragon's Health & Wellness: Dehydration

  • Take 100 mg of Vitamin B-6 daily along with a high potency Vitamin B-Complex supplement. This will restore the normal balance of sodium and potassium in your body fluids and promote better function of your liver and nervous system.

  • To assist in obtaining proper Protein and Mineral levels, add up to 3 tablespoons of powdered Protein supplement, Spirulina or Chorella to your daily diet.


  • If diagnosed and treated throughout the pregnancy, the problem usually disappears without complications within 7 days after delivery. Severe PIH and hypertensive disease continues to be a significant contributor to maternal mortality. Cesarean delivery may need to be done in severe cases to prevent maternal and fetal loss. If premature labor occurs, the newborn's survival chances depend on its maturity. Fetal death is common. It is much better to prevent this disturbance with good nutritional habits than to remedy it once it occurs.


  • Stroke.
  • Increased risk of high blood pressure unrelated to pregnancy after age 30.
  • Seizures.
  • Pulmonary edema.
  • Kidney failure.


  • Diagnostic tests may include laboratory studies, 24 hour urine study (to check the protein levels), and others to rule out complications.

  • Treatment will depend on severity of the signs and symptoms, and the maturity of the fetus. Home care for mild symptoms with careful dietary counseling and monitoring, hospital care if the condition deteriorates, and early delivery if the situation is severe. Eclampsia, because of seizure activity, is more likely to require hospital care and rapid delivery (often cesarean section).

  • If you are at home, weigh yourself daily and keep a record. Use a home test to check for protein in the urine (instructions will be provided). Follow carefully the nutritional guidelines your midwife has suggested and drink or take any nutritional supplements that may be recommended.


    Hypertensive disorders can affect 6 to 8 percent of women and increase the risk of morbity and mortality in both the expectant mother and the unborn child. Hypertension in pregnancy is divided into four categories: Chronic Hypertension; Gestational Hypertension; Preeclampsia; and Preeclampsia Superimposed on Chronic Hypertension. Preeclampsia is a pregnancy-specific syndrome of unknown etiology, is a multiorgan diseae process characterized by the development of hypertension and proteinuria after 20 weeks gestation. (See Diagnostic Criteria for Preeclampsia below.) History of antiphopholipid antibody syndrome, chronic hypertension, chronic renal disease, elevated body-mass index, age 40 years or older, multiple gestation, nulliparity, preeclampsia in a previous pregnancy, and pregestational diabetes mellitus increase a woman's risk of preeclampsia.


  • Measure 6 hours apart on at least or greater than 2 occasions.
  • Systolic blood pressure greater than 140 mmHg.
  • Diastolic blood pressure equal to or greater than 90 mmHg.

  • Preeclampsia is classified as mild or severe based on the degree of hypertension, the level of proteinuria, and the presence of symptoms resulting from the involvement of the kidneys, brain, liver, and cardiovascular system. The incidence of severe preeclampsia is 0.9 percent in the United States. Severe preeclampsia is associated with multiorgan involvement such as pulmonary edema, seizures, oliguria, thrombocytopenia (platelet count less than 100,000/mm3), abnormal liver enzymes in association with epigastric or right upper quadrant pain, and central nervous system (CNS) involvement (altered mental status, headaches, blurred vision, blindness).

    The timing of the diagnosis affects the rate of neonatal complications. Women who develop severe preeclampsia in their second trimester are at increased risk for neonatal complications compared with women who develop it after 35 weeks gestation.

    Severe preeclampsia requires emergent management because it is associated with an increased risk of maternal mortality and morbidity such as convulsions, pulmonary edema, acute renal failure, liver failure, disseminated intravascular coagulopathy, and stroke.

    Women who develop severe preeclampsia are usually admitted to the hospital, limited to bed rest, and monitored closely for signs and symptoms of seizures. The goals of treatment are to prevent seizures, lower blood pressure to avoid maternal end-organ damage, and expedite delivery. Although delivery is the only cure for preeclampsia, the decision to deliver depends on maternal and fetal factors such as gestational age, lung maturity, and signs of fetal compromise.

    Women who develop severe preeclampsia prior to 23 weeks gestation should be offered pregnancy termination because expectant management results in high maternal and perinatal morbidity and mortality. Patients who develop severe preeclampsia after 34 weeks gestation or who show signs of fetal lung maturity should deliver. Patients who do not achieve blood pressure control or who show signs of maternal or fetal deterioration should be delivered within 24 hours, irrespective of other factors. For patients with severe preeclampsia at 24 to 34 weeks gestation, current opinion is to either intervene (delivery or pregnancy termination) or expectantly manage existing symptoms. Odendaal et al and Sibai et al found improved perinatal outcomes with expectant management in selected patients with severe preeclampsia at 28 to 34 weeks gestation.


    Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome develops in approximately 20 percent of women with severe preeclampsia. The presence of HELLP syndrome increases the risk of adverse outcomes such as pulmonary edema, acute renal failure, disseminated vascular coagulopathy, abruptio placentae, hepatic hemorrhage or failure, and fetal or maternal death. In HELLP syndrome, women present with nonspecific complaints of right upper quadrant or epigastric pain, nausea, and vomiting.

    Limited information about treatment options is available, as most studies evaluating treatment exclude patients with HELLP syndrome. Most experts recommend prompt vaginal delivery within 48 hours, as cesarean delivery can increase the risk of bleeding because of low platelet count and reduced intravascular volume, which will adversely affect blood pressure. Visser and Wallenberg and van Runnard Heimel et al offer a contrary opinion, recommending expectant treatment in selected patients with severe preeclampsia and HELLP syndrome. Although these findings prolonged pregnancy, perinatal outcomes were not improved.


    Medications used to treat preeclampsia are presented in table below:


    Magnesium Sulfate
  • Loading dose 4 to 6 grams diluted in 100 mL normal saline IV over 15 to 20 minutes.
  • Continuous infusion 2 grams per hour.

  • Labetalol
  • 20 mg IV x 1 dose; if no response, increase to 40 mg and then to 80 mg at 10-minute intervals until target blood pressure is achieved (maximum dose 220 mg).

  • Hydralazine
  • 5 to 10 mg IV every 15 to 30 minutes (maximum dose 30 mg).

  • Betamethasone
  • 12 mg IM x 1 dose, then repeat in 24 hours.

  • Dexamethasone
  • 6 mg IM x 1 dose, then repeat every 12 hours for 3 additional doses.

  • IM: intramuscularly

    Magnesium sulfate is the mainstay of therapy, as it prevents seizures by slowing neuromuscular conduction and depressing CNS irritability without affecting blood pressure. IV labetalol and hydralazine are commonly used to achieve blood pressure control. Patients should be closely monitored for blood pressure, urine output, cerebral status, and the presence of epigastric pain, tenderness, labor, or vaginal bleeding. Fetal monitoring parameters include heart rate, evidence of lung maturity, amniotic-fluid volume, and signs of fetal compromise. Patients who do not respond to pharmacologic management and who show signs and symptoms of deterioration should deliver within 24 to 48 hours, irrespective of gestational age.

    Corticosteroids such as betamethasone and dexamethasone can accelerate fetal lung maturity. The use of corticosteroids may reduce the risk of neonatal respiratory distress syndrome, intravascular hemorrhage, infection, and death. Interventionist management involves induction or cesarean delivery after 12 to 24 hours of corticosteroid treatment. Expectant management involves monitoring both mother and fetus closely and delaying delivery, when possible, to reduce neonatal complications.

    Most patients improve after delivery and should be monitored for eclampsia for the next 48 hours. Patients should continue taking magnesium sulfate for 12 to 24 hours. Blood pressure, fluid intake, and urine output should be closely monitored.


    1. Leeman L, Fontaine P. Hypertensive disorders of pregnancy. Am Fam Physician. 2008;78:93-100.
    2. Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol. 2003;102:181-192.
    3. Sibai BM, Barton JR. Expectant management of severe preeclampsia remote from term: patient selection, treatment, and delivery indications. Am J Obstet Gynecol. 2007;196:514e1-514e9.
    4. Sibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105:402-410.
    5. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002;99:159-167.
    6. Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103:981-991.
    7. Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 2000;183:S1-S22.


  • Antihypertensive drugs, if needed to lower blood pressure, are generally only used in acute situations, unless you have been on hypertension therapy prior to pregnancy.

  • Anticonvulsants to prevent seizures. High dose Magnesium is the most widely accepted anticonvulsant used.


  • Rest often, this is important in controlling preeclampsia.
  • Rest on your left side to help circulation.


    Proper nutrition is extremely important in preventing pre-eclampsia while pregnant. You may be given a special pregnancy diet by your midwife with many helpful suggestions for nutrition and supplementation as a preventive. Eat sufficient protein, salt to taste, adequate calcium and calories. Eat a well balanced diet with plenty of vegetables, fruits, vegetable proteins, nuts, whole grains, etc.

    MoonDragon's Nutrition Information: Pregnancy Diet
    MoonDragon's Nutrition Information: Nutritional Guidelines


    The right diet can help you have a healthier pregnancy.
    By Debbi Donovan, IBCLC
    Article From: Parenting:

    Dr. Tom Brewer's name may not be familiar to you. He is not in the public eye much anymore. But Dr. Brewer, a pioneer in the field of nutrition and pregnancy, has spent the past 47 years of his life working as a trained obstetrician, counseling women in both research and clinical settings during their pregnancies. He has fought a lifelong - and uphill - battle to conquer disorders of pregnancy and complications of birth, by doing something as simple as making it his business to see that pregnant moms are properly nourished.

    Over the past five decades, Dr. Brewer has been frustrated by the failure on the part of health care providers to recognize the important role played by good nutrition during pregnancy and, moreover, to make this an important part of their practice, counseling pregnant mothers in the importance of good nutrition. Brewer believes that it is crucial that pregnant women eat a healthful, balanced diet every day during their pregnancy. Rarely does a pregnant woman get asked by her obstetrician what she is eating. Though they usually take an otherwise complete history, this important part of the puzzle is ignored. Why is one of the simplest solutions (like a good, balanced diet) often ignored and ultimately forgotten?

    What set Dr. Brewer on this path? As a medical student, Dr. Brewer worked on the ward at the Charity Hospital in New Orleans. He was fascinated by teachings about toxemia. He was told that it was a disease of poverty, and also commonly seen in teens and poorly controlled diabetics. James Ferguson, his first instructor at Tulane and New Orleans Charity Hospital, made an big impact on him as he discussed how the high rates of disorders such as toxemia seen in poor women in the South were due to the extremely poor diets of these impoverished women. He began to ask the women in the wards what they were eating. Many were living on hominy grits, cornbread and sorghum. It was not long before Dr. Brewer became convinced - the missing link was nutrition.

    From 1953 to 1954, he served his family practice residency in the Lallie Kemp Charity Hospital in Louisiana. Twenty-five percent of the women admitted had toxemia. They had something in common - they were poor and malnourished. Later, as he worked in family practice in the more affluent community of Fulton, Missouri, he rarely saw problems with toxemia.

    At Contra Cosa Hospital in Martinez, California, (between the years of 1963 and 1976), Brewer completed a retrospective study of 5,615 births. He did not see one case of convulsive toxemia in the mostly high-risk group of women who followed his diet throughout their pregnancies. Each women was counseled in nutrition at each prenatal visit and asked what she was eating. Mild toxemia was present in fewer than one percent of the women studied. Toxemia is preventable, says Dr. Brewer.

    Prevention is the key to a healthy pregnancy, a good birth and a healthy baby. Dr. Brewer believes that by eating properly during your pregnancy, you will help to protect yourself and your baby from many complications such as:
    • Miscarriage.
    • Metabolic Toxemia of Late Pregnancy (Eclampsia).
    • Anemia.
    • IUGR.
    • Premature Rupture of Membranes.
    • Low birth weight or premature baby.
    • Stillbirth.
    • Placental abruption.
    • HELLP Syndrome.
    • Babies who are prone to illness.


    1. What is the best advice you have for a newly pregnant mom?
    Diet is the most important thing that you can take care of. In clinical practice, I would assume that everyone was undernourished, and then would I would set about educating them about the nutritional requirements for a healthy pregnancy and a healthy baby. We need someone with the authority of a physician to speak with every pregnant woman. But, even today, not much time is spent educating doctors about nutrition in medical school.

    2. What do you consider a healthy pregnancy weight gain?
    As long as the pregnant mother is eating an adequate diet, there is a large variation in what is considered to be a normal and healthy pregnancy weight gain. Some women lose weight during a pregnancy, while others may gain 70 pounds. It is the quality of the diet that is most important.

    3. Your diet recommends 2,400 calories each day? Isn't that awfully high?
    Do not concentrate on calories. Instead, eat the healthy foods included in a good diet, making sure to get between 80 and 100 grams of protein each day. Dr. Maurice Strauss of Harvard, in the 1930s, found that women with toxemia who were placed on very high protein diets (260 grams a day) were able to turn their conditions around.

    4. What if I suffer from nausea and vomiting - how important is it for me to eat everything on the diet?
    Malnutrition at the end of pregnancy is a much bigger threat, particularly during the last trimester. The quality of your diet is still of utmost importance, though the quantity is not as big an issue. Morning sickness usually fades away by around the 12th to 14th week of pregnancy. Up until that time, small meals containing some protein and carbohydrates should be eaten frequently. This can even help to relieve morning sickness in some mothers.

    5. How about salting my foods to taste - will it cause my blood pressure to rise?
    Salting foods to taste is very important. During pregnancy, blood volume must increase 40 to 50 percent. The goal of the Brewer Diet is to provide you with the foods and nutrients necessary to help with this protective increase. It is normal to have swelling in late pregnancy while following a good diet. Extra water protects in case of excessive bleeding after the birth, and helps to protect the new mother from going into shock.

    6. How would you adapt your diet if you are overweight at the start of a pregnancy?
    Normally you should eat the same foods. Eat to appetite. Overweight women usually have bigger babies with fewer problems. Women who are too thin are more at risk for complications than moms who are overweight.

    7. What about moms of twins?
    I recommend that mothers eat for the number of babies they are carrying. With twins, it is important to take in between 130 and 150 grams of protein each day, and with triplets, 200 grams. Get plenty of salt in your diet. Women are usually told that they can expect for their twins to be born early. Today, it is considered normal for twins to be born at 34 to 35 weeks and triplets at 32 to 33 weeks. The fact is that their nutritional needs are not being met.


    Metabolic Toxemia of Late Pregnancy (MTLP) is a disease of low blood plasma volume, rather than high blood pressure. It is caused by not enough high-quality proteins and vitamins in the diet, and from salt deprivation. Women with MTLP suffer convulsions, coma, heart failure, shock and often death for both mother and baby.

    MTLP is often diagnosed today when a woman has an observed rise in blood pressure, coupled with edema (swelling). Blood pressure can rise for many reasons totally unrelated to preeclampsia. Ninety percent of women have swelling of their extremities during late pregnancy, and 65 percent will have swelling of their hands and face. I won't blindly diagnose without a complete dietary history. Women exhibiting these symptoms, while following an adequate diet, have less infant mortality than the general population.

    Some doctors continue to prescribe a low-calorie, low-salt diet for women, particularly those starting out their pregnancy overweight. This can be very dangerous to both the mother and baby.

    The World Health Organization reports that there are 75,000 deaths per year worldwide from this disease. MTLP would be totally preventable, but people don't believe the missing link in its treatment is adequate nutrition. If a health care provider doesn't know it himself, and if he doesn't believe it, he can't teach it.

    It isn't always easy to eat well during pregnancy. With the hectic schedules many families have today it may seem very hard to take the time to eat right. But, it pays to remember that what you eat affects your baby's health for life.


    4 exchanges of milk (1 cup each): whole milk, low fat, skim, buttermilk. If using soy milk, 1.5 cups per serving. One serving of cheese is approximately 1.25 ounces.

    2 calcium replacements for each serving of unfortified soy: almonds, walnuts, sunflower seeds brazil nuts, broccoli, molasses, wheat germ*.

    2 eggs.

    6 exchanges of fish, liver, chicken, lean beef, lamb or pork, any kind of cheese. Beans, grains, nuts and seeds and vegetables may also be included in this area, but do not count an item twice. (Average exchange is 1 ounce meat or hard cheese, 1/4 cup of tuna or soft cheese, 1 cup of milk, 1 egg, 1/2 cup beans or grains, 2 to 3 ounces of nuts, and about 5 ounces of most vegetables.)

    2 exchanges of fresh, dark green, leafy vegetables: broccoli, brussels sprouts, spinach, romaine lettuce. (Average exchange is 1/2 to 1 cup.)

    5 exchanges of whole grain bread, starchy vegetables and fruits. (An average exchange is 1 slice bread, 1/2 cup cereal, pasta or rice, and 1/2 piece of fruit.)

    2 exchanges Vitamin C foods: orange, grapefruit, pepper, tomato, cantaloupe, potatoes, cabbage, cauliflower (Average exchange is 1 fruit or 1/2 cup.)

    5 exchanges fats and oils. (1 tablespoon butter, oil or mayonnaise.)

    1 exchange Vitamin A food: carrots, peaches, sweet potato or yam, cantaloupe, apricots.

    Drink to thirst.

    Salt foods to taste.

    Liver (4 ounces) once a week.

    This diet can be adapted for vegetarians, by using complementary protein at one meal. Choose to eat 2 plant proteins at the same time, such as rice and beans, or to eat some animal protein along with plant protein, such as eggs, cheese or milk.*

    *Adapted diet in The Brewer Medical Diet for Normal and High Risk Pregnancy, 1983
    Adapted with permission from Metabolic Toxemia of Late Pregnancy, Thomas Brewer, MD, 1982

    Dr. Brewer, now retired in Vermont has his own Website, Blue Ribbon Baby Pages, continues to counsel pregnant moms who have questions about nutrition, preeclampsia and toxemia. He operates a free hotline. You can reach Dr. Brewer's Pregnancy Nutrition Hotline at: 802-388-0276.

    Dr. Brewer's Pregnancy Diet Webpage

    - Middlebury, VT, November 22, 2005

    Thomas Harrington Brewer, M. D., an obstetrician known for "The Brewer Diet" for pregnancy and a researcher who devoted his career to promoting better understanding and prevention of toxemia of pregnancy (pre-eclampsia/ eclampsia), died on November 22 in Middlebury, VT. He was 80.

    The cause of death was complications of white matter disease, a degenerative brain disorder, according to his daughter, Cornelia Brewer.

    Dr. Brewer spent more than 50 years researching and studying the relationships between an adequate maternal diet and improved pregnancy outcomes and was an outspoken advocate for the establishment of practice protocols for nutritional guidance, surveillance, and intervention as mandated, reportable components of routine prenatal care.

    His goal was simple - to apply in daily clinical obstetric care the findings of numerous other researchers and clinicians who had instituted nutritional approaches in public clinics and private practice in order to prevent pre-eclampsia, eclampsia, hypovolemia, preterm labor, prematurity, low birth weight, and other nutrition-mediated complications of pregnancy.

    Dr. Brewer was internationally published. He authored more than 40 articles in medical journals such as the Journal of Obstetrics and Gynecology, Obstetrics and Gynecology, Journal of Reproductive Medicine, Lancet, Gynecologia, Australia New Zealand Journal of Obstetrics and Gynecology, Journal of Applied Nutrition, and Pediatrics and contributed numerous book chapters. His book for prenatal care providers, Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition was published in 1963 and in paperback in 1982.

    He was also the medical consultant on numerous books written by his former wife, Gail Sforza Krebs, including What Every Pregnant Woman Should Know; The Truth About Diets and Drugs in Pregnancy (Random House, 1977 and Penguin, 1979 and 1985), The Brewer Medical Diet for Normal and High-Risk Pregnancy (Simon and Schuster, 1982), The Pregnancy After 30 Workbook (Rodale, 1979), and The Brewer Pregnancy Hotline (Kalico, 2000).

    Born April 9, 1925 Dr. Brewer grew up in Houston, Texas, the only child of Mary and Horace H. Brewer, who was treasurer of the Rouse Company, a real estate development concern. Among his ancestors was Horatio Chriesman, who came to Texas in 1822 and was a surveyor for Stephen F. Austin and fought in the army of General Sam Houston.

    During Dr. Brewer's freshman year at the University of Colorado, where he planned to study for the Episcopal ministry, he enlisted in the United States Army at the age of 17 and served in the 33rd Infantry in the Philippines, Leyte, and Okinawa during World War II. He was wounded in action and received the Purple Heart and Bronze Star among other military honors. After being discharged he entered the University of Texas as a pre-med student, then graduated from Tulane Medical School in 1951. As a result of his war experiences, he became an ardent peace activist. He was particularly moved by the impact of war on children.

    Dr. Brewer completed general practice residencies at Jefferson Davis Hospital - Baylor Medical School and at Lallie Kemp Charity Hospital in rural Louisiana, where he found toxemia rates of 25 percent or higher. He had been instructed by his OB professor, Dr. James Henry Ferguson, that toxemia of pregnancy was linked to the severe malnutrition that Ferguson documented in his own research into maternal death in the rural South during the 1940's. Dr. Brewer developed the practice of asking women on the toxemia wards what they were eating. Finding that their diets indeed were typically of poor quality or wholly inadequate he started counseling women on what they should be eating, using guidelines from the U. S. Department of Agriculture as the basis for his recommendations. Dr. Brewer reasoned that by intervening early in pregnancy and changing the patients' dietary intake before they became ill to that of a well-balanced, adequate protein diet, toxemia could be eliminated, and prematurity reduced to 2 percent in this extremely high risk population.

    In 1958, Dr. Brewer completed a residency in obstetrics and gynecology at the University of Miami Medical School where he was also a research fellow at the Howard Hughes Medical Institute, studying the formation of collagen in the uterus during pregnancy, a process that is directly linked to efficiency of labor.

    Subsequently, he was an instructor in the Department of OB/GYN at University of California at San Francisco Medical School, a position he left to develop a prenatal nutrition program as part of the public prenatal clinics in the Contra Costa County, CA Medical Services in the East Bay area of San Francisco. Dr. Brewer's special attention was given to the problem of toxemia of pregnancy, which is also referred to today as "PIH" or "pregnancy induced hypertension" (but which he defined more precisely as metabolic toxemia of late pregnancy, also known as pre-eclampsia/eclampsia or "HELLP syndrome"). Controversy about management of this disorder has affected the nutritional advice and maternity care given to pregnant women for more than a century and continues to do so today. Dr. Brewer's work focused on specific diagnostic pathways (clinical protocols) to insure that women are not misdiagnosed with this problem. He conducted this work for 13 years and his results were published in the Journal of Reproductive Medicine.

    A 1973 film, "Nutrition in Pregnancy" depicted Dr. Brewer's nutrition counseling technique developed for the Contra Costa Nutrition Education and Toxemia Prevention Project, known as the "brown bag lectures", which he gave on hundreds of occasions at conferences around the world. It is distributed by Academy Communications of Sherman Oaks, California (The Bradley Method®) for which Dr. Brewer was an advisor for 30 years.

    For 15 years he was medical director of SPUN (Society for the Protection of the Unborn through Nutrition), a non-profit organization that was based in Chicago that spearheaded a ten-year campaign that was ultimately successful to have the FDA disapprove the use of diuretics as a routine feature of prenatal care in the United States, developed materials for pregnancy nutrition education, and provided direct counseling about maternal nutrition to pregnant women in prenatal clinics and by mail. These activities took place during a period in prenatal care in which the weight gain of pregnant women was rigidly restricted and low-calorie, low-salt diets and diuretics were promoted by every major pharmaceutical company and upheld by professional obstetrical societies as a standard feature of prenatal care. Dr. Brewer's activist stance on this issue set him apart from his obstetrical colleagues.

    Two other organizations based on the SPUN model, the Pre-Eclamptic Toxemia Society, a registered charity in Great Britain, and AG Gestose-Frauen in Issum, Germany, were established in the 1980s and continue to the present time.

    In recent years Dr. Brewer resided in Middlebury, VT where he continued to staff a pregnancy hotline, a direct successor to SPUNs work with pregnant women, their families, and their care givers.

    Dr. Brewer took the position that failure to maintain a diet adequate for pregnancy is a matter of clinical significance and a matter that should be addressed by the prenatal caregiver at every visit: In other words, inadequate prenatal nutrition has predictable obstetrical and neonatal consequences that matter for mother and baby. Therefore, thorough and purposeful consideration of the mother's nutrition, visit-by-visit, should be an essential feature of routine prenatal care. From contact with thousands of pregnant women each year via the hotline service and through his website, Dr. Brewer concluded that the effective standard of care he championed is still not being met in the vast majority of prenatal encounters taking place today, regardless of the mother's race, socioeconomic status, or pregnancy risk status. Dr. Brewer's work is to be continued by The Brewer InstituteTM, a privately funded organization that will begin operations in 2006.

    This year Dr. Brewer had been working with Gail Sforza Krebs on a new book, an anthology of the critical research papers published in the field of applied nutrition in pregnancy and the prevention of common pregnancy complications. The title is: Clinical Nutrition in Pregnancy: The Classic Papers.

    Survivors include his former wives, Nancy Brewer of Capitola, California and Ms. Krebs of Port Jervis, New York; his children, Eric Brewer of Hyattsville, MD, Laurie Brewer of Capitola, Claire Lohmann of Denver, Colorado, Daniel Hayes of Sacramento, California, Bruce Brewer of Oregon City, Oregon, Cornelia Brewer of Burlington, Vermont, Thomas Brewer of Portsmouth, New Hampshire, and former step-children, Marisa Bellingrath of Albany, New York, Ginevra Blumenfeld of Stamford, Connecticut, Elizabetta Krebs of Gettysburg, PA and Francesca Krebs of Canton, New York; a son-in-law, Willard Chastain of Vienna, Virginia; a cousin, Gerald Harrington of Tampa, Florida; 11 grandchildren, and a lifelong friend, Norman Kittrell of Sugar Land, Texas. Dr. Brewer was predeceased by two daughters, Linda Chastain of Starksboro, Vermont and Lisa Brewer of San Francisco, California and his second wife, Susan Hayes of Richmond, California.

    Private interment at Arlington National Cemetery will be held at the convenience of the family. A series of appreciations for Dr. Brewer's life and work will be held in 2006 in conjunction with the annual national conferences of the many maternal and child health organizations to which he consulted and served as an advisor.

    Contact for additional information:
    Gail S. Krebs

    Your work will go on Dr. Brewer.

    Dr. Brewer's Pregnancy Diet Webpage


  • If you or your family member has symptoms of preeclampsia at any stage of pregnancy.
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  • If the following occur during treatment:
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    MoonDragon's Pregnancy Information: Pregnancy Information & Survival Tips
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