Document Type : Original Research Article
Authors
Department of Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background & Objective: Hypertension during pregnancy is associated with significant negative outcomes. In this study, we evaluated the effectiveness of dietary approaches to stop hypertension (DASH) on pregnancy outcomes of pregnant women with gestational and chronic hypertension.
Materials & Methods: This randomized controlled clinical trial study was conducted on 60 pregnant women with a diagnosis of gestational hypertension and chronic hypertension. Women were randomly divided into the control (n=30) and the DASH diet (n=30) groups for 2 months and were followed until delivery. The outcomes of maternal pregnancy including the incidence of preeclampsia, placental abruption and preterm delivery (<37 weeks) were assessed during follow-up examinations. Birth weight and minute 1 and minute 5 Apgar score of the infant were also assessed.
Results: After 1 and 2 months of intervention, systolic and diastolic blood pressure in the DASH diet group was significantly lower than the control group (P<0.05). The incidence of preeclampsia (P=0.035), preterm delivery (P=0.020) and placental abruption (P=0.007) in the DASH diet group was significantly lower than the control group. The mean gestational age at the time of termination of pregnancy was not significantly different between the two groups (P = 0.467). There was no significant difference between minute 1 and minute 5 Apgar scores of the infants and the mean birth weight of the infants was not significantly different between the DASH and control groups (P = 0.756, P = 0.115 and P = 0.101, respectively).
Conclusion: The DASH diet could be used as an effective strategy to improve the clinical outcomes of pregnant women with gestational and chronic hypertension.
Keywords
Main Subjects
1. Antza C, Stabouli S, Kotsis V. Practical guide for the management of hypertensive disorders during pregnancy. J Hypertens. 2022;40(7):1257-64. [DOI:10.1097/HJH.0000000000003194] [PMID]
2. Behaile A, Kelta E, Adugna T, Shimeles S, Chekol E. Evaluation of Lactate Dehydrogenase and Gamma Glutamyl Transferase Among Pregnant Women with Hypertensive Disorders and Their Association with Disease Severity in Jimma Medical Center, Ethiopia. J Obstet Gynecol Cancer Res. 2022;7(6):497-506. [DOI:10.30699/jogcr.7.6.497]
3. Amon E, Dickert E. Gestational hypertension and pre-eclampsia. Clinical Maternal-Fetal Medicine Online: CRC Press; 2021. p. 6.1-6.14. [DOI:10.1201/9781003222590-6]
4. Sole KB, Staff AC, Laine K. Maternal diseases and risk of hypertensive disorders of pregnancy across gestational age groups. Pregnancy Hypertens. 2021;25:25-33. [DOI:10.1016/j.preghy.2021.05.004] [PMID]
5. Braunthal S, Brateanu A. Hypertension in pregnancy: Pathophysiology and treatment. SAGE open medicine. 2019;7:1-15. [DOI:10.1177/2050312119843700] [PMID] [PMCID]
6. American College of Obstetricians and Gynecologists. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstetrics and gynecology. 2013;122(5):1122-31.
7. Saraei M, Estakhrian Haghighi P, Amirifard H, Najafi A. Association between Gestational Hypertension and Obstructive Sleep Apnea: A Case-Control Study. J Obstet Gynecol Cancer Res. 2021;6(1):29-34. [DOI:10.30699/jogcr.6.1.29]
8. A. IoH. National Maternity Data Development Project 1 National Maternity Data Development Project: Hypertensive disorders during pregnancy Hypertensive disorders during pregnancy. 2014:1-9.
9. Shen M, Smith GN, Rodger M, White RR, Walker MC, Wen SW. Comparison of risk factors and outcomes of gestational hypertension and pre-eclampsia. PloS One. 2017;12(4):e0175914. [DOI:10.1371/journal.pone.0175914] [PMID] [PMCID]
10. Ghafourian M, Mahdavi R, Akbari Jonoush Z, Sadeghi M, Ghadiri N, Farzaneh M, et al. The implications of exosomes in pregnancy: emerging as new diagnostic markers and therapeutics targets. Cell Commun Signal. 2022;20(1):1-19. [DOI:10.1186/s12964-022-00853-z] [PMID] [PMCID]
11. Mustafa R, Ahmed S, Gupta A, Venuto RC. A Comprehensive Review of Hypertension in Pregnancy. J Pregnancy. 2012;2012:105918. [DOI:10.1155/2012/105918] [PMID] [PMCID]
12. Nzelu D, Dumitrascu-Biris D, Hunt KF, Cordina M, Kametas NA. Pregnancy outcomes in women with previous gestational hypertension: A cohort study to guide counselling and management. Pregnancy Hypertens. 2018;12:194-200. [DOI:10.1016/j.preghy.2017.10.011] [PMID]
13. Jarman M, Mathe N, Ramazani F, Pakseresht M, Robson PJ, Johnson ST, et al. Dietary Patterns Prior to Pregnancy and Associations with Pregnancy Complications. Nutrients. 2018;10(7):914. [DOI:10.3390/nu10070914] [PMID] [PMCID]
14. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. J Obstet Gynaecol Can: JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC. 2014;36(5):416-41. [DOI:10.1016/S1701-2163(15)30588-0] [PMID]
15. Wiertsema CJ, Mensink-Bout SM, Duijts L, Mulders A, Jaddoe VWV, Gaillard R. Associations of DASH Diet in Pregnancy With Blood Pressure Patterns, Placental Hemodynamics, and Gestational Hypertensive Disorders. J Am Heart Assoc. 2021;10(1):e017503. [DOI:10.1161/JAHA.120.017503] [PMID] [PMCID]
16. Ozemek C, Laddu DR, Arena R, Lavie CJ. The role of diet for prevention and management of hypertension. Curr Opin Cardiol. 2018;33(4):388-93. [DOI:10.1097/HCO.0000000000000532] [PMID]
17. Urrico P. Nonpharmacological Interventions in the Management of Hypertension in the Adult Population With Type 2 Diabetes Mellitus. Can J Diabetes. 2018;42(2):196-8. [DOI:10.1016/j.jcjd.2018.02.004] [PMID]
18. Hinderliter AL, Babyak MA, Sherwood A, Blumenthal JA. The DASH diet and insulin sensitivity. Curr Hypertens Rep. 2011;13(1):67-73. [DOI:10.1007/s11906-010-0168-5] [PMID] [PMCID]
19. Harrington JM, Fitzgerald AP, Kearney PM, McCarthy VJ, Madden J, Browne G, et al. DASH Diet Score and Distribution of Blood Pressure in Middle-Aged Men and Women. Am J Hypertens. 2013;26(11):1311-20. [DOI:10.1093/ajh/hpt106] [PMID]
20. Siervo M, Lara J, Chowdhury S, Ashor A, Oggioni C, Mathers JC. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr. 2015;113(1):1-15. [DOI:10.1017/S0007114514003341] [PMID]
21. Li S, Gan Y, Chen M, Wang M, Wang X, H OS, et al. Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Complement Ther Med. 2020;54:102551. [DOI:10.1016/j.ctim.2020.102551] [PMID]
22. Asemi Z, Samimi M, Tabassi Z, Sabihi SS, Esmaillzadeh A. A randomized controlled clinical trial investigating the effect of DASH diet on insulin resistance, inflammation, and oxidative stress in gestational diabetes. Nutrition (Burbank, Los Angeles County, Calif). 2013;29(4):619-24. [DOI:10.1016/j.nut.2012.11.020] [PMID]
23. Nerenberg K, Daskalopoulou SS, Dasgupta K. Gestational Diabetes and Hypertensive Disorders of Pregnancy as Vascular Risk Signals: An Overview and Grading of the Evidence. Can J Cardiol. 2014;30(7):765-73. [DOI:10.1016/j.cjca.2013.12.030] [PMID]
24. Courtney AU, O'Brien EC, Crowley RK, Geraghty AA, Brady MB, Kilbane MT, et al. DASH (Dietary Approaches to Stop Hypertension) dietary pattern and maternal blood pressure in pregnancy. J Hum Nutr Diet. 2020;33(5):686-97. [DOI:10.1111/jhn.12744] [PMID]
25. Jiang F, Li Y, Xu P, Li J, Chen X, Yu H, et al. The efficacy of the Dietary Approaches to Stop Hypertension diet with respect to improving pregnancy outcomes in women with hypertensive disorders. J Hum Nutr Diet. 2019;32(6):713-8. [DOI:10.1111/jhn.12654] [PMID]
26. Arvizu M, Stuart JJ, Rich-Edwards JW, Gaskins AJ, Rosner B, Chavarro JE. Prepregnancy adherence to dietary recommendations for the prevention of cardiovascular disease in relation to risk of hypertensive disorders of pregnancy. Am J Clin Nutr. 2020;112(6):1429-37. [DOI:10.1093/ajcn/nqaa214] [PMID] [PMCID]
27. Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction A Randomized Trial. JAMA. 2005;293(1):43-53. [DOI:10.1001/jama.293.1.43] [PMID]
28. Al-Solaiman Y, Jesri A, Mountford WK, Lackland DT, Zhao Y, Egan BM. DASH lowers blood pressure in obese hypertensives beyond potassium, magnesium and fibre. J Human Hypertens. 2010;24(4):237-46. [DOI:10.1038/jhh.2009.58] [PMID] [PMCID]
29. Chiu S, Bergeron N, Williams PT, Bray GA, Sutherland B, Krauss RM. Comparison of the DASH (Dietary Approaches to Stop Hypertension) Diet and a Higher-Fat DASH Diet on Blood Pressure and Lipids and Lipoproteins: A Randomized Controlled Trial. Am J Clin Nutr. 2016;103(2):341-7. [DOI:10.3945/ajcn.115.123281] [PMID] [PMCID]
30. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin PH, et al. Effects of the DASH Diet Alone and in Combination With Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women With High Blood Pressure The ENCORE Study. Arch Internal Med. 2010;170(2):126-35. [DOI:10.1001/archinternmed.2009.470] [PMID] [PMCID]
31. Yao J, Cong L, Zhu B, T W. Effect of dietary approaches to stop hypertension diet plan on pregnancy outcome patients with gestational diabetes mellitus. Bangladesh J Pharmacol. 2015;10(4):732-8. [DOI:10.3329/bjp.v10i4.23813]
32. Van Horn L, Peaceman A, Kwasny M, Vincent E, Fought A, Josefson J, et al. Dietary Approaches to Stop Hypertension Diet and Activity to Limit Gestational Weight: Maternal Offspring Metabolics Family Intervention Trial, a Technology Enhanced Randomized Trial. Am J Prev Med. 2018;55(5):603-14. [DOI:10.1016/j.amepre.2018.06.015] [PMID]
33. Vesco KK, Karanja N, King JC, Gillman MW, Leo MC, Perrin N, et al. Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: A randomized trial. Obesity. 2014;22(9):1989-96. [DOI:10.1002/oby.20831] [PMID] [PMCID]
34. Asemi Z, Tabassi Z, Samimi M, Fahiminejad T, Esmaillzadeh A. Favourable effects of the Dietary Approaches to Stop Hypertension diet on glucose tolerance and lipid profiles in gestational diabetes: a randomised clinical trial. Br J Nutr. 2013;109(11):2024-30. [DOI:10.1017/S0007114512004242] [PMID]
35. Fulay AP, Rifas-Shiman SL, Oken E, Perng W. Associations of the dietary approaches to stop hypertension (DASH) diet with pregnancy complications in Project Viva. Eur J Clin Nutr. 2018;72(10):1385-95. [DOI:10.1038/s41430-017-0068-8] [PMID] [PMCID]
36. Arvizu M BA, Madsen MT, Granstrom C, Halldorsson TI, Olsen SF, et al. Corrigendum for Arvizu et al. Sodium Intake During Pregnancy, but Not Other Diet Recommendations Aimed at Preventing Cardiovascular Disease, Is Positively Related to Risk of Hypertensive Disorders of Pregnancy. J Nutr. 2020;150(4):159-66. [DOI:10.1093/jn/nxz197] [PMID] [PMCID]
37. Irani RA, Xia Y. Renin Angiotensin Signaling in Normal Pregnancy and Preeclampsia. Semin Nephrol. 2011;31(1):47-58. [DOI:10.1016/j.semnephrol.2010.10.005] [PMID] [PMCID]
38. Schwingshackl L, Chaimani A, Hoffmann G, Schwedhelm C, Boeing H. Impact of different dietary approaches on blood pressure in hypertensive and prehypertensive patients: protocol for a systematic review and network meta-analysis. BMJ open. 2017;7(4):e014736. [DOI:10.1136/bmjopen-2016-014736] [PMID] [PMCID]
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