330: Diet pattern is associated with an increased risk of hypertensive disorders of pregnancy

Abstract

Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, remain significant contributors to maternal morbidity and preterm birth. Despite being a therapeutic target, the contribution of diet to these disorders is largely unstudied. The Diet Approach to Stop Hypertension (DASH) approach is rich in fruits, vegetables, and low fat dairy and limited in salt, saturated fat, total fat and cholesterol. DASH adherence was linked to reduced cardiovascular risk factors and blood pressure in hypertensive, non-pregnant subjects. While the DASH approach is recommended to prevent and treat hypertension, it has not been studied in HDP. The objective of this study was to evaluate the impact of DASH diet adherence obtained before the 3rd trimester on the development of HDP. A nested case-control study within a cohort of 303 nulliparous women was conducted. Mean intake from 3 dietary recalls obtained at weeks 21-26 was coded into a DASH adherence score (0-9), where higher score is a healthier dietary pattern. A diagnosis of HDP was obtained from chart review, using ACOG definitions for disorders, confirmed by a perinatologist. Cases with HDP (n= 81) were compared to controls (n=161) with no HDP or spontaneous preterm birth. Logistic regression models tested the association of DASH score or tertiles of DASH adherence score on outcomes of HDP. Models were uncontrolled or adjusted for age, BMI, insurance, and race. Racial distribution and maternal age were not significantly different between the groups but mean BMI was slightly higher in cases, mean DASH score was lower, and high DASH diet adherence was less common in cases than controls (Table 1). Greater adherence to DASH diet was associated with reduced risk of HDP (OR -0.41, 95%CI -0.69 to -0.14) even when adjusted for race, type of insurance, BMI and age (OR -0.38, 95% CI -0.69 to -0.28) (Table 2). The lowest tertile of DASH diet adherence was associated with greatest likelihood of HDP (OR 2.52, 95%CI 1.23-5.19), even in the adjusted model (OR 2.29, 95% CI 1.03-5.19). This study demonstrates that diet is associated with the development HDP. The provision of a healthy diet emphasizing fruits, vegetables, and low-fat dairy with limited salt and fat may hold promise as a therapeutic strategy towards prevention of HDP. (Penn March of Dimes Prematurity Research Center).