Diet, Nutritional Indicators, Infections and Inflammation Are Associated with Mean Arterial Pressure (MAP) in Indigenous Pregnant and Lactating Women in Rural Panama

Abstract

BackgroundHypertensive disorders of pregnancy (HDPs) are the leading cause of maternal mortality in Latin‐America. Mean arterial pressure (MAP) has been used as an early indicator of HDPs. However, to understand its usefulness in early detection of HDPs, it is important to understand the range of factors associated with MAP in resource poor environments.ObjectiveWe explored associations of MAP or elevated MAP (eMAP) with wood smoke exposure, multiple nutrient deficiencies, infections and inflammation in indigenous Panamanian pregnant and lactating women living in extreme poverty.MethodsA cross‐sectional study recruited 213 pregnant and 99 lactating indigenous women from the Ngäbe‐Buglé Comarca in rural Panama. Information on systolic and diastolic blood pressure (SBP, DBP), environmental and dietary factors, measures of inflammation (C‐reactive protein and cytokines), nutritional status (serum retinol binding protein ‐ RBP, folic acid, vitamins B12, A and D), and several infections (skin, oral, urogenital and intestinal nematodes) was collected. MAP was defined as DBP + 1/3 (SBP‐DBP). eMAP was defined as blood pressure >87 mmHg between 10–18 weeks of gestation, >84 mmHg in weeks 18–34, >86 mmHg after week 34; and ≥95 in lactating women. Bivariate comparisons were followed by adjusted linear and logistic regression models for MAP and eMAP, respectively.ResultsPrevalence of eMAP was 11.2% in pregnancy and 12.1% in lactation. Bivariate comparisons: In pregnancy, MAP was higher in women with folic acid<10 nmol/L, urinary specific gravity (USG)>1020 and hookworm infection, and lower in women with vaginal diplococcal infection and Ascaris. In lactation, MAP was higher in women with USG>1020, intake of animal source foods ≥7/wk and bacteriuria. Regression models: In pregnancy, wood smoke exposure, RBP<30 mg/L, presence of hookworm and TNF‐α were positively associated with MAP whereas basophil numbers, diplococcal infection score and presence of Ascaris were negatively associated with MAP. RBP<30 mg/L, folate deficiency, Trichuris and higher IL‐6 increased the odds of eMAP. During lactation, vitamins B12 and A and bacteriuria were positively associated with MAP whereas animal source foods and bacteriuria increased the odds of eMAP.ConclusionGiven that we identified both positive and negative associations of infections and nutrient deficiencies with MAP and eMAP during pregnancy and lactation, a strategy that simultaneously reduces all infections and all nutrient deficiencies may not be advisable. Rather, a reduction in eMAP may be achieved by reducing wood smoke exposure, treating intestinal nematodes, addressing folate and protein deficiencies in pregnancy, and by treating bacteriuria during lactation.Support or Funding InformationSENACYT (Panama), McGill Vitamin Fund