Intended for healthcare professionals

Rapid response to:

Primary Care

The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:576

Rapid Response:

PRECOG should include nutritional status

It is important to include assessments of essential nutrient status in the pre-eclampsia community guideline (PRECOG) screening lists.1

Magnesium deficiency significantly potentiates contractile responses to bradykinin, angiotensin II, serotonin, and prostaglandin F2 alpha and can cause spasms of umbilical and placental vasculature.2 Red blood cell or sweat magnesium analyses could be included in annual screening tests for women of reproductive age.

A decrease in maternal as well as umbilical plasma zinc concentrations was observed in pre-eclamptic women, and this decrease was statistically significant in severe pre-eclampsia.3 Elevated copper and lowered zinc levels were found in the placentas of pre-eclamptics.4 Mean activity of superoxide dismutase (SODase) in 45 pre-eclamptic placentas was significantly lower (3.89) compared to levels in placentas from normal pregnancies (6.75).5

Women with the lowest concentrations of toenail selenium had a 4.4- fold (95% CI 1.6-14.9) greater incidence of pre-eclampsia and more severe disease.6

Mineral deficiencies cause functional B vitamin deficiencies and block essential fatty acids pathways, allowing saturated fats to increase in cell walls. Ensuring a normal copper/zinc balance and using a red blood cell superoxidase dismutase test for copper status and a glutathione peroxidase function test for selenium status, along with other available screening tests can prevent pregnancy complications.7,8

Essential nutrient deficiencies should be diagnosed and repleted. In my experience this also helps to prevent, along with removal of main headache precipitants, persistent increases in serum antibody levels in patients with or without the antiphospholipid syndrome.9

1 Milne F,Redman C,Walker J,et al.The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community.BMJ 2005; 330: 576-580

2 Altura BM, Altura BT, Carella A. Magnesium deficiency-induced spasms of umbilical vessels: relation to preeclampsia, hypertension, growth retardation. Science 1983;221:376-8.

3 Bassiouni BA, Foda AI, Rafei AA. Maternal and fetal plasma zinc in pre-eclampsia. Eur J Obstet Gynecol Reprod Biol. 1979; 9: 75-80.

4 Brophy MH, Harris NF, Crawford IL. Elevated copper and lowered zinc in the placentae of pre-eclamptics. Clin Chim Acta 1985;145:107-11.

5 Wiktor H, Kankofer M. Superoxide dismutase activity in normal and preeclamptic placentas. Ginekol Pol 1998;69:915-8.

6 Rayman MP, Bode P, Redman CW. Rayman MP, Bode P, Redman CW. Low selenium status is associated with the occurrence of the pregnancy disease preeclampsia in women from the United Kingdom. Am J Obstet Gynecol 2003; 189: 1343-9.

7 Grant ECG. Nutritional supplements to prevent pregnancy complications., 16 Jul 2004

8 Grant ECG. Monitored nutritional supplements to prevent pregnancy complications., 6 Aug 2004

9 Grant ECG. Systemic Lupus erythematosus. Lancet 2001; 358: 586-7.

Competing interests: None declared

Competing interests: No competing interests

16 March 2005
Ellen C G Grant
physician and medical gynaecologist
Kingston-upon-Thmaes, KT2 7JU,UK