Plea for a new generation of research in eclampsia

Abstract

Eclampsia is responsible for more than 50,000 maternal deaths a year worldwide. The strong correlations between standard of living and prevalence of eclampsia (and severe pre-eclampsia) suggest the importance of nutritional factors in the genesis of this disease. Yet most studies are conducted in developed countries. They investigate mild forms of the disease and ignore nutritional factors (apart from a small number of studies investigating the effects of micronutrients). They cannot help moderating the rates of maternal deaths and infant morbidity. They have not lead to significant advances in our understanding of the pathophysiological processes. This is why there is an urgent need for studies of nutrition in pregnancy among at-risk populations with low standards of living.

The current project is to evaluate the effects of supplements of tinned sardines, given as early as possible in pregnancy, on birth outcomes in a low-income population in the peripheral part of Rio de Janeiro, Brazil. This trial, conducted by two Brazilian nurse-midwives, will take place at the Alexander Fleming hospital (and in the attached birthing centre founded by nurse-midwives), in a poor district of the city. In that hospital, where the number of births a year is around 5,600, eclampsia is still common (about four cases a month).

Women in the study group will be offered a sardine sandwich once a week. This will be eaten in the meeting room of the hospital. Women in the control group will be offered a mussarella cheese sandwich once a week. One of the objectives is to test the hypothesis that eclampsia is the expression of a conflict between mother and fetus, assuming that meeting the specific nutritional needs of the fetal developing brain is a priority among humans. Sardines provide a good balance of all the nutrients that meet the needs of human brain. The rates of pre-eclampsia are exceptionally low in populations with high sea fish consumption.

Brazil, characterized by a low per capita fish consumption (6.5 kg yearly), is an appropriate place for such a study.

This project might inspire similar projects among other at-risk populations.