The Collaborative Diueetic also found that a Diuretic effect on pregnancy birth weight is the most fffect indicator of future neurologic development. Sørensen, grants HD and HD from the National Institute of Child Health and Human Development to Dr. However, I've been listening to some of the things that they have been saying.

Diuretic effect on pregnancy -

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A corresponding patient information leaflet on USE OF DIURETICS IN PREGNANCY is available. This document focuses on the diuretics amiloride, chlorothiazide, furosemide and spironolactone, which are among some of the more commonly prescribed diuretics for which there is pregnancy outcome data Diuretics are not routinely recommended in pregnancy due to the potential risk of altered uteroplacental blood flow, and in the case of spironolactone and eplerenone, antiandrogenic effects which could theoretically affect the development of a male fetus.

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This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS. org to ensure you are using the most up-to-date version. Keep salting food to taste. Swelling can result from too little salt in the diet.

If the doctor suggests diuretics at any time in pregnancy, the mother must ask questions. First, of herself: Am I eating a good, balanced diet for pregnancy? Am I getting enough protein, calories and salt? Swelling can result from deficiencies of any of these nutrients.

Next, of the doctor: Do I have any medical disease which causes an abnormal increase in blood volume, such as heart failure or nephritis? Diseases in which excess fluid is retained in the circulation may be aided by judicious diuretic therapy. An internist should be consulted and careful evaluation of the mother's condition made if any of these medical diseases are suspected.

The good obstetrician recognizes his limitations and will seek consultation from other specialists when indicated. Women must know that these diseases are exceedingly rare during the childbearing years.

So rare, in fact, that if a doctor prescribes a diuretic for her, she must ask why she needs it. If he assures her she has no abnormal increase in her blood volume due to underlying medical disease, she should refuse to take the pills. Diuretics can do nothing but harm except in these rare situations.

Modern renal physiology makes it clear that the use of diuretics in pregnancy has little or no basis. There is a strong body of belief that they are causative of complications. The use of diuretics in pregnancy should be banned; they should be abandoned in modern prenatal care.

What Every Pregnant Woman Should Know available here. The following is reprinted from Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition , by Thomas H. Brewer, M. Several investigators in this country and in England and in Canada have recorded similar experiences.

Salt restriction has some undesirable results, particularly when combined with the use of saluretic diuretics. Many women have told me that both physicians and public health nurses had told them not to drink milk because it contains too much salt. This is wrong, because milk is one of the most important and cheapest sources we have available for high biological quality proteins.

A low salt diet is not very savory, and the patients often do not eat well when actually following such a diet. It is in the hospitalized patients that one of the most glaring errors is often made in pregnancy nutrition.

Here we have opportunity to provide the patient with an optimum diet planned and prepared by expert nutritionists. I have been in several hospitals in our nation where the routine management of the toxemic patient calls for a "low salt diet" which on inquiry is found to contain only 50 gm of protein.

To reduce the toxemic patient's protein intake below that of the requirements of normal pregnancy is to make a grave physiological and biochemical mistake. Figure 11 Chap. A diuresis may blind the physician to the fact that the patient is really getting worse.

Diuretics are absolutely contraindicated in the severely toxemic patient who has a contracted blood volume, low serum albumin and hemoconcetration.

The following three cases [to be added to this website at a later date] are presented in detail to illustrate the clinical reality of these ideas.

It was from the careful study of these and other similar cases that I began to crystallize my ideas about the pathogenesis of metabolic toxemia of late pregnancy and to turn from concentration upon sodium, water, diuretics and the kidneys to concentration upon nutrition and hepatic dysfunction.

Robinson, Margaret: Salt in pregnancy. Lancet, 1 Jan. Mengert, W. Bower, David: The influence of dietary salt intake on pre-eclampsia. Metabolic Toxemia of Late Pregnancy available here.

The following is reprinted from Medikon International no. Frank Hytten tells us in his pregnancy physiology textbook of two pioneers in the field of iatrogenic starvation in human pregnancy. A century later Prochownick is given credit in for introducing the idea that caloric and fluid restrictions during human pregnancy could produce an infant who weighed less at birth.

As surgical techniques developed with the practices of asepsis and improved anesthesia established, Western European obstetricians lost all fear of operative delivery.

Prochownick's valuable clinical observation that caloric and fluid restrictions do in fact lower the birth weight of the newborn human infant was forgotten.

Thus a very important clue to the mystery of "low birth weight for dates" newborns was buried. Unfortunately, this still universal misconception became established as a dogma in clinical obstetrical teachings in Western medical culture: the human fetus is a parasite, will grow according to its "genetic code" to a given weight and length before birth, and that this growth and development are in no concrete, material sense influenced by the foods and fluids the pregnant woman is taking in during the course of her gestation.

In officially in the United States the cause of eclampsia, the disease I term convulsive metabolic toxemia of late pregnancy MTLP , was "unknown. It has been long believed that the Nutrition of the pregnant woman during gestation does in fact influence her development of MTLP.

Women who develop MTLP are still accused of eating too many calories and too much salt NaCl. When I began to work in the Tulane Service's prenatal clinics at Charity Hospital, New Orleans, Louisiana, as a third year medical student, pregnant patients were being told to restrict their caloric intake and to restrict their dietary salt intake: "So you won't have fits so you and your baby won't die from toxemia.

nothing has changed in this field since you were here over 20 years ago. Jackson Memorial Hospital, Miami, Florida, from to A reliable communication from an established ostetrician in Miami in March, informed me that " nothing has changed in this field since you left here over ten years ago.

Since it is now clear that the sudden, rapid weight gain observed in patients with severe MTLP is a result of malnutrition with a falling serum albumin concentration, hemoconcentration, a falling blood volume with increasing interstitial fluid, we no longer need to blindly "control weight" with starvation type diets.

However, fear of the unknown drives the most rational and "scientific" people to irrational actions; millions of pregnant women in Western European medical culture still suffer from iatrogenic starvation diets in the vague hope that caloric and salt restriction will in some way protect them and their unborn from the "ancient enigma of obstetrics," eclampsia.

Iatrogenic starvation in human pregnancy has a long and ignoble history in the United States: its traditions run strong and deep in one of our oldest and most respectable journals of obstetrics, the American Journal of Obstetrics and Gynecology.

In its second volume published in we find this account by Rucker:. On August 17 her weight had increased 6 pounds and her legs were swollen up to her knees. She had no headache. Urine was free from albumin and sugar. She was placed upon a bread and water diet.

The urine showed a trace of albumin. No casts were found. Subsequently this poor woman had 11 convulsions. It is now clear that a "bread and water diet" is not effective prophylaxis for MTLP!

In the very first volume of The American Journal of Obstetrics and Gynecology published 53 years ago [as of], Ehrenfest reviewed "Recent Literature on Eclampsia," and found that venesection was still in common use for this dread disease: "For the purpose of reducing the blood pressure and of eliminating toxins He reported another then widespread approach: "Diuretics should be accompanied by a total or partial restriction of salt.

No meat shall be allowed. They seem to need all the blood they have and more too. Here was the obvious clinical recognition of the hypovolemic shock which so commonly causes maternal and fetal deaths in severe metabolic toxemia of late pregnancy. In April, , I presented a paper to an international meeting on "toxemia of pregnancy" in Basel, Switzerland, by invitation of Dr.

Ripperman, Secretary of the Organization Gestose. The incidence of low birth weight babies born in the University Hospital, Basel, in the year , from some 3, deliveries was 3.

My own paper presented in Basel was received with the utmost skepticism: the European obstetricians almost to the man responded: "Surely there is no severe malnutrition in rich America. The incidence of low birth weight in our nation has risen from 7.

Iatrogenic starvation during human pregnancy is still widely practiced throughout our nation today because none of our medical or "public health" institutions have taken concrete actions to stop it. A review of the unbound issues of The American Journal of Obstetrics and Gynecology reveals that for most of the 's and 's amphetamines and other "diet pills" were widely advertised for "weight control" in human pregnancy.

Salt diuretics, long recognized to be lethal to the severely toxemic patient and to her fetus, were promoted by this journal form to Professor Leon Chesley finally recognized their harmful effects on the maternal plasma volume.

Today in the problems of rising prices for essential foods like lean meats, chicken, eggs, vegetables and fruits, and the continuing poverty and economic depression in many areas of our nation can not be solved by the nation's physicians.

However, do not humane physicians today have a special and moral responsibility to stop the blind errors of iatrogenic starvation in human pregnancy? Do not obstetricians, especially, in charge of human antenatal care in public clinics and private offices, have a responsibility to their pregnant patients to give them scientific nutrition information?

The protective effects of applied, scientific nutrition in human antenatal care have recently been dramatically documented by Mrs. Agnes Higgins of the Montreal Diet Dispensary.

What actions must they take to insure maternal-fetal and newborn health for each woman who wants to produce a normal, full term child and remain in good health herself? Recognize the complications of human pregnancy caused by malnutrition. Insure that she actually eats an adequate, balanced diet all through gestation.

Encourage her to salt her food "to taste. when nutrition is adequate and balanced, the weight gain takes care of itself with an average gain in healthy pregnancy of about 35 pounds Protect each pregnant woman and her unborn from all harmful drugs, especially salt diuretics and appetite depressants.

On the postpartum wards educate all pregnant patients who have suffered nutritional complications during pregnancy--so that those complications will not recur in subsequent pregnancies.

These measures will begin to open a new era in preventive obstetrics in our nation and dramatically reduce the numbers of low birth weight and brain-damaged and mentally retarded children now being born. There is more information following these references.

and Leitch, I. The Physiology of Human Pregnancy. Prochownick, L. Williams, Sue Rodwell. Nutrition and Diet Therapy, 2nd Edition.

Louis, Mosby, , Chapter Brewer, T. Pitkin, Roy M. Rucker, M. Ehrenfest, Hugo. Basel Chesley, Leon C. Primrose, T. and Higgins, A. Pomerance, J. Applied Nutrition , My concern is that there is no way to know at the beginning of the pregnancy which women will be more prone to complications due to low blood volume, and which ones will not be as prone to them, or how much that blood volume will need to drop before she starts to show the symptoms.

There is also no way to know how early in her pregnancy each mother might be prone to these complications. For a few months in , I interacted with members of a message board where the pregnant mothers were all very much interested in using herbs of all kinds.

As I recall, some of these women were taking a quart or more a day of raspberry tea that had been mixed with nettle. Several of them were having problems with rising BPs, pre-eclampsia, and possibly some of the other complications that I've listed.

I looked up the herbs that they were on, and found that many of them had diuretic properties. So I explained to them why that could be a problem. As I recall, those who tried my ideas got better, and those who continued on the diuretic herbs, even adding more diuretic herbs at times, either stayed with their current level of problems, or got worse.

I also have a midwife writing to me whose practice is largely comprised of women who use a lot of herbs. When she read my diuretic herb information, she started taking her pregnant moms off all of the diuretic herbs that they were on.

One of those mothers who was having problems that seemed like IUGR gained 5 cm fundal height in one week after going off the herbs and going on the Brewer Diet. Others in her group of pregnant women have reported feeling better when they go off the herbs and go on the Brewer Diet, and they have started telling their friends about this new way of thinking.

There have also been other improvements in the health of this group of clients. There also exists an organization comprised of women who are vehemently anti-Brewer.

I interacted with them for about months in the winter of , on one of their message boards. They maintain that a number of them have developed pre-eclampsia and some of these other complications as early as 20 weeks, and that sometimes the symptoms progressed to life-threatening degrees in a matter of hours, and that that happened to some of them in spite of their being on the Brewer Diet.

Unfortunately, there is no way for us to know whether those women were actually on a legitimate version of the Brewer Diet, or whether they also increased their calorie or salt intake to Brewer levels along with their protein intake , or whether they adapted the Brewer Diet to their unique lifestyle needs, or whether they were also on some of these herbs.

In their belief system the Brewer Diet gets the blame for having failed them. However, I suspect that at least some of these women were on these diuretic herbs.

Therefore, as an advocate of the Brewer Diet, I think that it's important for pregnant women and their care-givers to understand the potential risk of using these herbs.

These anti-Brewer mothers are also very much interested in reading all the latest mainstream medical research about the possible causes of pre-eclampsia and HELLP.

As a result, they consider these complications to be random, unpredictable acts of nature--situations that we have no control over at all, and which are completely unconnected to the mother's nutrition or lifestyle. Obviously, they strongly disagree with me, and the Brewer principles, and I strongly disagree with them.

However, I've been listening to some of the things that they have been saying. The various theories that their studies have come up with apparently include the following It is my belief that all of these theories are just the result of mainstream medical researchers trying to "close the barn door after the horse has gone".

In other words, it seems like a huge likelihood to me that the physical developments that these researchers are finding and describing are just the end results of low blood volume, which is caused by a lack of certain kinds of food protein plus calories plus salt.

When I see all of these dire results, all of the mechanisms that are possibly triggered and put into motion by something as simple as low blood volume and when I hear how early it can come to a head sometimes as early as 20 wks and how fast it can progress to a life-threatening situation sometimes just a matter of hours then I just want to tell everyone that I possibly can how much we are risking here how very, very, very important it is to protect that pregnant blood volume as the precious, precious treasure that it is, and how it is no small thing to give the mother some herbs which may stimulate her kidneys to pee out some of that priceless circulatory fluid which she has worked so hard to build up.

In addition, I know that some women find it to be a challenge to keep up with the Brewer Diet on a daily basis. So it just doesn't make sense to me to be encouraging a pregnant woman to build her blood volume with the Brewer Diet on the one hand, and then on the other hand to be encouraging her to take an herb which may cause her body to lose some of that hard-earned blood volume thru its diuretic action.

It seems to me as though that would be like taking two steps forward and a half-step backwards every day.

My suggestion to anyone caring for pregnant women is that if they have a woman on a daily cup or more of one of these herb teas with diuretic properties, or if she is taking a supplement that contains one of these herbs, and if they see her BPs start to creep up, or her baby's growth start to fall behind, or her swelling start to increase, the wisest thing might be to take her off whatever small amount of these herbs that she is on.

If I were a midwife, I might not want to risk having any of my patients on any amount of diuretic herbs, because once you see the obvious symptoms of a falling or fallen blood volume, the process may be already much progressed, and playing catch-up, by adding extra protein, salt, and calories to the diet, and by discontinuing the doses of herbs, or by giving IV albumin, is often much more difficult than prevention would have been, and occasionally the necessary dietary changes may not come soon enough or work fast enough to make a difference in the outcome.

These are the reasons that I respond so strongly when the discussion comes up about using herbs which have some diuretic properties during pregnancy. Joy Jones, January 8, See here for a Brewer way of diagnosing and treating pre-eclampsia. Swelling: A Benign Side-Effect of Diuretic Use in Pregnancy?

Joy Jones, RN February 9, I just became aware of a situation in which one pregnant mother is taking a diuretic through a prescription from her OB, and experiencing extra swelling edema as a side effect.

I also just became aware of at least one other pregnant mother whose husband is a doctor , who is also on a diuretic, and who is under the impression that extra swelling is a normal, benign side effect of being on a diuretic.

She also believes that diuretics are presumed to be the safest blood pressure medication for pregnant women! She is also of the opinion that diuretics are currently the most prescribed medication for pregnant women! I don't know if the second mother has her facts straight, but if her impressions are even remotely accurate, modern US American obstetrics has certainly taken a huge leap backwards!

For several years now those who are critical of the Brewer writings have been asserting that one proof that those writings are outdated and out of touch with current obstetrical practices is the emphasis that Dr. Brewer places on avoiding the use of diuretics in pregnancy.

Those critics have been ridiculing his writings by saying that Dr. Brewer and those who would support him should know that doctors never prescribe diuretics for their pregnant patients any more. Well, if this mother's statements are anywhere near being accurate, it seems that unfortunately those criticisms were a little premature.

Personally, I am shocked and amazed and horrified that there is still even one OB out there, let alone possibly more than one, who is prescribing diuretics for a rising BP in pregnancy!

In , an entire 34 years ago, there was extensive testimony given to the FDA regarding the hazards of using diuretics in pregnancy, to the extent that the FDA finally had to concede and issue regulations requiring a change of labeling on the drugs, removing the indication that they are effective in toxemia!!!

According to the account of this FDA hearing, as it is reported in What Every Pregnant Woman Should Know , in his testimony "Dr. You can read more about that testimony to the FDA in this Brewer timeline, under the entry for In fact, there was actually a precedent-setting lawsuit in , a full 24 years ago, in which the OBs, the hospital, and the drug company which produced the diuretic used to treat a pregnant woman, were successfully sued for the detrimental effects that the diuretic had had on her!

See here for more details about that lawsuit. Suffice it to say that any obstetrician should know better by now than to prescribe a diuretic for edema or a rising blood pressure in pregnancy, 24 years after this lawsuit, and 34 years after the FDA decreed that the use of diuretics in pregnancy is not a good idea.

There is most definitely a direct link between the use of diuretics in pregnancy and the increased amount of swelling edema that the mother will experience as a side effect of that treatment.

Then in the third trimester, the pregnant body needs to maintain that expanded blood volume. The action of renin on the body is to constrict the capillaries, for the purpose of sending most of the blood supply, inadequate as it is, to the vital internal organs, to preserve the life of the body for as long as possible.

Pathological swelling edema in pregnancy is another symptom caused by an inadequate blood volume, and it is also made worse by the use of diuretics, regardless of the source of those diuretics.

If there is not enough osmotic pressure in the blood to hold this conserved fluid in the blood stream, osmotic pressure normally created by the presence of albumin protein and salt in the blood, this conserved fluid will not stay in the blood stream.

Instead, it will leak out of the capillaries into the tissues in the ankles, legs, fingers, and face. It is vitally important for pregnant women to understand, and for those who care for them and supply them with diuretics to understand, that there is a huge difference between the edema and hypertension of people with heart disease, kidney disease, or circulatory disease; and the edema and hypertension of normal, otherwise-healthy pregnant women.

Helping the pregnant mother to eat more calories, more salt, and more protein is the therapy which will help her body to expand its blood volume to the level that is needed for sustaining a healthy pregnancy.

Thus the only situation in which diuretics might be indicated in pregnancy is one where the mother was already on diuretics before the pregnancy for some pre-existing condition, such as heart or kidney disease, or one where she developed that condition during the pregnancy, and even then she would have to be closely monitored to see if her dosage of the diuretic should be decreased during the pregnancy.

Some mothers may have been taking herbal diuretics to help feed and sustain their livers, which is actually another goal of the Brewer diet and philosophy. Little did they know that by taking either prescription or herbal diuretics they were actually undoing some of their diligent nutritional work with which they'd intended to keep their blood volume well-expanded and healthy.

See here for more about how extra swelling can be caused by low blood volume from the use of diuretics, or from inadequate amounts of salt, calories, and protein.

Having the perspective that swelling is a normal side effect of using a diuretic in pregnancy all depends on your definition of "normal".

The result, or side effect, of swelling, when you are on a diuretic during pregnancy is a common and very expected side effect, so therefore it is "normal" for a woman to have swelling as a side effect of being on a diuretic.

But while it is "normal" for a pregnant woman to see swelling as a side effect of being on a diuretic, it is also not a safe side effect at all. It is very, very, very dangerous for a pregnant woman to be on a diuretic, unless she has pre-existing or co-existing heart or kidney disease.

And for the mother's care-givers, the appearance of this "normal" side effect of swelling edema should raise all kinds of red flags and set off all kinds of alarms that the pregnant patient's blood volume is dropping to dangerously low levels. Anyone who considers the extra swelling that is the result of the use of diuretics in pregnancy to be a "normal" and benign side effect is someone who does not fully understand the physiology of the situation.

Adding the use of diuretics to the already volatile situation of salt-deprivation and low blood volume creates a situation which is literally life-threatening. To illustrate that perspective, I would like to change the word "normal" to the term "natural consequence" and add an analogy.

It is a "natural consequence" for a pregnant woman to get extra swelling when she is on a diuretic. It is also a "natural consequence" for us to get an explosion if we light a match while we are putting gasoline in a car.

But although it would be normal for us to expect that "natural consequence", that does not mean that that explosion would be an acceptable "natural consequence" for us to experience. In the same way, the side effect of swelling edema due to diuretic use is not an acceptable "natural consequence" in pregnancy.

See here for more information about the risks of using herbal or prescription diuretics during pregnancy. Here is Dr. Brewer's perspective on the use of diuretics in pregnancy, as he wrote it in What Every Pregnant Woman Should Know: The Truth About Diets and Drugs in Pregnancy , a book that he wrote in partnership with his wife Gail Brewer available from Amazon.

com, or from your local public library, or through inter-library loan During pregnancy the liver is working overtime to meet the stress of increased metabolic functions of all kinds. If the mother is malnourished in the last half of pregnancy, impairment of albumin synthesis can occur in a matter of weeks!

If the mother's diet is not improved, the blood volume continues to fall. Her body compensates in at least three ways:. the kidneys start to reabsorb water in an effort to restore fluid to the circulation. But without sufficient albumin, the reabsorbed water also leaks into the tissues, thus aggravating the edema; blood pressure rises in an attempt to maintain adequate blood flow to all organs; if blood volume becomes critically low, the kidneys shut down completely causing urinary output to dwindle to zero.

At this point in the traditional management of the severely toxemic patient, the answer has been to administer ever more potent diuretics to the mother in hopes of boosting her urinary output and reducing abnormal swelling. In these circumstances, the diuretics are lethal. They act in the body only to remove more water from the already perilously shrunken blood volume.

Lindberg; Salt, Diuretics ln Pregnancy. Gynecol Obstet Invest Diabetes exercise guidelines April ; Diuretic effect on pregnancy 4 : Protein intake for muscle growth This article reviews the Diuretci of effecy and salt in normal and peegnancy pregnancy. During pre-eclampsia there is a decrease in circulating plasma volume, which the administration of diuretics reduces still further. There is no proof that diuretics have a beneficial effect on prevention or treatment of toxemia of pregnancy. They should thus be regarded as contraindicated, except in cases of cardiac insufficency and certain renal diseases. Sign In or Create an Account. Diuretics are Diabetes exercise guidelines to reduce oedema Diuretoc Diuretic effect on pregnancy in the Diabetes exercise guidelines of heart failure and other Low-carb and healthy fats associated with fluid overload. They Diuetic also used to treat hypertension, although are effecf contraindicated in pregnancy for this Diuretic effect on pregnancy purpose. This Improved cognitive abilities focuses on the diuretics amiloride, oj, furosemide Diretic spironolactone, which are among some of the more commonly prescribed diuretics for which there is pregnancy outcome data. Diuretics are not routinely recommended in pregnancy due to the potential risk of altered uteroplacental blood flow, and in the case of spironolactone and eplerenone, antiandrogenic effects which could theoretically affect the development of a male fetus. However, their use may be justified under specialist supervision in cases of severe maternal illness for which other treatments are likely to be ineffective or have to be discontinued due to pregnancy such as an ACE-inhibitor or ARB. There are few controlled studies of diuretic use during pregnancy, and for each individual diuretic; data are therefore limited.