There is a significant relationship in pregnancy among maternal nutrition, blood volume expansion, and the increased demand on the liver.  Metabolic toxemia (also known as pre-eclampsia) is a well-known diagnosis of pregnancy and refers to liver malfunction resulting from protein/calorie deficiencies.  What many women don’t realize, however, is that there are many other problems experienced in pregnancy that directly relate to inadequate nutrition, and therefore inadequate blood volume and liver compromise.  The following is an outline to give you an understanding of exactly how the adaptations of your body in pregnancy can help keep you and your baby in a healthy state.  This can occur ONLY if you give your body and your baby adequate nutrition.

The following is a summary of points from pages 194-196 of Anne Frye’s Holistic Midwifery Volume 1 (1):

• A well-nourished uterus will produce an endometrial lining that supports firm placental implantation at the very beginning of pregnancy.
• When conception takes place, and the placenta implants and begins to form during the early weeks of pregnancy, normal growth depends on the nutrients available from the uterine lining and the maternal bloodstream.
• As pregnancy advances, maternal nutrition influences how well uterine growth takes place and the quality of the new tissues that develop.
• The amount of blood in a pregnant woman’s circulation increases as pregnancy advances, with peak volume occurring at 28 to 30 weeks.  This occurs because the mother’s body must provide support for an increasingly larger and more complex organ:  the placenta.
• Adequate blood volume expansion provides good profusion of the placental surface.  It is the amount of blood and the pressure of the blood which bathes the placental surface that stimulates placental growth.  Gradual blood volume expansion results in continued adequate exchange of nutrients and wastes as the baby grows.  Additional fluid is also a protection against shock, should the mother lose excess blood after birth.
• Maintaining this dramatically expanded blood volume is made possible by the increased activity of the body’s salt and water retention mechanisms, by an adequate intake of dietary salt, and by an increase in the synthesis of albumin (a protein which attracts water into the circulation) by the liver.
• Liver-related demands increase as pregnancy advances.  Maintaining liver function at peak efficiency requires a well-balanced diet with enough protein, calories, vitamins, salt, other minerals, and fluids to meet the demands of increased metabolic activity.  The liver can only make albumin from dietary protein.  If the diet is inadequate in any essential nutrient, the pregnancy suffers.  If calories are inadequately applied in the mother’s diet, she will burn protein for her energy needs.  Malnutrition due to a lack of either calories or high quality proteins can result in many complications of pregnancy, labor, birth and postpartum.
• Adequate blood volume expansion by 28 weeks serves as a foundation for adequate transport of nutrients to the baby during the last trimester, when he begins to put on more weight and store nutrients for after the birth as well as rapidly develop his brain.  If the blood volume is not expanded adequately during the first 28 weeks, the mother’s body is inadequately prepared to cope with the increased fetal demand and secondary symptoms of metabolic toxemia of late pregnancy become manifest during the last trimester.
• Increased fetal and placental demands place more stress on the liver to increase blood volume, which it cannot do without proper nourishment.  As a result, metabolism becomes increasingly deranged.  The kidneys respond to an inadequate blood volume by reabsorbing larger amounts of water and salt as they filter the blood.  This reabsorbed fluid and salt is returned to the circulation.  If there isn’t enough albumin or sodium to hold this reabsorbed fluid within the circulatory system, much of it leaks out into the tissues through the blood vessel walls.  The kidneys continue to reabsorb fluid at one end and the fluid keeps leaking out of the capillaries at the other.  Pathological weight gain and edema are the result, with eventual reduction in urinary output as the body desperately tries to maintain the blood volume.  

 The  symptoms of a contracted blood volume and liver compromise include: (1)  

• Intrauterine growth retardation:  poor placental function produces a poorly nourished baby
• Hypovolemina (low blood volume) threatens placental function and brings the mother into labor in a state bordering on dehydration.
• Nausea, tiredness, insomnia, and general malaise develop due to chronic hypoglycemia and liver damage
• Pathological swelling
• High blood pressure:  the mother’s body tries to compensate for a contracted blood volume by attempting to adequately supply the placenta, although it doesn’t have a large enough blood volume to do so properly.  In response to a low or falling blood volume, the kidneys produce rennin which constricts blood vessels.  This is the same mechanism which raises the blood pressure in order to preserve vital organs after blood loss (such as hemorrhage) occurs.
• Headaches and visual disturbances due to nerve irritation resulting from excessive swelling, vasoconstriction and high blood pressure.
• Epigastric pain from liver damage (under the ribs on the right side)
• Hyperreflexes due to extreme stress and nervous system irritability
• Oliguria:  urine production falls off as the body desperately tries to preserve minimal blood volume. 

  Other complications often related to malnutrition include: (1) 

•  Abruption of the placenta:  poor implantation and underlying clots cause separation before birth.  Clots form easily when the blood volume is contracted because the blood is thicker.
• Prematurity:  if blood volume reaches a critical low, the mother’s body rejects the pregnancy in an effort to maintain a balance
• Stillbirth:  a weak fetus/inadequate placenta cannot maintain life either before or in conjunction with the stress of labor.
• Poor healing of the perineum or uterus
• Infections in the mother or baby before, during, or after the birth
• Maternal nutritional anemias.  Anemia has been shown to increase the mother’s chances of postpartum depression.
• Weak contractions, long labors, maternal exhaustion in labor
• Postpartum hemorrhage and coagulation deficiencies. 

In the past, a number of physicians (Pinard, Dodge, Frost, Mitchell, Thompkins, Wiehl, Ross, Hamlin, and others) have proven this nutritional link in their clinical practices.  Unfortunately, their work has been largely ignored.  The most recent of these researchers is Dr. Tom Brewer.  The Brewer Nutritional Plan for Pregnancy (as I like to call it, instead of a “diet”) acknowledges the important part nutrition plays in pregnancy, birth, and postpartum and it gives guidelines on maintaining adequate nutrition for maximum health during this time.  Read more about the Brewer Pregnancy Diet HERE.

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