How A Healthy Microbiome Could Help Prevent Preeclampsia

Alejandra Carrasco, MD 

Preeclampsia is a disease that can occur during pregnancy and affects approximately 2-8% of women. 

Its symptoms generally include : 

  • High blood pressure (especially in the third trimester) 
  • Swelling of face, hands, and ankles 
  • Blurred vision 
  • Headache 
  • Abdominal pain 
  • Too much protein in the urine. 

 Thanks to advances in prenatal care, preeclampsia is no longer as deadly as it once was.   However, it’s still a scary diagnosis because it’s a leading cause of maternal morbidity and mortality for mother and baby, and the only cure is to birth the baby and placenta.  

 This results in thousands of inductions, c-sections, and preterm births per year, which increase the risk of other ailments for mom and baby. In fact, most adverse outcomes related to severe preeclampsia are caused by the need for preterm delivery and not the disease itself. 

 In addition, preeclampsia can increase the risk of cardiovascular complications in the mother and cardiovascular disease in the baby later in life.  

 I’ve dedicated countless hours researching ways to help women avoid preeclampsia because I developed it during my first pregnancy, and it was a really scary experience.

The illusive causes and risk factors for preeclampsia 

Preeclampsia (PE) is most common in first pregnancies, but is seven times more likely to occur in subsequent pregnancies if the mother was previously diagnosed. 

 As I mentioned above, while there’s not a consensus on a single cause certain women can be at greater risk, including those with:  

  • a family history of PE 
  • previous PE 
  • multiple pregnancy 
  • Obesity 
  • Diabetes 
  • metabolic disorders 
  • chronic high blood pressure or kidney disease before pregnancy 
  • women over over 40 
  • women of African American ethnicity 

Some pre-existing conditions can also increase your risk (and we’ll explore this link more coming up), including: 

  • certain autoimmune diseases 
  • urinary tract infections 
  • gum disease 
  • gestational diabetes 
  • sickle cell disease 
  • migraines 

In terms of cause, since the cure for preeclampsia requires delivery of the baby and placenta, it is believed that an abnormal placenta plays a role in the cause. However, to find real answers we must dig deeper and ask: what caused the placenta to become abnormal or “insufficient” to begin with?

Thankfully, research into the microbiome is starting to connect the dots on the interconnectedness of these risk factors and placental health. 


Meet your maternal microbiome 

Women have a maternal microbiome, and it’s nothing short of miraculous. 

The maternal microbiome is essentially your body’s microbiome “on pregnancy”, which changes as your hormones, blood flow, nutrition, digestive function, immune system, and entire body adapt to your growing baby.

It is also the microbiome you share with your baby, and scientists now believe that the mother’s microbiome has a direct effect on baby’s health and development. 

What’s even cooler is each organ and system that makes up your maternal microbiome has its own individual microbiome (like galaxies within galaxies), and they all influence one another in terms of microbial diversity and health.  

The most notable players in this symphony of organs include your uterus, vagina, oral cavity, gut, and placenta—an organ once believed to be sterile until its microbiome was discovered in 2014. It could even be argued that your partner or doners reproductive organs are part of your maternal microbiome because they made your baby and, if you’re still sexually active during pregnancy, continue to influence your vaginal microbiome. 


Connecting the dots...the maternal microbiome’s role in preeclampsia 

The maternal microbiome has been indicated in processes that contribute to abnormal placentation, including periodontal disease, cardiometabolic complications, and excessive gestational weight gain. 

Of all the interconnected biomes within your maternal microbiome, researchers have found that your oral cavity (aka: your mouth and throat) most closely resembles your placental microbiome in terms of bacterial species. Some scientists even believe that the placental microbiome is born from the mouth. This explains quite a few things in terms of PE risk-factors including: the periodontal or gum disease connection, the heart disease connection (because heart disease and gum disease are connected), and a probable route for bacteria and pathogens to access the placenta via bleeding or damaged gums.  

There’s also a link in terms of obesity (another risk factor for PE), with obese or overweight pregnant mothers harboring the same types of bacteria families in the oral microbiome as in the placenta.  

The uterine microbiome also plays a role in placental health, with research showing it may help prepare the body for embryo implantation and placental formation by modulating the local immune system, which could have a direct impact on placental health and the development of preeclampsia.  

The gut microbiome plays an important role in preeclampsia prevention and even treatment as well.  

  • For example, it’s been shown that alterations in the gut microbiome and intestinal permeability (aka: Leaky Gut) increases one’s risk of obesity, and thus, preeclampsia.  
  • It’s also been shown that an obese gut microbiome can be altered with diet and exercise, thus reducing one’s risk of preeclampsia or even helping treat existing conditions. 


How the placental barrier becomes breached 

The placenta is brilliantly designed as a barrier to protect the baby from most infections (some people refer to it the baby’s “guardian angel” or “first mother”), but certain symbiotic bacteria and pathogens can translocation to the placenta via the mother’s bloodstream, causing placental abnormalities and/or trouble for the fetus. 

These pathogens are believed to come from three sources: the mouth, the vagina, and the gut.  

Researchers have postulated that specific pathogenic bacteria found in all three cavities (oral, vaginal, gut) end up in the bloodstream and placenta because of intestinal and oral permeability (your gums tend to bleed more during pregnancy due to hormonal fluctuations and many women have intestinal permeability before getting pregnant).  

The vaginal microbiome may also play a role, as a robust vaginal ecosystem helps prevent vaginosis (vaginosis causes a reduction in the good bacteria, Lactobacillus, which plays a critical role in preventing an overgrowth of pathogenic bacteria)  sexually transmitted bacterial infections, and urinary tract infections (remember, UTIs are a risk factor for preeclampsia?) all of which can degrade the cervical barrier potentially increasing the risk of pathogen transfer to the placenta/uterus. 

There’s also the issue of chronic inflammation, which can degrade the placenta and cause preeclampsia, and is often rooted in an imbalance or dysbiosis of gut bacteria (aka: intestinal permeability or “leaky gut syndrome).  

Chronic inflammation also stems from or is a causal factor in a number of preeclampsia-related risk factors including autoimmune disease, gum disease, obesity, diabetes, kidney disease, and metabolic disorders. 

Are you starting to connect the dots?! Because this growing body of research is providing a gold mine of potential answers into one of the most mysterious and feared conditions of pregnancy. 


Caring for your maternal microbiome to prevent preeclampsia 

Given all the risk factors, there are no guarantees when it comes to avoiding preeclampsia.  

However, with what you’ve just learned you can take steps to improve your microbiome before and during pregnancy. 

Some of the proactive steps I recommend to my patients include: 

  • Dealing with any digestive health issues ASAP 
  • Addressing autoimmune or inflammatory conditions, which are (again) often rooted in gut health problems 
  • Getting your thyroid checked (as you thyroid health and gut health are interconnected) 
  • Addressing any dental health issues NOW, especially gum disease or cavities which can introduce harmful bacteria 
  • Taking good care of your teeth and gums in a way that doesn’t wipe out all your healthy oral flora. 
  • Practice self-care to reduce stress daily 
  • Have your homocysteine levels checked, as imbalance is associated with an increased risk of PE 
  • Taking a high-quality probiotic to support healthy gut flora 
  • Stop douching, it messes up your vaginal microbiome! 
  • Get help losing weight. So often, weight issues are not just a matter of calories in calories out, so find a doctor to check for other causal factors (like gut dysbiosis, thyroid issues, toxic body burden, etc.) 
  • Optimize key nutrients.  Magnesium is a big one for preeclampsia prevention and magnesium sulfate is even used as a treatment for preeclampsia
  • Start stockpiling nutrients right now. Preconception and pregnancy are the times to focus on nutrient-dense, unprocessed, antioxidant-rich whole foods (antioxidants have been shown to help prevent PE
  • Talk to your doctor or practitioner about supplementing B-vitamins, magnesium, and vitamin D, and choline all of which may reduce your risk 
  • Eat plenty of fiber in the form of vegetables, fruits, gluten-free grains, and legumes/beans 
  • Be aware of the signs of preeclampsia and attend all your prenatal checkups.  

There is so much in the maternal world that we cannot control. However, by taking responsibility for cultivating a healthy and diverse maternal microbiome (before, during, and after pregnancy), we can set the stage for a healthier pregnancy, delivery, postpartum, and even a healthier child.  

And it doesn’t have to be complicated. Eat healthy, address any health issues, take probiotics, reduce stress, visit your dentist, take care of your teeth, and be sure to show up for all your prenatal check ups. You got this!


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