11 Questions About Toxemia

These 11 questions are taken directly from the book by Dr. Tom Brewer, Metabolic Toxemia of Late Pregnancy.  Page numbers are noted.  We highly recommend this book as well as Dr. Brewer’s other books:  What Every Pregnant Woman Should Know, the Truth About Diet and Drugs During Pregnancy and The Brewer Medical Diet for Normal and High-Risk Pregnancy.

1.  What are the common symptoms and signs of MTLP?  (Metobolic Toxemia of Late Pregnancy?)

Common symptoms are:  headache, dizziness, visual disturbances, anorexia, nausea, vomiting, upper abdominal pain, swelling of the face and extremities and a history of acute starvation of several days, along with chronic malnutrition.  The signs are:  hypertension (high blood pressure, usually 140/90 or higher), edema (swelling), proteinuria (spilling protein in the urine), and in severe cases, convulsions, coma, congestive heart failure with pulmonary edema, vascular collapse with shock and death.  (Pages 7-8). 

2.  What causes MTLP?

Studies conducted by Dr. Tom Brewer and others indicate that MTLP may be the result of steroid hormones, which are produced by the placenta being “trapped” in the liver.  The liver is not capable of breaking them down, and so a toxic condition ensues.  (The idea that these hormones are of placental origin is supported by the evidence that this condition is not present in non-pregnant people, and once the placenta is removed after birth, the condition begins to subside.)  In addition to this, the enzymes in the lower GI tract work on certain amino acids and produce potentially toxic substances which are carried to the liver.  These compete with the steroid hormones for detoxification.  In a nutshell, the liver gets overloaded.  (Pages 26-27). 

3.  Why do some women get MTLP and others do not?  Why does the liver overload for some and not for others?

MTLP is caused by any condition which results in malnutrition.  Malnutrition causes fundamental changes in metabolism of liver cells during pregnancy.  There is strong evidence that essential amino acids contained in high quality protein may be deficient, thus impairing liver function.  In other words, the liver needs high quality protein to do its job of detoxification.  When sufficient protein is not provided, the liver can’t detoxify.  However, every pregnant woman who eats, digests, absorbs and metabolizes normally an adequate diet for her pregnancy will not develop MTLP.  (Pages 67-68). 

4.  Why would a woman go into labor early if she has toxemia?

She may go into labor early because of the effect of placental steroid hormones on the cervix, “ripening” it earlier than for most women.  (Page 24).

 5.  Is there any effect on the placenta with MTLP?

Yes, there is an increased risk of abruption (premature separation) of the placenta with MTLP.  (Page 61).

 6.  What effect does abruptio placenta have on the baby and mother?

In Dr. Brewer’s practice in the South, approximately 50% of mothers with abruptio placenta had intrauterine fetal deaths before they were able to reach the labor unit.  Speed is essential to deliver the baby to prevent maternal blood loss, shock and kidney damage, which can lead to the mother’s death.  (Page 63).

7.  Is rapid weight gain always a sign of toxemia?

No.  Some women who develop toxemia never experience rapid weight gain, but are malnourished on an inadequate diet.  On the other hand, some healthy women gain more than the typically-recommended “pound per week” eating a well-balanced diet of nutritious food.  Therefore, weight-gain alone is not a reliable indicator of toxemia.  It is only one possible indication.  (Page 71).

8.  What is the best course of action for someone who has developed MTLP?

If it is a mild case, it may be treated with increased protein intake, under the supervision of the doctor.  There is no rationale for diuretics or high blood pressure medication.  If it is a severe case, the safest course may be to deliver the baby.  Most women with MTLP are easily induced due to the “ripe” cervix.  If delivery by C-section becomes necessary, it is important not to oversedate the mother and increase the load on her liver by requiring it to detoxify the drug as well.  (Page 83).

9.  What is a summary of the Brewer diet that will prevent MTLP?

Dr. Brewer recommends daily:  1 quart of milk, 2 eggs, plus lean meat, leafy greens, fruits and vegetables, whole grains and citrus.  Eat a well-balanced diet and avoid too many sweets and extra fats.  (Page 87).

10.  What are the statistical results of the Brewer diet?

Dr. Brewer compared similar socioeconomic groups of women while in practice.  In contrast to the 35% of patients who developed toxemia in Jackson, Mississippi’s University of Mississippi Hospital, there were no cases of toxemia in Dr. Brewer’s first 235 patients from Richmond Health Center in Richmond, California.  This group’s premature rate was also less than 2%.  (Page 90).

11.  Isn’t toxemia just a disease limited to women in poverty, or with no prenatal care?

Dr. Brewer used to believe that was primarily the case, since those in poverty often have a difficult time affording to eat properly.  However, he has seen an increase in toxemia among higher socioeconomic classes due to either doctor’s mismanagement for fear of toxemia (imposing low calorie, salt restrictive diets) or a woman’s concern with thinness (self-imposing low calorie diets with or without consent of her doctor).  Dr. Brewer sites case studies to illustrate each.  (Page 142).

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