Acupuncture & Pregnancy

What Acupuncturists Need to Know About Pre-Eclampsia

Acupuncture & Preeclampsia

            Pre-eclampsia, simply put, is defined as high blood pressure that is over 140/90, high levels of protein in the urine (proteinuria), and fluid retention. This condition usually occurs in women during the 2nd and 3rd trimesters, but some women experience this as early as 20 weeks and if left untreated can cause premature birth or even death. In the United States pre-eclampsia is the cause of 15% (roughly 3 in 20) of premature births and affects 2 to 8 percent of pregnancies worldwide. There is also a condition known as postpartum pre-eclampsia which can happen as late as two weeks postpartum. Incorporating acupuncture and Traditional Chinese Medicine (TCM) has shown to be quite effective on many different issues involving pregnancy, and pre-eclampsia is one of those that can also be treated but isn’t talked about as much as something like morning sickness or back pain.

Signs, Symptoms, & Causes

            While the main symptoms of pre-eclampsia are high blood pressure, protein in the urine, and fluid retention, it can also harm the kidneys, liver, and brain potentially leading to long-term health issues if left untreated. In addition to the main symptoms of pre-eclampsia listed below, there are also many other signs that may present themselves during pregnancy that may indicate a potential pre-eclampsia diagnosis.

Some of the other symptoms include:

  • Fatigue

  • Nausea or abdominal pain/tenderness (especially on the upper right side)

  • Quick weight gain and swollen ankles

  • Swelling in hands, feet, and face (especially if it is quick and sudden)

  • Headaches (usually localized to the front)

  • Visual disturbances (“floaters”)

  • Dizziness

  • Vision changes

  • Decreased urination

  • Blood clotting problems

  • Breathing problems (especially when lying flat)

  • Seizures (in severe cases)

These are some of the symptoms that may show in the woman but there are also some more mild cases of pre-eclampsia that show no symptoms at all (at least from a western medicine standpoint.) Even though the symptoms are much clearer, the causes of pre-eclampsia are not as clearly defined or well understood.

Factors said to play a role in the development of pre-eclampsia:

  • Underlying kidney disease, diabetes or other diseases that cause blood vessel issues

  • First pregnancy

  • Obesity

  • Smoking during pregnancy

  • Having a birth with multiples

  • Family history

  • Hypertension prior to pregnancy

  • Pregnancy with a new partner or husband

  • High cortisol levels (which can lead to secondary hypertension)

TCM Diagnosis/Herbs vs. Western Diagnosis

             In western medicine, most experts believe that pre-eclampsia starts with a shallowly implanted placenta that doesn’t circulate the blood normally. This causes an inflammatory response and increases vascular pressure. A western medicine doctor will typically monitor the woman’s blood pressure.

If the blood pressure increases to an unsafe level they will prescribe medication to decrease the hypertension, and in severely high blood pressure cases (which can result in poor fetal growth), will be prescribed anti-hypertensive medication. Aspirin is also said to help prevent pre-eclampsia and is sometime given as such in a low dosage only after the second trimester.

Some other protocols in the treatment/prevention of pre-eclampsia are:

  • Exercise

  • Balanced diet

  • Calcium supplements

Common medications for pre-eclampsia:

  • Methyldopa – 1st choice oral medication

  • Nifedipine – 1st choice oral medication

  • Magnesium Sulfate – safest & most effective anti-convulsant for severe cases

The west certainly has a decent understanding and framework on this condition, and in some cases depending on the patient and her specific condition, may still be needed in conjunction with TCM modalities. The west, however, seems to treat only the high blood pressure aspect of pre-eclampsia, which is where eastern medicine would potentially step in to aid or take over in treatment/prevention.

TCM diagnoses hypertension as a disturbance within the climate of the organs involving treating the underlying causes for and symptoms associated with pre-eclampsia. In general, it is caused by a liver and/or kidney yin deficiency. Yin is unable to anchor yang or fire is likely causing hypertension. This will be accomplished through a combination of acupuncture, Chinese herbs, and nutritional guidance based on TCM principles for a healthy lifestyle.

In regards to Chinese herbs, the focus is on relieving the symptoms and treating the root cause of the pre-eclampsia. Certain herbs have shown that with proper formulations, and under proper supervision, they can establish proper placental boundaries and strengthen the health of the fetus. It is very important, especially in herbal formulations relating to pregnancy, that you are well experienced in Chinese herbology before prescribing a formula.

Some common Chinese herbs to lower blood pressure by increasing circulation are:

  • Hawthorn berries – said to relax constricted blood vessels

  • Cramp Bark – relax muscles and blood vessels reducing pain and lowering blood pressure

  • Milk Thistle – lowers blood pressure by lowering blood sugar (which is said to cause high blood pressure) and eliminating excessive cholesterol within the arteries

  • Dandelion Roots/leaves – the roots promote liver detoxification and the leaves are a natural diuretic increasing urine production which is often needed in the treatment of high blood pressure

Research shows the effectiveness of TCM in regulating the immune system, decreasing swelling, reducing headaches, improving abdominal pain, and adjusting cortisol levels. In addition, acupuncture and nutritional guidance from a TCM professional will help with obesity and diabetic factors possibly contributing to pre-eclampsia.

Going with herbs, TCM recommends eating whole foods rich in vitamin B6 and calcium to reduce pre-eclampsia symptoms. Eating these foods smooths the liver qi which helps keep the blood pressure normal and the body relaxed. With the western theory that a shallowly implanted placenta may be root cause of pre-eclampsia, a diet to nourish the health of the placenta and uterus is also recommended. A diet that strengthens the meridians and energies that support and tone the uterine lining is usually what is prescribed.

Meridian Focus for the Placenta and Uterus:

  • Kidney – the foundation of reproductive health, weakened by cold liquids and foods and strengthened by warm foods and liquids. Examples of this would be hot soups and stews which are very nourishing and blood building.

  • Spleen – accountable for the tone of the body’s tissues and organs, and integral for the uterus and placenta. Eating yellow root vegetables can fortify this meridian.

The foods that need to be avoided for pre-eclampsia according to TCM are frozen, raw, or chilled. Using the above nutritional recommendations will build healthy and vital blood important in the treatment of pre-eclampsia.

Acupuncture for Pre-eclampsia

            Often times in relation to pre-eclampsia and eastern medicine, it is the liver meridian that is imbalanced due to the stress/demands of pregnancy, and liver yang. Liver yang tends to go up contributing to the hypertension. Using acupuncture for pre-eclampsia to address these issues can help regulate the endocrine system by easing the tension affecting the functions of it as well as toning it. Although acupuncture protocol is fine tuned for balancing blood pressure to the unique individual, it is often times used in conjunction with western medicine.

In fact, a study was done in 2016 showing its effects on patients having acupuncture in conjunction with standard care, and showing great results in favor of combining the two as opposed to standard care alone.

The study showed:

  • Acupuncture group (acupuncture and standard care) had considerably lower blood pressure at the time of delivery and postpartum than patients in the control group (standard care only).

  • Individual change in blood pressure between the baseline and the end of treatment was exceptionally greater in the acupuncture group versus the control group for both systolic blood pressure and diastolic blood pressure.

  • No adverse effects of treatment

  • Acupuncture plus standard care showed greater reduction in blood pressure than standard care alone, but further studies are needed to solidify role of acupuncture in the treatment of pre-eclampsia.

As it was stated above, many times the liver meridian is treated for pre-eclampsia due to stress. Research suggests that stress could increase a woman’s risk of being diagnosed with pre-eclampsia. The stress release alone could potentially help, especially with those that have more mild symptoms of the condition.

Acupuncture is safe to have during pregnancy, but there are some acupuncturists that will steer clear from it because there are certain points that are contraindicated during pregnancy. Below we will look at some acupuncture points for high blood pressure, and points that are best avoided during pregnancy as they are known to potentially stimulate labor.

Acupuncture points for high blood pressure:

  • KD1 – Gushing Spring – Yongquan – located on the sole of the foot in the depression with the foot in plantar flexion at the junction of the anterior third and posterior two thirds of the line connecting the base of the 2nd and 3rd toes to the back of the heel.

  • LI18 – Protuberance Assistant – Fu Tu – located on the lateral side of the neck level with the tip of the Adam’s Apple between the sternal head and clavicular head of the SCM (sternocleidomastoideus).

  • SI17 – Celestial Countenance – Tian Rong – located on the lateral aspect of the neck, posterior to the angle of the mandible in a depression on the anterior border of the SCM.

  • ST11 – Qi Abode – Qishe – located on the neck at the superior border of the clavicle between the sternal and clavicular heads of the SCM muscle.

  • ST9 – Man’s Prognosis – Renying – located on the neck lateral to the Adam’s Apple on the anterior border of the SCM muscle where the pulse of the common carotid artery is felt.

Acupoints to avoid during pregnancy before 38 weeks:

  • LI4 – Union Valley – He Gu – known to promote labor, located in the middle of the 2nd metacarpal bone on the radical side.

  • SP6 – Three Yin Intersection – Sanyinjiao – known to induce labor, 3 cun above the tip of the medial side of the leg in the depression under the tibia.

  • GB21 – Shoulder Well – Jian Jing – may cause weakness in the pelvic floor which could be problematic if there is a history of incompetent cervix or preterm labor, located on the shoulder directly above the nipple at the midpoint of the line connecting GV14 and the acromion.

  • UB60 – Kunlun Mountains – Kunlun – aids in labor, located on the foot behind the external malleolus in the depression between the tip of the external malleolus and tendo calcaneus (behind the ankle bone, in front of the achilles tendon).

  • UB67 – Reaching Yin – Zhiyin – used to turn the fetus, located on the lateral side of the end of the small toe, .1 cun from the corner of the nail.

  • Any acupoints located in the upper and lower abdomen

  • Any acupoints located in the lumbo-sacral area

Even with no evidence that these points have caused adverse reactions, it is better safe than sorry. As all of you know, a little goes a long way, and its best during a sensitive time such as pregnancy to keep it simple using essential points as well as points used for uplifting, holding, and in the case of pre-eclampsia, ones for high blood pressure and stress.

Can Acupuncture help with Pre-eclampsia?

            Yes!  Research has shown beneficial effects of acupuncture for pre-eclampsia.  As with most conditions along with acupuncture, more larger scale studies are needed to solidify the results seen with patients daily in our acupuncture practices. It is best with this condition to just make sure you are aware of any precautions for a pregnant woman with acupuncture, be mindful, and keep it simple in treating pre-eclampsia and any condition while a woman is pregnant. As always, have the patient consult their primary doctor to be sure no additional care is needed and/or what to potentially avoid for that individual as far as TCM is concerned.

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