妊娠期高血压的营养策略：钙、镁、锌

同义索引: 不伴有蛋白尿的妊娠期高血压，产前惊厥(不伴有蛋白尿), 妊娠引起的高血压 (不伴有蛋白尿)

1. 简介 

2. 一览表

3. 症状 

4. 治疗 

5. 饮食习惯的改变 

6. 生活方式的改变 

7. 营养补充剂 

8. 参考文献 

“妊娠期高血压” (GH)是指孕妇在怀孕第12周后出现血压升高，如果该妇女既往血压正常的话，那么，她在分娩以后血压又可恢复至正常。

妊娠期高血压可能是“产前惊厥”或“慢性高血压”的早期征兆。^[1]如果这些并发症不发生进展，或者慢性高血压虽然有进展，但依然还处于轻度水平的话，怀孕对于母亲和新生儿都是有好处的。现已有研究表明，在肥胖妇女或葡萄糖不耐受的妇女中，发生妊娠期高血压的几率会比较高。^[2,3,4]

妊娠期高血压的辅助疗法

妊娠期高血压的症状

症状一般会在怀孕12周后出现，包括颜面部浮肿，手浮肿，视力模糊，头痛，高血压，以及皮肤和眼睛粘膜黄染等。

医药治疗

在各类用于治疗高血压的处方药中，利尿剂是很常用的一类。 其中常用利尿剂包括：噻嗪类利尿剂，包括氢氯噻嗪（hydrochlorothiazide，HydroDIURIL）， 吲哒帕胺（indapamide，Lozol），以及美托拉腙（metolazone，Zaroxolyn）等；袢利尿剂类，包括呋塞米（furosemide，Lasix），布美他尼（bumetanide，Bumex），以及托拉塞米（torsemide，Demadex）等；保钾利尿剂类，包括螺内酯（spironolactone，Aldactone），氨苯蝶啶（triamterene，Dyazide, Maxzide），以及阿米洛利（amiloride，Midamor）等。利尿剂通常与β阻断剂联合用药，β阻断剂包括普萘洛尔（propranolol，Inderal），美托洛尔（metoprolol ，Lopressor, Toprol XL），阿替洛尔（atenolol，Tenormin），以及比索洛尔（bisoprolol，Zebeta）等。第二类治疗高血压的处方药为血管紧张素转化酶抑制剂（ACE inhibitors），其中包括卡托普利（captopril，Capoten)，贝那普利（benazepril，Lotensin），赖诺普利（lisinopril，Zestril, Prinivil)， 依那普利（enalapril，Vasotec）以及喹那普利（quinapril，Accupril）。第三类抗高血压处方药为血管紧张素II 受体拮抗剂，包括氯沙坦（losartan，Cozaar），颉沙坦（valsartan，Diovan），厄贝沙坦（irbesartan，Avapro），坎地沙坦（candesartan，Atacand）以及替米沙坦（telmisartan (Micardis)等，这些药物可单独使用，也可以和其他药剂联合使用。第四类为钙通道拮抗剂，包括氨氯地平amlodipine (Norvasc), 维拉帕米verapamil (Calan SR, Verelan PM)以及地尔硫卓diltiazem (Cardizem CD), 这些药也可被单独使用，或与其他药物联合使用来治疗高血压。

治疗妊娠期高血压还应多卧床休息，限制盐的摄入量，如果有必要的话，应留在医院作进一步观察。有时医生还会推荐患者静脉注射镁制剂。“终止妊娠”是治疗妊娠期高血压的最终方法，而终止妊娠的方法有两种，其一为分娩，其二进行剖腹产。

可能有益的饮食习惯

低盐饮食

“低盐饮食”对于原发性高血压患者有显著的降血压效果，但是对于妊娠期高血压妇女来说，限制盐摄入量并没有显著的降血压效果。^[5,6,7]因此，医生并不建议妊娠期高血压的妇女限制饮食中的盐摄入量。^[8]

鱼类

另外，研究表明，多吃鱼类可以使妊娠期高血压妇女的血压下降。^[9]如果某个地方的人很少吃鱼，那么该地区妇女的妊娠期高血压发病率比较高，但是如果某个地方的人有吃鱼的习惯，那么该地区的发病率明显较低。

可能有益生活方式

减少工作压力

对于妊娠期高血压妇女，在怀孕时或分娩以后需要做定期检查，这样可以预防或尽早发现“产前惊厥”和“慢性高血压”等并发症。^[10,11,12]

工作中的压力，比如工作节律、工作时间以及休息频率都难以自己控制，这对妇女来说危害是比较大的。因此，减少工作压力可能对预防妊娠期高血压有好处。^[13]而且也有研究表明，长期工作压力很大的女性与工作较为清闲的女性相比，前者发生妊娠期高血压的风险性更大。^[14]

卧床休息

医生常常会在开医嘱时建议妊娠期高血压的妇女多卧床休息，但是这一点受到了一些研究者的质疑。^[15]不过，这些研究者的试验结果并不是很统一。^[16,17]某一项对照研究发现，卧床休息可减慢妊娠期高血压的加重进程，避免进展成“恶性高血压”的可能性。^[18]但是，目前能证明卧床休息对妊娠期高血压患者有益的证据还不是很充分。 

可能有益的营养补充剂

钙

缺钙可能是引起妊娠期高血压的原因之一。^[19,20]研究发现，妊娠期高血压的女性往往在平时饮食中摄入的钙明显低于血压正常的女性。^[21,22]大多数研究表明，钙补充剂确实可以降低妊娠期高血压妇女的血压值。^{[23,24,25,26,27,28,29]}，但也有例外。^[30]对于平时饮食中钙摄入较少的女性患者，补钙是缓解高血压的最有效的方法。对于正常的怀孕妇女，美国国立卫生研究院（NIH）推荐的钙补充剂剂量为每日1200毫克至1500毫克。^[31]但是对于处于妊娠期高血压高风险的妇女，一般推荐剂量为每日2000毫克，^{[32,33,34,35,36,37]}并且非常值得一提的是，在补钙期间，无论对于母亲还是对于胎儿，钙补充剂均没有出现任何副作用。^[38,39]尽管如此，很多医生还是坚持认为，每日钙补充剂服用量不应超过1500毫克。

镁

缺镁是另一个可能引起妊娠期高血压的原因。^[40,41,42]很多妇女在怀孕期间，饮食中镁的摄入量往往低于推荐水平。^[43,44]研究表明，镁补充剂可减少妊娠期高血压的发病率。^[45,46,47]除了预防作用以外，对于已经出现妊娠期高血压的妇女，镁补充剂可能还可以减轻病情的严重程度。^[48]每日的镁补充剂的服用量范围为165克至365克。

锌

在一项以西班牙低收入水平的孕妇为受试者的双盲试验中，每日服用20毫克锌补充剂后，结果发现，妊娠期高血压的发病率有所下降。并且要指出的是，这些孕妇之前并不存在缺锌的问题。^[49]

抗氧化剂

大多数研究显示，在妊娠期高血压妇女中，血中抗氧化剂水平降低。^{[50,51,52,53]}但是，补充抗氧化剂对预防或减轻妊娠期高血压究竟有多大作用呢？目前还没有任何相关的研究。

有无副作用及药物之间相互作用？

请参考各种营养补充剂的副作用及相互作用。

参考文献

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