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'A regular chocolate treat 'could halve a woman's risk of giving birth prematurely,'" reported theDaily Mail. The story is based on research that looked at whether regular chocolate consumption during pregnancy is associated with reduced risks of pre-eclampsia and high blood pressure. It found that a higher chocolate intake in the first or third trimester was associated with a lower risk of pre-eclampsia and in the first three months of pregnancy with a lower risk of high blood pressure. This study does not provide firm evidence that chocolate consumption can reduce the risk of high blood pressure in pregnancy or pre-eclampsia. However, it does warrant further research into the possible benefits of chocolate. One important limitation is that it relied on women remembering and reporting how much chocolate they ate during pregnancy, which introduces the risk of error. Chocolate contains caffeine, which should only be consumed in moderate amounts during pregnancy. It is also high in calories and fats. The current advice about chocolate for both pregnant women and everyone else, is to consume it as an occasional treat rather than on a regular basis. Women thought to be at risk of pre-eclampsia during pregnancy should always follow their doctors advice.
eclampsia does not always lead to premature birth, although women who are at high risk may need to be delivered early. The Mail did mention that the results may have been skewed by women being asked to remember what they had eaten during pregnancy. The newspaper also correctly pointed out that the study failed to distinguish between dark and light chocolate.
a week, and four or more servings a week. They also calculated chocolate consumption for both trimesters combined. The researchers used blood pressure and urinary protein readings from prenatal and hospital delivery charts to categorise the women as having either high blood pressure, pre-eclampsia or normal blood pressure during pregnancy. Accepted diagnostic definitions were used to do this and the results were validated in a second sample. The researchers used standard statistical techniques to analyse any potential association between chocolate consumption and the risk of high blood pressure and pre-eclampsia. They adjusted their figures for various potential confounders, including established risk factors for pre-eclampsia such as body mass index (BMI) and maternal age.
Conclusion
The findings from this well-conducted study warrant further research, but do not provide firm evidence that chocolate can protect against pre-eclampsia. One problem is the possibility of reverse causality, with women who developed high blood pressure in pregnancy possibly being less likely to consume chocolate after diagnosis. Although the researchers say that they took account of this possibility by excluding women with high blood pressure before 20 weeks gestation, it is not certain that this applies to the later analyses. They also claim that the protective effects of chocolate were apparent in the first trimester. A strength of the study is its size, with a large cohort of women being asked detailed questions about chocolate consumption both in early pregnancy and just after delivery. Classification of pre-eclampsia and high blood pressure were also based on accepted definitions and the researchers controlled for risk factors that might influence the outcomes they were studying. As the authors note, the study has several limitations:
The women self-reported their chocolate consumption and had to recall their consumption over a relatively long period of time, which raises the chance that errors were introduced. It did not differentiate between dark and other types of chocolate. No direct measures of any biomarkers were taken (such as theobromine) to validate associations between self-reported chocolate consumption and the risk of pre-eclampsia and high blood pressure. It did not assess what else the women were eating during pregnancy, other than caffeine, which could have skewed the results, although the researchers point out that diet is not currently thought of as a risk factor for pre-eclampsia. The findings could be biased by underreporting of chocolate intake by overweight women although the researchers say re-ran their analyses to take account of this and got the same results. Although many confounders were taken into account, the results could still have been affected by some of these or other unmeasured confounders, such as other foods or drinks associated with chocolate eating that were not recorded.
Women thought to be at risk of pre-eclampsia during pregnancy should always follow their doctors advice.