Middlebury, VT, November 22, 2005
Thomas Harrington Brewer, M. D., an obstetrician known for “The Brewer Diet” for pregnancy and a researcher who devoted his career to promoting better understanding and prevention of toxemia
of pregnancy (pre-eclampsia/ eclampsia), died on November 22 in Middlebury, VT. He was 80.
The cause of death was complications of white matter disease, a degenerative brain disorder, according to his daughter, Cornelia Brewer.
Dr. Brewer spent more than 50 years researching and studying the relationships between an adequate maternal diet and improved pregnancy outcomes and was an outspoken advocate for the establishment of practice protocols for nutritional guidance, surveillance, and intervention as mandated, reportable components of routine prenatal care.
His goal was simple - to apply in daily clinical obstetric care the findings of numerous other researchers and clinicians who had instituted nutritional approaches in public clinics and private practice in order to prevent pre-eclampsia, eclampsia, hypovolemia, preterm labor, prematurity, low birth weight, and other nutrition-mediated complications of pregnancy.
Dr. Brewer was internationally published. He authored more than 40 articles in medical journals such as the Journal of Obstetrics and Gynecology, Obstetrics and Gynecology, Journal of Reproductive Medicine, Lancet, Gynecologia, Australia New Zealand Journal of Obstetrics and Gynecology, Journal of Applied Nutrition, and Pediatrics and contributed numerous book chapters. His book for prenatal care providers, Metabolic Toxemia of Late Pregnancy: A Disease of Malnutrition was published in 1963 and in paperback in 1982.
He was also the medical consultant on numerous books written by his former wife, Gail Sforza Krebs, including What Every Pregnant Woman Should Know; The Truth About Diets and Drugs in Pregnancy (Random House, 1977 and Penguin, 1979 and 1985), The Brewer Medical Diet for Normal and High-Risk Pregnancy (Simon and Schuster, 1982), The Pregnancy After 30 Workbook (Rodale, 1979), and The Brewer Pregnancy Hotline (Kalico, 2000).
Born April 9, 1925 Dr. Brewer grew up in Houston, Texas, the only child of Mary and Horace H. Brewer, who was treasurer of the Rouse Company, a real estate development concern. Among his ancestors was Horatio Chriesman, who came to Texas in 1822 and was a surveyor for Stephen F. Austin and fought in the army of General Sam Houston.
During Dr. Brewer’s freshman year at the University of Colorado, where he planned to study for the Episcopal ministry, he enlisted in the United States Army at the age of 17 and served in the 33rd Infantry in the Philippines, Leyte, and Okinawa during World War II. He was wounded in action and received the Purple Heart and Bronze Star among other military honors. After being discharged he entered the University of Texas as a pre-med student, then graduated from Tulane Medical School in 1951. As a result of his war experiences, he became an ardent peace activist. He was particularly moved by the impact of war on children.
Dr. Brewer completed general practice residencies at Jefferson Davis Hospital - Baylor Medical School and at Lallie Kemp Charity Hospital in rural Louisiana, where he found toxemia rates of 25% or higher. He had been instructed by his OB professor, Dr. James Henry Ferguson, that toxemia of pregnancy was linked to the severe malnutrition that Ferguson documented in his own research into maternal death in the rural South during the 1940’s. Dr. Brewer developed the practice of asking women on the toxemia wards what they were eating. Finding that their diets indeed were typically of poor quality or wholly inadequate he started counseling women on what they should be eating, using guidelines from the U. S. Department of Agriculture as the basis for his recommendations. Dr. Brewer reasoned that by intervening early in pregnancy and changing the patients’ dietary intake before they became ill to that of a well-balanced, adequate protein diet, toxemia could be eliminated, and prematurity reduced to 2% in this extremely high risk population.
In 1958, Dr. Brewer completed a residency in obstetrics and gynecology at the University of Miami Medical School where he was also a research fellow at the Howard Hughes Medical Institute, studying the formation of collagen in the uterus during pregnancy, a process that is directly linked to efficiency of labor.
Subsequently, he was an instructor in the Department of OB/GYN at University of California at San Francisco Medical School, a position he left to develop a prenatal nutrition program as part of the public prenatal clinics in the Contra Costa County, CA Medical Services in the East Bay area of San Francisco. Dr. Brewer’s special attention was given to the problem of toxemia of pregnancy, which is also referred to today as “PIH” or “pregnancy induced hypertension” (but which he defined more precisely as metabolic toxemia of late pregnancy, also known as pre-eclampsia/eclampsia or “HELLP syndrome”). Controversy about management of this disorder has affected the nutritional advice and maternity care given to pregnant women for more than a century and continues to do so today. Dr. Brewer’s work focused on specific diagnostic pathways (clinical protocols) to insure that women are not misdiagnosed with this problem. He conducted this work for 13 years and his results were published in the Journal of Reproductive Medicine.
A 1973 film, “Nutrition in Pregnancy” depicted Dr. Brewer’s nutrition counseling technique developed for the Contra Costa Nutrition Education and Toxemia Prevention Project, known as the “brown bag lectures”, which he gave on hundreds of occasions at conferences around the world. It is distributed by Academy Communications of Sherman Oaks, California (The Bradley Method®) for which Dr. Brewer was an advisor for 30 years.
For 15 years he was medical director of SPUN (Society for the Protection of the Unborn through Nutrition), a non-profit organization that was based in Chicago that spearheaded a ten-year campaign that was ultimately successful to have the FDA disapprove the use of diuretics as a routine feature of prenatal care in the United States, developed materials for pregnancy nutrition education, and provided direct counseling about maternal nutrition to pregnant women in prenatal clinics and by mail. These activities took place during a period in prenatal care in which the weight gain of pregnant women was rigidly restricted and low-calorie, low-salt diets and diuretics were promoted by every major pharmaceutical company and upheld by professional obstetrical societies as a standard feature of prenatal care. Dr. Brewer’s activist stance on this issue set him apart from his obstetrical colleagues.
Two other organizations based on the SPUN model, the Pre-Eclamptic Toxemia Society, a registered charity in Great Britain, and AG Gestose-Frauen in Issum, Germany, were established in the 1980s and continue to the present time.
In recent years Dr. Brewer resided in Middlebury, VT where he continued to staff a pregnancy hotline, a direct successor to SPUNs work with pregnant women, their families, and their care givers.
Dr. Brewer took the position that failure to maintain a diet adequate for pregnancy is a matter of clinical significance and a matter that should be addressed by the prenatal caregiver at every visit: In other words, inadequate prenatal nutrition has predictable obstetrical and neonatal consequences that matter for mother and baby. Therefore, thorough and purposeful consideration of the mother’s nutrition, visit-by-visit, should be an essential feature of routine prenatal care. From contact with thousands of pregnant women each year via the hotline service and through his BlueRibbonBaby.org website, Dr. Brewer concluded that the effective standard of care he championed is still not being met in the vast majority of prenatal encounters taking place today, regardless of the mother’s race, socioeconomic status, or pregnancy risk status. Dr. Brewer’s work is to be continued by The Brewer InstituteTM, a privately funded organization that will begin operations in 2006.
This year Dr. Brewer had been working with Gail Sforza Krebs on a new book, an anthology of the critical research papers published in the field of applied nutrition in pregnancy and the prevention of common pregnancy complications. The title is: Clinical Nutrition in Pregnancy: The Classic Papers.
Survivors include his former wives, Nancy Brewer of Capitola, California and Ms. Krebs of Port Jervis, New York; his children, Eric Brewer of Hyattsville, MD, Laurie Brewer of Capitola, Claire Lohmann of Denver, Colorado, Daniel Hayes of Sacramento, California, Bruce Brewer of Oregon City , Oregon, Cornelia Brewer of Burlington, Vermont, Thomas Brewer of Portsmouth, New Hampshire, and former step-children, Marisa Bellingrath of Albany, New York, Ginevra Blumenfeld of Stamford, Connecticut, Elizabetta Krebs of Gettysburg, PA and Francesca Krebs of Canton, New York; a son-in-law, Willard Chastain of Vienna, Virginia; a cousin, Gerald Harrington of Tampa, Florida; 11 grandchildren, and a lifelong friend, Norman Kittrell of Sugar Land, Texas. Dr. Brewer was predeceased by two daughters, Linda Chastain of Starksboro, Vermont and Lisa Brewer of San Francisco, California and his second wife, Susan Hayes of Richmond, California.
Private interment at Arlington National Cemetery will be held at the convenience of the family. A series of appreciations for Dr. Brewer’s life and work will be held in 2006 in conjunction with the annual national conferences of the many maternal and child health organizations to which he consulted and served as an advisor.