Trial of Calcium to Prevent Preeclampsia (original) (raw)
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Calcium Supplementation For The Prevention Of Pregnancy Induced Hypertension/Preeclampsia
2022
Background: Pregnancy induced hypertension (PIH) and preeclampsia (PE) contribute significantly to maternal and perinatal morbidity and mortality. The role of calcium supplementation towards preventing PIH/PE however remains unclear. Objective: To assess the efficacy of calcium supplementation in prevention of PIH and PE. Materials and methods: An open label, randomized controlled trial conducted at the antenatal clinic of University of Abuja Teaching Hospital between July 2014 and June 2015. A total of 484 nulliparous women 16 weeks or less gestation and with normal blood pressures were randomly assigned to either receive 1200mg of calcium tablet daily (N=242) or not to receive calcium tablets (N=242) from 16weeks until delivery. Primary outcome measure was development of PIH or PE and secondary outcome measure was preterm birth. Results: The incidence of PIH was 7.7% among the intervention group compared to 13.7% in the control, p=0.039 and calcium supplementation reduced the risk of PIH (RR=0.56 (95% CI: 0.32-0.98)), but not PE. It also prolonged the duration of pregnancy in women who developed PIH (p=0.02). Incidence of preeclampsia was not significant, RR-0.56 (95% CI: 0.21-1.52) so also was the incidence of preterm delivery between the two groups (RR-0.65 (95% CI: 0.32-1.31)). No serious maternal side effects of treatment were recorded. Conclusion: Calcium supplementation during pregnancy reduced the risk of PIH and thus may have a role in the prevention of PIH amongst nulliparous women. Its role in the absolute prevention of PE was not demonstrated in this study.
Calcium supplementation for the prevention of pre-eclampsia
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2009
Objective: To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes. Method: A total of 524 healthy primigravidas with a blood pressure less than 140/ 90 mm Hg were randomly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery. Results: The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group (4.0% vs 12.0%; odds ratio [OR], 0.31; 95% confidence interval [CI], 0.15-0.63); the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group (P = 0.007 and P = 0.02). The risk for preterm delivery was less in the calcium (7.0%) than in the placebo (12.7%) group (OR, 0.51; 95% CI, 0.28-0.93). The mean baseline calcium intake was 313.83 ± 203.25 mg/day (range, 85.71-910.71 mg/day), which is lower than the recommended dietary intake of 1000 mg, and the 24-hour urinary calcium excretion was 130.82 ± 67.44 mg/dL (range, 40.5-387 mg/dL). Conclusion: Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances.
Annals of the New York Academy of Sciences, 2022
Most low-and middle-income countries present suboptimal intakes of calcium during pregnancy and high rates of mortality due to maternal hypertensive disorders. Calcium supplementation during pregnancy is known to reduce the risk of these disorders and associated complications, including preeclampsia, maternal morbidity, and preterm birth, and is, therefore, a recommended intervention for pregnant women in populations with low dietary calcium intake (e.g., where ≥25% of individuals in the population have intakes less than 800 mg calcium/day). However, this intervention is not widely implemented in part due to cost and logistical issues related to the large dose and burdensome dosing schedule (three to four 500-mg doses/day). WHO recommends 1.5-2 g/day but limited evidence suggests that less than 1 g/day may be sufficient and ongoing trials with low-dose calcium supplementation (500 mg/day) may point a path toward simplifying supplementation regimens. Calcium carbonate is likely to be the most cost-effective choice, and it is not necessary to counsel women to take calcium supplements separately from iron-containing supplements. In populations at highest risk for preeclampsia, a combination of calcium supplementation and food-based approaches, such as food fortification with calcium, may be required to improve calcium intakes before pregnancy and in early gestation.
Trial of calcium for preeclampsia prevention (CPEP): Rationale, design, and methods
Controlled Clinical Trials, 1996
The results of ten clinical trials suggest that supplemental calcium may prevent preeclampsia. However, methodologic problems and differences in study design limit the acceptance of the results and their relevance to other patient populations. Many of the trials were conducted in countries where, unlike the United States, the usual daily diet contained little calcium. Moreover, none of the trials has reported the outcome of systematic surveillance for urolithiasis, a potential complication of calcium supplementation. In response to the need for a thorough evaluation of the effects of calcium supplementation for the prevention of preeclampsia in the United States, the trial of Calcium CPEP Rationale, Design, and Methods
Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems
The Cochrane database of systematic reviews, 2000
BACKGROUND Calcium supplementation may prevent high blood pressure through a number of mechanisms and may help to prevent preterm labour. OBJECTIVES The objective of this review was to assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child adverse outcomes. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register and we contacted study authors. Date of last search: February 2000. SELECTION CRITERIA Randomised trials comparing at least one gram daily of calcium during pregnancy with placebo. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed. Data extraction was carried out and double entered. MAIN RESULTS Ten studies were included, all of good quality. There was a modest reduction in high blood pressure with calcium supplementation (relative risk 0.81, 95% confidence interval 0.74 to 0.89). The effect was great...
The Lancet, 2019
Background Reducing deaths from hypertensive disorders of pregnancy is a global priority. Low dietary calcium might account for the high prevalence of pre-eclampsia and eclampsia in low-income countries. Calcium supplementation in the second half of pregnancy is known to reduce the serious consequences of pre-eclampsia; however, the effect of calcium supplementation during placentation is not known. We aimed to test the hypothesis that calcium supplementation before and in early pregnancy (up to 20 weeks' gestation) prevents the development of pre-eclampsia Methods We did a multicountry, parallel arm, double-blind, randomised, placebo-controlled trial in South Africa, Zimbabwe, and Argentina. Participants with previous pre-eclampsia and eclampsia received 500 mg calcium or placebo daily from enrolment prepregnancy until 20 weeks' gestation. Participants were parous women whose most recent pregnancy had been complicated by pre-eclampsia or eclampsia and who were intending to become pregnant. All participants received unblinded calcium 1•5 g daily after 20 weeks' gestation. The allocation sequence (1:1 ratio) used computer-generated random numbers in balanced blocks of variable size. The primary outcome was pre-eclampsia, defined as gestational hypertension and proteinuria. The trial is registered with the Pan-African Clinical Trials Registry, number PACTR201105000267371. The trial closed on Oct 31, 2017. Findings Between July 12, 2011, and Sept 8, 2016, we randomly allocated 1355 women to receive calcium or placebo; 331 of 678 participants in the calcium group versus 320 of 677 in the placebo group became pregnant, and 298 of 678 versus 283 of 677 had pregnancies beyond 20 weeks' gestation. Pre-eclampsia occurred in 69 (23%) of 296 participants in the calcium group versus 82 (29%) of 283 participants in the placebo group with pregnancies beyond 20 weeks' gestation (risk ratio [RR] 0•80, 95% CI 0•61-1•06; p=0•121). For participants with compliance of more than 80% from the last visit before pregnancy to 20 weeks' gestation, the pre-eclampsia risk was 30 (21%) of 144 versus 47 (32%) of 149 (RR 0•66, CI 0•44-0•98; p=0•037). There were no serious adverse effects of calcium reported. Interpretation Calcium supplementation that commenced before pregnancy until 20 weeks' gestation, compared with placebo, did not show a significant reduction in recurrent pre-eclampsia. As the trial was powered to detect a large effect size, we cannot rule out a small to moderate effect of this intervention.
Calcium supplementation and prevention of preeclampsia: a meta-analysis
Journal of Maternal-Fetal and Neonatal Medicine, 2012
Background: Since the early 1980s, epidemiological evidence has suggested a connection between low calcium intake and preeclampsia The purpose of this meta-analysis is to summarize current evidence regarding calcium supplementation during pregnancy in predicting preeclampsia and associated maternalfetal complications. Methods: Literature revision of all RCT (random allocation of calcium versus placebo) available in MEDLINE/ PUBMED up to 2/29/2012 regarding calcium supplementation during pregnancy for preventing preeclampsia. We used the Mantel-Haenszel's Method for four subgroup of patients: Adequate calcium intake; Low calcium intake; Low risk of preeclampsia; High risk of preeclampsia. We considered p < 0.05 as significant. Results: There is no consensus in Literature about: (1) the efficacy of calcium supplementation in the prevention of preeclampsia, (2) other/adverse/long-term effects of calcium supplementation in pregnancy. Conclusions: Preeclampsia is likely to be a multifactorial disease. However, inadequate calcium intake represents a factor associated with an increased incidence of hypertensive disease. The results of our meta-analysis demonstrate that the additional intake of calcium during pregnancy is an effective measure to reduce the incidence of preeclampsia, especially in populations at high risk of preeclampsia due to ethnicity, gender, age, high BMI and in those with low baseline calcium intake.
Is there an association between calcium level and preeclampsia in pregnant women? A systemic review
2020
Background: Pregnancy-induced hypertension is a diagnosis used to describe a wide spectrum of patients who may have only mild elevations in blood pressure or severe hypertension with various organ dysfunctions. Preeclampsia is a form of pregnancy-induced hypertension which is defined as the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. Preeclampsia has been identified as the leading reason for maternal admission to the intensive care unit in the puerperal period. Trends of pregnancy-induced hypertension in low-and middle-income countries were increasing. The WHO recommend calcium supplementation as part of the antenatal care for the prevention of preeclampsia in pregnant women, particularly among those population where calcium intake low and at higher risk of developing hypertension. Methods: The data were searched electronically From Pub Med, Google Scholar, Cochrane database reviews and Google. Case-control, retrospective...
Comparison of High Dose and Low Dose Calcium Intake to Prevent Preeclampsia and Eclampsia
https://www.ijrrjournal.com/IJRR\_Vol.5\_Issue.8\_Aug2018/Abstract\_IJRR0020.html, 2018
Preeclampsia is a condition, which is the combination of raised blood pressure and proteinuria levels, occurs after 20 weeks of gestation, which leads to maternal complications (eclampsia) and fetal complications. According to worldwide epidemiology the incidence of preeclampsia is reported to be 8-10% among pregnant women. Current WHO recommendations are 1.5-2 g/day calcium supplementation for low-calcium intake pregnant women to prevent complications. The main aim of our study is to compare the high dose & low dose calcium intake to prevent preeclampsia & eclampsia. A prospective Interventional study was performed in south Indian tertiary care teaching hospital for about 6 months [August 2017-january 2018].We had recruited 60 pregnant women and were divided in to two groups: group A[low dose,500 mg, BID] and group B [high dose,500 mg, TID] based on simple randomization technique. After collection of patient data, both the groups were followed for 4 follow ups and Hb, proteinuria levels and Blood Pressure were monitored. Our study results shows that average mean Blood Pressure in low dose group was 109.33/72.66 and 110.33/76.33 and high dose was 125.00/84.33 and 104.333/69.667 before and after treatment respectively. By using SPSS Software results were analysed. By this comparison, we found extreme statistical significant difference between low dose Vs high dose calcium supplementation. Low dose calcium group has poor statistical significance [systole(p<0.586) ,diastole(0.125)],where as high dose calcium group shows extreme statistical significance [systole(p<0.0001),diastole(p<0.0002)]. Finally, we may conclude that high dose calcium supplementation is preferable than that of the low dose calcium in preventing the Preeclampsia and Eclampsia.