José M Belizán

• Scientist
• Institute for Clinical Effectiveness and Health Policy

Background Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added t...

Objective:to simulate the impact on calcium intake- effectiveness and safety- of fortifying wheat flour with 200, 400 and 500 mg of calcium per 100 g of flour. Design:secondary analysis of cross-sectional data collected through repeated 24-hour dietary recalls using IOWA the Intake Modelling, Assessment and Planning Program. Setting:urban cities in...

Background: Obesity is a major health problem worldwide as it can lead to high blood pressure, heart disease, stroke, diabetes, and insulin resistance. The prevalence of overweight and obesity is increasing worldwide across different age groups. There is evidence of an inverse relationship between calcium intake and body weight. The clinical relev...

Background Calcium intake is below recommendations in several parts of the world. Improving calcium intake has benefits not only for bone health but also helps to prevent pregnancy hypertension disorders. Calcium concentration of tap water is usually low The aim of the present study was to determine the maximum amount of calcium that can be added t...

I am a medical doctor who treats women during pregnancy and childbirth. I aspire to give them the best possible care, based on scientific evidence. In this article, I will explain how we do scientific experiments in medicine and how we use the results to improve healthcare. I will then tell you about an important relationship I found between calciu...

( BJOG . 2022;129:1833–1843) Pre-eclampsia effects 2% to 5% of pregnancies. Health disparities are apparent with 99% of maternal pre-eclamptic deaths occurring in low- and middle-income countries (total deaths are between 30,000 and over 500,000 annually). A daily dose of aspirin (150 mg) has been shown to prevent 60% of preterm (<37 wk of gestatio...

Adequate calcium intake is essential for health, especially for infants, children, adolescents, and women, yet is difficult to achieve with local foods in many low‐ and middle‐income countries. Previous analysis found it was not always possible to identify food‐based recommendations (FBRs) that reached the calcium population recommended intake (PRI...

Globally, dietary intake of calcium is often insufficient, and it is unclear if adequacy could be achieved by promoting calcium‐rich local foods. This study used linear programming and household consumption data from Uganda, Bangladesh, and Guatemala to assess whether local foods could meet calcium population reference intakes (Ca PRIs). The most p...

Objective: To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. Design: Population-based, multi-country analysis. Setting: National data systems in 23 middle- and high-income countries. Population: Liveborn infants. Methods: Country teams with high-quality data were invited to be...

Small newborns are vulnerable to mortality and lifelong loss of human capital. Measures of vulnerability previously focused on liveborn low-birthweight (LBW) babies, yet LBW reduction targets are off-track. There are two pathways to LBW, preterm birth and fetal growth restriction (FGR), with the FGR pathway resulting in the baby being small for ges...

The risk of inadequate calcium intake is a worldwide problem. We performed a simulation exercise on the impact, effectiveness, and safety of increasing calcium levels in drinking water using the 2019 Health and Nutrition National Survey of Argentina, which provides water intake and water sources data at the individual level. We simulated the distri...

Objective: The purpose of this study was to estimate the global distribution and financial cost associated with the inequities present in the use of cesarean sections (CS) worldwide. Study design: We used the latest estimates on CS rates published by WHO and we adopted 10-15 % as the range of CS rates that are considered optimal for adequate use...

Dietary calcium intake is low in many countries, particularly in low‐ and middle‐income countries (LMICs). Water is often overlooked as a source of dietary calcium despite it being universally consumed and providing good calcium bioavailability. Our objective was to assess water distribution systems in LMICs and to develop a formula to simulate the...

OBJETIVO: Evaluar las tasas de cesárea en la finalización de embarazos registrados en el sector privado de la Obra Social de la provincia de Buenos Aires (Instituto de Obra Médico Asistencial) entre los años 2017 a 2021. MATERIALES Y MÉTODOS: Estudio analítico y descriptivo de cesáreas registradas en el Sistema de Modulación Centro Único de Audito...

Purpose: Preclinical data suggest that antiprogestins inhibit the growth of luminal breast carcinomas that express higher levels of progesterone receptor isoform A (PRA) than isoform B (PRB). Thus, we designed a pre-surgical window of opportunity trial to determine the therapeutic effects of mifepristone in patients with breast cancer based on the...

Synopsis There is a sustained annual increase of overweight and obesity in pregnant women in Uruguay with almost 45% incidence of overweight or obesity in 2019.

Background: Calcium supplementation reduces the risk of pre-eclampsia, but questions remain about the dosage to prescribe and who would benefit most. Objective: To evaluate the effectiveness of high- (≥1 g/d) and low-dose (<1 g/d) calcium for pre-eclampsia prevention, and according to baseline dietary calcium, pre-eclampsia risk, and co-interven...

Calcium Supplementation in Pregnancy Trial This Patient Platform recalls the experience of four pregnant women who were enrolled in a clinical trial in Argentina 35 years ago, as described to narrator and translator, Dr. José M. Belizán. None had enrolled in a clinical trial before, but all four women found it rewarding. The trial examined the role...

Low calcium intake and its impact on maternal and child health are a major concern in low‐ and middle‐income countries. Given the low calcium in diet, as well as the low adherence and acceptability of calcium pills in those settings, the discussion about policies to increase calcium intake has moved toward staple food fortification strategies. Neve...

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, a...

Background Adolescence is a critical period of maturation when nutrient needs are high, especially among adolescents entering pregnancy. Using individual-level data from 140,000 participants, we examined socioeconomic, nutrition, and pregnancy and birth outcomes for adolescent mothers (10–19 years) compared to older mothers in low and middle-income...

Purpose This study explores postpartum depression (PPD) in women who screened negative in mid-pregnancy to assess the impact of the peripartum period on the development of depressive symptoms. Methods A prospective cohort study was carried out in two facilities in Argentina. The Edinburgh postnatal depression scale (EPDS) scale was applied to preg...

Calcium intake remains inadequate in many low‐ and middle‐income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food‐based approaches to improve calcium consumption an...

Background: Hypertension is a major public health problem that increases the risk of cardiovascular and kidney diseases. Several studies have shown an inverse association between calcium intake and blood pressure, as small reductions in blood pressure have been shown to produce rapid reductions in vascular disease risk even in individuals with nor...

Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to dr...

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,...

This article challenges the “tyranny of P-value” and promote more valuable and applicable interpretations of the results of research on health care delivery. We provide here solid arguments to retire statistical significance as the unique way to interpret results, after presenting the current state of the debate inside the scientific community. Ins...

Maternal mortality (MM) reflects one of the most striking global health inequalities. Global figures of MM fell significantly from 1990 to 2017. The reduction was largely due to a 70% fall in haemorrhages, and a limited (18.2%) improvement in hypertensive disorders of pregnancy (HDP). If this trend continues, by 2021 HDP will be the main cause of g...

Background: Food fortification is an effective strategy that has been recommended for improving population calcium inadequate intakes. Increasing calcium concentration of water has been proposed as a possible strategy to improve calcium intake. The objective of this study was to determine the sensory threshold of different calcium salts added to dr...

Background: Hypertension is a major public health problem that increases the risk of cardiovascular and kidney diseases. Several studies have shown an inverse association between calcium intake and blood pressure, as small reductions in blood pressure have been shown to produce rapid reductions in vascular disease risk even in individuals with nor...

Background Low dietary calcium is associated with the hypertensive disorders of pregnancy, and evidence suggests that the risks associated with pre-eclampsia are reduced by calcium supplementation. In the general (non-pregnant) population, low dietary calcium intake is associated with hypertension with inconsistent evidence that calcium supplementa...

The objectives of this cross-sectional study were to estimate the prevalence of depressive symptoms and affective disorders during pregnancy in a maternity hospital in Argentina and to explore potential risk factors. Symptoms of depression were measured with the Edinburgh Postnatal Depression Scale (EPDS), and the Mini International Neuropsychiatri...

Calcium supplementation and fortification are strategies widely used to prevent adverse outcome in population with low-calcium intake which is highly frequent in low-income settings. We aimed to determine the effectiveness and cost-effectiveness of calcium fortified foods on calcium intake and related health, or economic outcomes. We performed a sy...

Objectives To evaluate the comparative clinical effectiveness and safety of dexamethasone versus betamethasone for preterm birth. Data sources The sources searched were MEDLINE, EMBASE, Cochrane Library, LILACS, Clinical Trials.gov, International Clinical Trials Registry Platform without language restrictions until October 2019, along with referen...

Calcium intake is low in many countries, especially in low‐income countries. Our objective was to perform a simulation exercise on the impact, effectiveness, and safety of a flour fortification strategy using the Intake Modelling, Assessment, and Planning Program. Modeling of calcium fortification scenarios was performed with available dietary inta...

Introduction Though interest is growing for trials comparing planned delivery mode (vaginal delivery [VD]; cesarean section [CS]) in low-risk nulliparous women, appropriate study design is unclear. Our objective was to assess feasibility of three designs (preference trial [PCT], randomized controlled trial [RCT], partially randomized patient prefer...

Reproductive Health has an interest in reproductive health status globally, but it has particular interest in phenomena affecting disadvantaged populations. This is the reason why this journal encourages submissions from researchers conducting studies in low- and middle- income countries (LMICs). Authorship usually reflects research leadership [1]....

Objective: To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations. Results: Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, Na...

Introduction Obesity is a major and challenging public health problem. The aim of this substudy is to evaluate the effect of calcium supplementation on body weight in women recruited in the Calcium and Preeclampsia trial. Methods Women were recruited before pregnancy and randomized to receive a calcium supplement containing 500 mg of elemental cal...

Background: Retrospective observational studies suggest that transmission of Trypanosoma cruzi does not occur in treated women when pregnant later in life. The level of parasitemia is a known risk factor for congenital transmission. Benznidazole (BZN) is the drug of choice for preconceptional treatment to reduce parasitic load. The fear of treatme...

An amendment to this paper has been published and can be accessed via the original article.

Objective To simulate the impact – effectiveness and safety – of water fortification with different concentrations of Ca using the Intake Modelling, Assessment and Planning Program. Design This is a secondary analysis of national or sub-national dietary intake databases. Setting and Participants Uganda, Lao People’s Democratic Republic (PDR), Ban...

CONICET's Translational Health Research Network is coordinating efforts to advance in translational medicine. Health researchers initiate and focus their research with the aim of improving the health and quality of life of the population. An efficient research system should address health problems relevant to the population resulting in interventio...

Background Retrospective observational studies suggest that transmission of Trypanosoma cruzi does not occur in treated women when pregnant later in life. The level of parasitemia is a known risk factor for congenital transmission. Benznidazole (BZN) is the drug of choice for preconceptional treatment to reduce parasitic load. The fear of treatment...

Daily calcium intake is well below current recommendations in most low- and middle-income countries (LMICs). Calcium intake is usually related to bone health, however an adequate calcium intake has also been shown to reduce hypertensive disorders of pregnancy, lower blood pressure and cholesterol values, and to prevent recurrent colorectal adenomas...

Background & aims Monitoring gestational weight gain (GWG) is relevant for perinatal outcomes, especially in the context of increasing obesity and overweight in the female population. This study analyses the association between GWG in Brazilian women, according to different body mass index (BMI) categories, and different outcomes, including hyperte...

( Lancet . 2019;393:330–339) Approximately 14% of maternal deaths worldwide are directly caused by hypertensive disorders of pregnancy, including preeclampsia. On the basis of surprisingly low rates of preeclampsia in low-income countries with high-calcium diets, it has been suggested that calcium deficiency may be linked to preeclampsia and severa...

There are striking inequities in calcium intake between rich and poor populations. Appropriate calcium intake has shown many health benefits, such as reduction of hypertensive disorders of pregnancy, lower blood pressure particularly among young people, prevention of osteoporosis and colorectal adenomas, lower cholesterol values, and lower blood pr...

( BJOG . 2018;125:1294–1302) There has been an international rise in cesarean section (CS) rates, sometimes attributed to an increase in nonmedically indicated CS, including CS on maternal request (CSMR). Some evidence has suggested that women prefer vaginal delivery, however, and provider’s attitudes may have a greater effect on this trend. This s...

(Abstracted from Lancet 2019;393:330–339) Hypertension complicates 5% of all pregnancies and 11% of first pregnancies, and half of these cases are associated with preeclampsia (gestational hypertension plus proteinuria). Hypertensive disorders of pregnancy are the direct cause of death of approximately 30,000 women annually, or approximately 14% of...

There is increasing epidemiologic and animal evidence that a low calcium diet increases blood pressure. The aim of this review is to compile the information on the link between low calcium intake and blood pressure. Calcium intake may regulate blood pressure by modifying intracellular calcium in vascular smooth muscle cells and by varying vascular...

Appendix S1. Search strategy.

Appendix S2. Risk of bias and quality assessment prompts for the included studies.

Figure S1. Risk of bias graph: author's judgment about each risk of bias item. Figure S2. Risk of bias summary. Figure S3. Means and 95% CIs for regions according to United Nations classification. Figure S4. Means and 95% CIs for trimester in low‐ and middle‐income countries and in high‐income countries. Figure S5. Means and 95% CIs for 35 incl...

Table S1. Reported daily calcium intakes from HICs. Table S2. Reported daily calcium intakes from LMICs. Table S3. Summary of risk of bias. Table S4. Studies reporting percentage of the population with inadequate intakes as percentages below the estimated average intake (EAR) order.

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 calci...

Background Maternal nutritional status before and during pregnancy is an important contributor to pregnancy outcomes and early child health. The aim of this study was to describe the preconceptional nutritional status and dietary intake during pregnancy in high-risk women from South Africa and Zimbabwe. Methods This is a prospective observational s...

Low birthweight (LBW) infants constitute a major public health concern in developed and developing countries. LBW infants includes those that were born early (preterm births), those that were born with intrauterine growth restricted (IUGR), or a combination of both. IUGR as a result of chronic malnutrition is more prevalent in developing countries...

Background Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low‐ and middle‐income countries (LMICs) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide t...

Background In Brazilian private hospitals, caesarean section (CS) is almost universal (88%) and is integrated into the model of birth care. A quality improvement intervention, “Adequate Birth” (PPA), based on four driving components (governance, participation of women and families, reorganisation of care, and monitoring), has been implemented to he...

A growing number of low- and middle-income country (LMIC) institutions have developed and implemented formal programs to support mentorship. Although the individual-level benefits of mentorship are well established, such activities can also sustainably build institutional capacity, bridge inequities in health care, and catalyze scientific advanceme...

Objective Few data are available on cesarean delivery and operative vaginal delivery trends in low- and middle-income countries. Our objective was to analyze a prospective population-based registry including eight sites in seven low- and middle-income countries to observe trends in operative vaginal delivery versus cesarean delivery rates over time...

Objective: To assess whether the implementation of a package of activities through the joint action of three international healthcare professional associations (HCPAs) increased the use of essential interventions (EIs) for delivery and neonatal care. Methods: A noncontrolled pre-intervention versus post-intervention study was conducted from June...

The active incorporation of men in the process of childbirth is an increasingly common practice internationally. However, there are no validated instruments for Latin America. Objective: To validate an instrument to assess new fathers' experiences during childbirth in Latin America. Design: Prospective validation study. Setting: Talcahuano, C...

Background: Caesarean section prevalence is increasing in Asia and Latin America while remaining low in most African regions. Caesarean section delivery is effective for saving maternal and infant lives when they are provided for medically-indicated reasons. On the basis of ecological studies, caesarean delivery prevalence between 9% and 19% has b...

The Jawaharlal Nehru Medical College (JNMC) Women's and Children's Health Research Unit (WCHRU) of the Karnataka Lingayat Education (KLE) Academy of Higher Education and Research Deemed-to-be-University and its collaborators convened the '2nd International Conference on Maternal and Newborn Health -Translating Research Evidence to Practice' to addr...

Objective: To describe country-level stillbirth rates and their change over time in Latin America, and to measure the association of stillbirth rates with socio-economic and health coverage indicators in the region. Design: Ecological study. Setting: 20 countries of Latin America. Population or sample: Aggregated data from pregnant women wit...

Over the last several years, a new legal construct has emerged in Latin America that encompasses elements of quality of obstetric care and mistreatment of women during childbirth – both issues of global maternal health import. Termed “obstetric violence,” this legal construct refers to disrespectful and abusive treatment that women may experience f...

Introduction: The use of self-report as a strategy for collecting data of women's weight and height is broadly spread both in clinical practice and epidemiological studies. This study aimed to compare self-reported and directly measured weight and height among women of reproductive age. Material and methods: In July 2015 we searched MEDLINE, EMB...

Objective: To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. Design: Cross-sectional study. Setting: Two public and two private hospitals in Argentin...

Compared with South America, there is a lack of epidemiologic studies about the risk of congenital transmission of Trypanosoma cruzi in Central America and Mexico. It has been suggested that T. cruzi genotypes might differ by region and that congenital transmission might vary according to the parasite's genotype. Our objective was to compare T. cru...

Purpose: to estimate the prevalence of depression at 4-week postpartum using the Edinburgh postpartum Depression Scale (EPDS) in women who delivered in a public maternity hospital in Argentina. Methods: This prospective cohort study was carried out from March to August 2016 in northwest Argentina. Eligibility included delivering a singleton live...