Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems (Review)

Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 08/2010; 8(8):CD001059. DOI: 10.1002/14651858.CD001059.pub3
Source: PubMed


Evidence from randomised controlled trials shows that calcium supplements help prevent pre-eclampsia and preterm birth and lower the risk of a woman dying or having serious problems related to high blood pressure in pregnancy. This is particularly for women on low calcium diets. Pre-eclampsia is evident as high blood pressure and protein in the urine. It is a major cause of death in pregnant women and newborn babies worldwide. Preterm birth (birth before 37 weeks) is often caused by high blood pressure and is the leading cause of newborn deaths, particularly in low-income countries. The review of 24 trials found good quality evidence that calcium supplementation with high doses (at least 1 g daily) during pregnancy (13 studies involving 15,730 women) is a safe and relatively cheap way of reducing the risk of pre-eclampsia, especially in women from communities with low dietary calcium and those at increased risk of pre-eclampsia. Women receiving calcium supplements were also less likely to die or have serious problems related to pre-eclampsia. Babies were less likely to be born preterm. No adverse effects have been found but further research is needed into the ideal dosage of supplementation. Limited evidence from 10 trials (2234 women) suggested that a relatively low dose may be effective although co-interventions such as vitamin D, linoleic acid or antioxidants were given in six of the included trials. In settings of low dietary calcium where high-dose supplementation is not feasible, the option of lower dose supplements (500 to 600 mg/day) might be considered in preference to no supplementation.

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Available from: Theresa A Lawrie, Oct 27, 2014
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    • "In general terms, the development of effective strategies for the prevention of pre-eclampsia has proven exceedingly difficult [5], related in part to the uncertainty of the precise ‘cause’ of the condition [1], and its likely multifactorial and complex nature. Many interventions have been proposed and evaluated in the prevention of pre-eclampsia, although low-dose aspirin [22] and calcium supplementation [23] remain the only strategies associated with a definitive reduction in risk. The use of antiplatelet agents has been associated with a 17% reduction in the risk of pre-eclampsia, and a modest 8% and 10% reduction in both preterm birth and small for gestational age infants, respectively [22]. "
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    ABSTRACT: Pre-eclampsia is a common pregnancy related condition, which contributes significantly both to maternal and perinatal morbidity and mortality. The precise pathophysiology of pre-eclampsia is uncertain, and the development of effective preventive strategies remains elusive. Schoenaker and colleagues conducted a systematic review and meta-analysis of observational studies reporting dietary intake and dietary patterns. The findings indicated that women with a low dietary calcium intake were more likely to be diagnosed with gestational hypertension, while there was a suggestion (although not statistically significant) of a beneficial effect of a diet rich in fruits and vegetables on risk of pre-eclampsia. This is in contrast to the findings of systematic reviews and meta-analyses of randomised trials in pregnancy evaluating calcium supplementation and anti-oxidant vitamin C and E supplementation. The validity of any systematic review is reliant on both the underlying methodology and the quality of each of the included studies; the review by Schoenaker and colleagues is limited by the observational nature of the included studies. Please see related article:
    Full-text · Article · Sep 2014 · BMC Medicine
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    • "Antiplatelet agents versus none for primary prevention of pre-eclampsia in women at risk of developing pre-eclampsia [32], routine calcium supplementation in pregnancy [35], and some rest in hospital versus routine activity at home for women with raised blood pressure [39] showed a significant reduction in PTBs <37 weeks (Additional file 3: Table S1d). "
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    ABSTRACT: Several factors are associated with an increased risk of preterm birth (PTB); therefore, various interventions might have the potential to influence it. Due to the large number of interventions that address PTB, the objective of this overview is to summarise evidence from Cochrane reviews regarding the effects and safety of these different interventions. We conducted a systematic literature search in the Cochrane Database of Systematic Reviews. Included reviews should be based on randomised controlled trials comparing antenatal non-pharmacological and pharmacological interventions that directly or indirectly address PTB with placebo / no treatment or routine care in pregnant women at less than 37 completed weeks of gestation without signs of threatened preterm labour. We considered PTB at less than 37 completed weeks of gestation as the primary outcome. We included 56 Cochrane systematic reviews. Three interventions increased PTB risk significantly. Twelve interventions led to a statistically significant lower incidence of PTBs. However, this reduction was mostly observed in defined at-risk subgroups of pregnant women. The remaining antenatal interventions failed to prove a significant effect on PTB < 37 weeks, but some of them at least showed a positive effect in secondary outcomes (e.g., reduction in early PTBs). As an unintended result of this review, we identified 28 additional Cochrane reviews which intended to report on PTB < 37 weeks, but were not able to find any RCTs reporting appropriate data. The possible effects of a diverse range of interventions on PTB have been evaluated in Cochrane systematic reviews. Few interventions have been demonstrated to be effective and a small number have been found to be harmful. For around half of the interventions evaluated, the Cochrane review concluded that there was insufficient evidence to provide sound recommendations for clinical practice. No RCT evidence is available for a number of potentially relevant interventions.
    Full-text · Article · Apr 2014 · BMC Research Notes
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    • "This finding is supported by many psychological theories of behaviour, including the CSM, which feature control as a central construct. There is evidence that certain personally modifiable behaviours, including rest at home (Meher and Duley, 2006b), consumption of antioxidants (Rumbold et al., 2008) and increased calcium consumption (Hofmeyr et al., 2010) reduces the risk of preeclampsia . Given the potential for behavioural interventions to have benefits beyond pre-eclampsia risk, and the relatively small investment in research in this area to date, a priority for research into behavioural interventions to reduce pre-eclampsia and other pregnancy risks is warranted. "
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    ABSTRACT: Abstract Objective A new first-trimester universal prenatal screening test for pre-eclampsia was introduced into two UK hospitals. The aim of this study was to investigate the potential psychological benefits, harms and acceptability of providing pregnant women with formal risk information for pre-eclampsia. Design Cross-sectional interview study. Women were interviewed using a theoretically informed semi-structured schedule and transcripts were analysed thematically using Framework Analysis. Setting and participants Primigravid women receiving prenatal care at a central London National Health Service Foundation Trust found either high-risk or low-risk for pre-eclampsia. Findings 15 primigravid women who received high risk (n=10) or low risk (n=5) results of a 12-week pre-eclampsia screening test were interviewed. Two types of coping typologies were evident from the data. The first were “danger managers” who had an internal sense of control, were focused on the risk that pre-eclampsia presented to them and exhibited information seeking, positive behaviour changes, and cognitive reappraisal coping mechanisms. The second were “fear managers” who had an external sense of control, were focused on the risk that pre-eclampsia presented to the fetus, and exhibited avoidance coping mechanisms. In addition to these typologies, three universal themes of ‘medicalising the pregnancy’, ‘embracing technology’ and ‘acceptability’ emerged from the data. Key Conclusions There are potential positive and negative unintended consequences following a first-trimester screening test for pre-eclampsia. A positive consequence could be self-instigated behaviour change, whereas a negative consequence could be reduced self-monitoring of fetal movements as the pregnancy develops. Implications for practice This study indicates that women with an increased risk of pre-eclampsia would be willing to engage in efforts to reduce their risk of pre-eclampsia, and there is a potential to use this screening test as a basis for improving health more broadly.
    Full-text · Article · Apr 2014 · Midwifery
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