Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Hofmeyr, G Justus; Lawrie, Theresa A; Atallah, Álvaro Nagib; Torloni, Maria Regina

doi:10.1002/14651858.cd001059.pub5

Cited by 209 publications

(209 citation statements)

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“…Across all comparisons, micronutrient and vitamin supplementation had little to no effect on mortality outcomes (maternal, neonatal, perinatal, and infant mortality), which is consistent with other systematic reviews [19,31,32,34,35,[37][38][39][40][41]. However, these findings differ from those reported in the meta-analysis of six RCTs upon which the WHO based their 2016 antenatal care guidelines [23].…”

Section: Discussionsupporting

confidence: 80%

“…Other similarities and differences were observed between this review and other systematic reviews for certain outcomes following maternal supplementation with zinc, vitamin A, vitamin D, and calcium [19,39,41,120]. Compared to a recent review by Ota et al (2015) which showed reduction in low birthweight babies and preterm births with zinc supplementation, this review showed minimal to no effect on the same outcomes [19].…”

Section: Discussionsupporting

confidence: 43%

“…Further, Roth et al (2017) showed a significant reduction in the risk of SGA infants, while this review showed no significant effect; the recent Cochrane review update by Palacios et al (2019) did not evaluate this outcome [39,120]. Lastly, similarities were noted between this review and a recent Cochrane review by Hofmeyr et al (2018) which examined calcium supplementation and possibly improved rates of pre-eclampsia/eclampsia among mothers [41]. This review indicated little to no improvement in low birthweight as a result of calcium supplementation compared to placebo; however, a recent systematic review found a 15% reduction in the risk of low birthweight infants [41].…”

Section: Discussionmentioning

confidence: 52%

“…Several existing systematic reviews-many of which include trials conducted in LMICs-have examined the impact of single and multiple micronutrient supplementation interventions in pregnancy [18,19,[31][32][33][34][35][36][37][38][39][40][41][42][43]. However, among the reported results, significant heterogeneity exists; this has not yet been explained by subgroup analysis.…”

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%

See 3 more Smart Citations

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

2020

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Almost two billion people are deficient in key vitamins and minerals, mostly women and children in low- and middle-income countries (LMICs). Deficiencies worsen during pregnancy due to increased energy and nutritional demands, causing adverse outcomes in mother and child, but could be mitigated by interventions like micronutrient supplementation. To our knowledge, this is the first systematic review that aimed to compile evidence from both efficacy and effectiveness trials, evaluating different supplementation interventions on maternal, birth, child health, and developmental outcomes. We evaluated randomized controlled trials and quasi-experimental studies published since 1995 in peer-reviewed and grey literature that assessed the effects of calcium, vitamin A, iron, vitamin D, and zinc supplementation compared to placebo/no treatment; iron-folic (IFA) supplementation compared to folic acid only; multiple micronutrient (MMN) supplementation compared to IFA; and lipid-based nutrient supplementation (LNS) compared to MMN supplementation. Seventy-two studies, which collectively involved 314 papers (451,723 women), were included. Meta-analyses showed improvement in several key birth outcomes, such as preterm birth, small-for-gestational age (SGA) and low birthweight with MMN supplementation, compared to IFA. MMN also improved child outcomes, including diarrhea incidence and retinol concentration, which are findings not previously reported. Across all comparisons, micronutrient supplementation had little to no effect on mortality (maternal, neonatal, perinatal, and infant) outcomes, which is consistent with other systematic reviews. IFA supplementation showed notable improvement in maternal anemia and the reduction in low birthweight, whereas LNS supplementation had no apparent effect on outcomes; further research that compares LNS and MMN supplementation could help understand differences with these commodities. For single micronutrient supplementation, improvements were noted in only a few outcomes, mainly pre-eclampsia/eclampsia (calcium), maternal anemia (iron), preterm births (vitamin D), and maternal serum zinc concentration (zinc). These findings highlight that micronutrient-specific supplementation should be tailored to specific groups or needs for maximum benefit. In addition, they further contribute to the ongoing discourse of choosing antenatal MMN over IFA as the standard of care in LMICs.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 43%

Section: Discussionmentioning

confidence: 52%

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

2020

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“…A retrospective study involving 11,387 pregnant women showed that daily supplementation of 500 mg of oral calcium for more than 6 months during pregnancy is associated with a 45% reduction in the risk of developing hypertension [Relative Risk (RR) = 0.55, 95%CI: 0.33; 0.93] [10]. A meta-analysis by the Cochrane Collaboration showed that calcium supplementation compared to placebo decreased the overall risk of pre-eclampsia in pregnancy (n = 15,730 women; RR = 0.45, 95%CI: 0.31; 0.65), with an even greater reduction in women clinically diagnosed at high risk (n = 587 women; RR = 0.22, 95%CI: 0.12; 0.42) [11]. Similar results were confirmed in a more recent meta-analysis of 27 clinical studies, involving a total of 28492 pregnant women (RR = 0.51, 95%CI: 0.40; 0.64) [12].…”

Section: Calciummentioning

confidence: 99%

Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

Fogacci

Cicero

2020

Nutrients

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The aim of the present critical review is to summarize the available clinical evidence supporting the use of some dietary supplements that have been shown to lower blood pressure in hypertensive pregnant women. A systematic search strategy was carried out to identify trials in MEDLINE (National Library of Medicine, Bethesda, Maryland, MD, USA; January 1980 to September 2019) and the Cochrane Register of Controlled Trials (The Cochrane Collaboration, Oxford, UK). The terms ‘nutraceuticals’, ‘dietary supplements’, ‘pregnancy’, ‘pre-eclampsia’, ‘clinical trial’, and ‘human’ were incorporated into an electronic search strategy. The references of the identified studies and review articles were reviewed to look for additional studies of interest. We preferably selected papers that reported recent comprehensive reviews or meta-analysis, or original clinical trials of substances with blood pressure-lowering or vascular protective effect in pregnancy. There is a relative body of evidence that supports the use of calcium, vitamin D, folic acid, and resveratrol in preventing the development of hypertensive disorders in pregnancy, and evidence supporting drug treatment too. Further clinical research is advisable to identify the dosage and timing of the supplementation, the group of women that might benefit the most from this approach, and the nutraceuticals with the best cost-effectiveness and risk-benefit ratio for widespread use in clinical practice.

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Antiplatelet agents for preventing pre-eclampsia and its complications

Duley

Meher

Hunter

et al. 2019

Cochrane Database of Systematic Reviews

205

210

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Aspirin in the prevention of pre-eclampsia in high-risk women* Sir, We thank Dr Thornton for his interest in our article 'Aspirin in the prevention of pre-eclampsia in high-risk women' published in the January 2013 issue of BJOG. 1 He raises four points we would like to respond to: the strength of effect; sample size; exclusion of participants from the main analysis; and trial registration.Dr Thornton concludes the commentary by writing that the effect of aspirin we reported in the meta-analysis for women who also have abnormal uterine artery Doppler waveforms at 14 weeks of gestation differs little from its effect in other high-risk groups. We have difficulty in agreeing with this; in our opinion the risk ratio in our meta-analysis (RR 0.55; 95% CI 0.37-0.83) differs from those reported by the Cochrane review. 2,3 The differences are even better encapsulated by comparing the numbers needed to treat (NNTs). In our meta-analysis, the substantial reduction in risk together with the high initial risk (36%) resulted in an NNT of six for preventing preeclampsia, whereas the Cochrane review reported an NNT for pre-eclampsia of 19 for women at high risk (20% risk) and 119 for women at moderate risk (6%), and concluded that 'further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose'. The PARIS meta-analysis reported a 10% reduction and an NNT of 56 for women at high risk (18% risk) and 167 for women at moderate risk (6%).In other respects our study represents both the strengths and weaknesses of clinician-initiated trials. With limited funding, from non-commercial sources only, the participating clinicians in ten centres were able to screen 947 women whose history indicated an increased risk of pre-eclampsia, to find those whose uterine artery flow indicates a particularly high risk. As we discuss in the article, in hindsight the criterion chosen was too strict, and only 152 women could be randomised. Although Dr Thornton is correct in stating that 31 of these women discontinued the treatment for various reasons and were excluded from the main analysis, he seems to overlook our description of the intention-to-treat analysis of all randomised women (except those who had a miscarriage), which gave a similar result. We do agree about the shortcomings of the information included in the ISRCTN registration (www.controlled-trials.com/ISRCTN140 30412/), submitted by one member of the study team. For example, variables that were eventually listed in the outcomes section include predictor variables such as biochemical measurements during pregnancy. It should also be noted that the planned number of participants stated on the ISRCTN website, of 1000 women, refers to the women to be screened by Doppler ultrasound, and not those to be eventually randomised, as Dr Thornton stated in his commentary.In our conclusion we echoed the words of the Cochrane review that 'further information is required to assess which women are most likely to benefit', and proposed that...

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Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 209 publications

References 115 publications

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Vitamin and Mineral Supplementation During Pregnancy on Maternal, Birth, Child Health and Development Outcomes in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Nutraceuticals and Hypertensive Disorders in Pregnancy: The Available Clinical Evidence

Antiplatelet agents for preventing pre-eclampsia and its complications

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