Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Hofmeyr, G Justus; Atallah, AN; Duley, Lelia

doi:10.1002/14651858.cd001059

Cited by 112 publications

(141 citation statements)

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“…Twelve trials were included (CPEP 1997, 26 WHO 2006, 28 Belizan et al1991, 35 Villar et al 1987, 16 Lopez-Jaramillo et al1989, 36 Villar, Repke 1990, 37 Lopez-Jaramillo et al 1990, 38 Sanchez-Ramos et al 1994, 39 Purwar et al 1996, 40 Lopez-Jaramillo et al 1997, 41 Crowther et al 1999, 42 and Niromanesh et al 2001 43 ), with a total of 15 528 women ( Table 1). Twenty-four studies were excluded (see Cochrane review 29 for references). The reasons for exclusion were: allocation to treatment group was not randomised (seven studies), there were no relevant outcome data (six studies), the interventions were not at least 1 g/day calcium compared with placebo (four studies), information about the study methods was unclear or inadequate (two studies), women recruited for treatment rather than prevention of hypertensive disorders of pregnancy (two studies), more than 20% of participants were excluded from the analysis (one study), the trial appeared to have been cancelled (one study), and the paper was a comment rather than a trial report (one study).…”

Section: Resultsmentioning

confidence: 99%

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Dietary calcium supplementation for prevention of pre‐eclampsia and related problems: a systematic review and commentary

Hofmeyr

Duley

Atallah

2007

BJOG

Self Cite

188

137

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Background Calcium supplementation during pregnancy may reduce the risk of hypertensive disorders of pregnancy. Search strategy We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Central Register of Controlled Trials (March 2006).Selection criteria Randomised trials comparing at least 1 g of calcium daily during pregnancy with placebo. Eligibility and trial quality were assessed.Data collection and analysis Data were extracted and analysed using Review Manager software.Main results Twelve studies (15 528 women) were included, all of good quality. Most women were at low risk and had low dietary calcium. High blood pressure was reduced with calcium supplementation rather than placebo (11 trials, 14 946 women: relative risk [RR] random effects model 0.70; 95% CI 0.57-0.86), as was pre-eclampsia (12 trials, 15 206 women: RR 0.48; 95% CI 0.33-0.69). The effect was greatest for women at high risk (five trials, 587 women: RR 0.22; 95% CI 0.12-0.42) and for those with low baseline calcium intake (seven trials, 10 154 women: RR 0.36; 95% CI 0.18-0.70). There was heterogeneity, with less effect in the larger trials. The composite outcome maternal death or serious morbidity was reduced (four trials, 9732 women: RR 0.80; 95% CI 0.65-0.97). The syndrome of haemolysis, elevated liver enzymes and low platelets was increased (two trials, 12 901 women: RR 2.67; 95% CI 1.05-6.82). There was no overall effect on the risk of preterm birth or stillbirth or death before discharge from hospital.Conclusions Calcium supplementation appears to reduce the risk of pre-eclampsia and to reduce the rare occurrence of the composite outcome 'maternal death or serious morbidity'. There were no other clear benefits or harms.Commentary We present the hypothesis that adequate dietary calcium before and in early pregnancy may be needed to prevent the underlying pathology responsible for pre-eclampsia. We suggest that the research agenda be redirected towards calcium supplementation at a community level.

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Section: Resultsmentioning

confidence: 99%

“…28 This paper summarises all the available evidence. It is based on a Cochrane review, 29 which is a regularly updated electronic publication. The objective of this review was to assess the effect of calcium supplementation during pregnancy on the risk of high blood pressure and related maternal and fetal/neonatal adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Dietary calcium supplementation for prevention of pre‐eclampsia and related problems: a systematic review and commentary

Hofmeyr

Duley

Atallah

2007

BJOG

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188

137

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“…(54) Identification and early treatment of syphilis is another strategy used to reduce stillbirth-related infections. (55) Logistical issues, such as the complexity of tests, maintaining supplies and low follow-up remain challenges to effective screening and treatment in many regions. (56)…”

Section: Strategies To Reduce Stillbirthmentioning

confidence: 99%

Stillbirth in developing countries: a review of causes, risk factors and prevention strategies

McClure

Saleem

Pasha

et al. 2009

The Journal of Maternal-Fetal & Neonatal Medicine

200

190

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In reviewing the research on stillbirth in developing countries, it becomes clear that because almost half of the deliveries in these settings occur at home, under-reporting of stillbirths is a significant problem, and reliable data about rates and causes are unavailable in some areas of the world. Nevertheless, of the estimated 3 million stillbirths which occur yearly, the vast majority in developing countries, with rates in many developing countries ten-fold higher than elsewhere. Classification systems have been adapted for developing countries; however, there is not a standard international system, nor is there agreement about stillbirth definitions making comparisons of cause of stillbirth over time or between sites problematic. From available data, prolonged and obstructed labor, and various infections all without adequate treatment, appear to account for the majority of stillbirths in developing countries. Strategies that have effectively reduced stillbirth in developed countries have had mixed results in developing countries or have not yet been tested; however, identification and treatment of infections such as syphilis has been shown effective in reducing stillbirth risk, while strategies to improve obstetric care have not been widely evaluated. Despite the large number of stillbirths worldwide, the topic of stillbirths in developing countries has received very little research, programmatic or policy attention. Better access to appropriate obstetric care, especially during labor, should reduce developing country stillbirth rates dramatically.

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“…While Ca ++ supplementation seems not to be efficacious in hypertensive subjects, it appears to be particularly useful in pregnant women. A meta-analysis of the Cochrane Collaboration, involving 13 RCTs and more than 15 000 women, supports its use during pregnancy as it appears approximately to halve the risk of pre-eclampsia, to reduce the risk of preterm birth and to reduce the rare occurrence of the composite outcome of death or serious morbidity, without evidence of any relevant side effects [50].…”

Section: Potassium Magnesium and Other Mineralsmentioning

confidence: 99%

Nutraceuticals with a clinically detectable blood pressure‐lowering effect: a review of available randomized clinical trials and their meta‐analyses

Borghi

Cicero

2016

Brit J Clinical Pharma

105

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AIMSThe aim of the present study was to review and comment on the available evidence on nutraceuticals with a clinically demonstrable blood pressure (BP)-lowering effect. METHODSWe reviewed studies published in the English language from 1990 to 2015 on dietary supplements or nutraceuticals claiming to show an effect on human BP. An initial list of possibly effective agents and studies was obtained from the online reference, the Natural Medicine Comprehensive Database. Using PubMed, we searched agents identified from this list using the MeSH terms 'hypertension', 'blood pressure', 'dietary supplement' and 'nutraceuticals', alone and in combination. We then focused our attention on meta-analyses and randomized clinical trials. RESULTSBeyond the well-known effects on BP of the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, a large number of studies have investigated the possible BP-lowering effect of different dietary supplements and nutraceuticals, most of which are antioxidant agents with a high tolerability and safety profile. In particular, a relatively large body of evidence supports the use of potassium, magnesium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin and aged garlic extract. The antihypertensive effect of all these nutraceuticals seems to be dose related and the overall tolerability is good. CONCLUSIONSome nutraceuticals might have a positive impact on BP in humans. Further clinical research is needed, to identify from the available active nutraceuticals those with the best cost-effectiveness and risk-benefit ratio for widespread and long-term use in the general population with a low-added cardiovascular risk related to uncomplicated hypertension.

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Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems

Cited by 112 publications

References 42 publications

Dietary calcium supplementation for prevention of pre‐eclampsia and related problems: a systematic review and commentary

Dietary calcium supplementation for prevention of pre‐eclampsia and related problems: a systematic review and commentary

Stillbirth in developing countries: a review of causes, risk factors and prevention strategies

Nutraceuticals with a clinically detectable blood pressure‐lowering effect: a review of available randomized clinical trials and their meta‐analyses

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