Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India

Kant, Shashi; Haldar, Partha; Gupta, Amit; Lohiya, Ayush

doi:10.3126/nje.v9i4.23150

Cited by 13 publications

(16 citation statements)

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“…In addition, previous reports indicated the link between low calcium and risk of PE [13][14] , which had not been confirmed by others [15] . Similarly, reduced antioxidant nutrients, such as zinc, iron, and selenium, had been reported to have a role in PE [16] , which could not be confirmed by randomized controlled trials [RCTs], revealed development of PE irrespective of supplementation by trace elements [17] .…”

Section: Introductionmentioning

confidence: 71%

“…However, Kant et al [15] questioned these findings as they revealed no association between calcium levels, dietary calcium intake or supplementation during pregnancy and prevention of PE development or reduction of adverse perinatal outcome. However, Kim et al [19] reported that, they a strong associated between reduced levels of serum calcium and zinc and risk of PE development.…”

Section: Discussionmentioning

confidence: 99%

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Selected Trace Elements in Egyptian Females with Preeclampsia

Emam¹,

Attia

2020

International Journal of Medical Arts

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Background: Evidence exist indicating that, trace elements could play a role in preeclampsia [PE]. However, controversy exist regarding the role of the value of trace elements supplementation on the pregnancy outcome. Aim of the work:To estimate serum levels of some trace elements [selenium, calcium, magnesium, iron and zinc] in females developed preeclampsia and compare them to healthy pregnant females and correlate it with pregnancy outcome.Patients and Methods: 140 females were included in each group [preeclampsia and controls]. All had been assessed clinically, and by laboratory and ultrasound investigations. In addition, serum levels of selenium, calcium, magnesium, iron and zinc, had been determined and correlated with pregnancy outcome.Results: There was statistically significant increase of all trace elements in preeclamptic when compared to control groups. There was significant increase of females with deficient zinc, iron, calcium, magnesium and selenium in PE when compared to control group [83.6%, 19.3%, 30.7%, 27.9% and 40.0% vs 22.9%, 5.7%, 4.3%, 2.9% and 5.0% respectively]. The odds ratio where higher for zinc, followed by selenium, magnesium, calcium and finally iron deficiency. In addition, zinc, iron, calcium, magnesium and selenium were inversely and significantly correlated with systolic blood pressure. Preeclampsia was associated with worse maternal-fetal outcome when compared to controls. Conclusion:Lower levels of studied trace elements are associated with development of preeclampsia and we assume that, supplementation by such elements could reduce the risk of preeclampsia. However, this assumption needs to confirmed in future trials.

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Section: Introductionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Selected Trace Elements in Egyptian Females with Preeclampsia

Emam¹,

Attia

2020

International Journal of Medical Arts

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“…In contrast to numerous systematic reviews of observational studies with vitamin D on the topic, there was one meta-analysis found for calcium, which found a significant protective effect with an OR of 0.63 (95% CI 0.41–0.97, I 2 0%, 7 studies) for high calcium intake during pregnancy (> 1600 mg/day) in comparison with insufficient intake (< 1000 mg/day) on gestational hypertension [ 15 ]. While the meta-analysis noted a consistent direction of higher calcium intake as protective [ 15 ], two subsequent cross-sectional studies from Haryana, India did not find a significant association between pre-eclampsia and hypocalcemia (serum calcium < 9 mg/day) [ 114 , 115 ]. However, the authors noted that while the majority of pregnant women had inadequate dietary calcium intakes, dietary intakes did not correspond with serum calcium concentration.…”

Section: Resultsmentioning

confidence: 99%

“…However, the authors noted that while the majority of pregnant women had inadequate dietary calcium intakes, dietary intakes did not correspond with serum calcium concentration. This was perhaps due to higher sun exposure among the rural women in the study as vitamin D formation may increase calcium serum concentration [ 114 , 115 ].…”

Section: Resultsmentioning

confidence: 99%

Maternal nutritional risk factors for pre-eclampsia incidence: findings from a narrative scoping review

et al. 2022

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Background Pre-eclampsia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-eclampsia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-eclampsia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-eclampsia. Methods A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility. Results The review found evidence for associations between nutritional inadequacies and a greater risk of pre-eclampsia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-eclampsia. Maternal nutritional risk factors for pre-eclampsia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-eclampsia incidence. Conclusion A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-eclampsia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary diversity and social, cultural contexts of food and meals.

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“…Low calcium intake significantly increases the likelihood of hypertensive diseases in pregnancy (gestational hypertension, pre-eclampsia and eclampsia) [ 10 , 11 ], leads to low birth weight (LBW), low birth length (LBL) and small for gestational age babies [ 12 ]. In a recent study in India, total hypocalcaemia was significantly associated with LBW but had no statistically significant association with preterm delivery, pre-eclampsia and neonatal mortality [ 13 ]. Similar findings showing a non-statistically significant association between pre-eclampsia and total hypocalcaemia have been reported in other studies [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting

et al. 2022

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Introduction Disorders of total calcium (tCa) in pregnancy have been associated with adverse maternofoetal outcomes. However, studies evaluating this from the viewpoint of ionised calcaemia are practically inexistent. This study estimates the prevalence of some adverse maternal and foetal outcomes and the potential effect of ionised calcium (iCa), tCa, albumin and calcium supplementation on some maternofoetal outcomes. Methods A cross-sectional study was conducted among 1074 pregnant women in late pregnancy from four health facilities in the Nkongsamba Health District. Data were collected by interview, analysis of maternal blood samples and measurement of maternal and foetal parameters. Total calcaemia and albuminaemia were measured by atomic absorption spectrophotometry, while iCa and pH were measured using ion-selective potentiometry. Associations were measured using the odds ratio in simple and multiple logistic regression. Results The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97–7.89]%, 4.78 [3.65–7.89]%, 10.24 [8.57–12.20]%, respectively. Following multiple logistic regression, women with iCa levels ≤ 1.31mmol/L had significantly increased odds of hypertension in pregnancy (AOR = 2.47 [1.63–3.74], p-value = 0.000), having babies with low birth weight (AOR = 2.02[1.33–3.61], p-value = 0.002), low birth length (AOR = 2.00 [1.34–2.99], p-value = 0.001), low brachial circumference (AOR = 1.41[1.10–1.81], p-value = 0.007), first minute Apgar score < 7 (AOR = 3.08[1.70–5.59], p-value = 0.000) and fifth minute Apgar score < 7 (AOR = 2.86[1.32–6.16], p-value = 0.007). Ionised calcaemia had no significant association with maternal body mass index immediately after birth and the head circumference of the baby. Total calcaemia was found to have no significant association with any of the selected outcomes, while women with total albuminaemia ≤ 30mg/L had significantly higher odds of having babies with low birth weight (AOR = 3.40[1.96–5.91], p-value = 0.000), and Apgar scores < 7 at the first (AOR = 2.07[1.16–3.70], p-value = 0.013). Calcium supplementation showed no significant association with any of the selected outcomes except for the first (OR = 0.42[0.24–0.72], p-value = 0.002) and fifth minute Apgar score (OR = 0.25[0.12–0.50], p-value = 0.000). Conclusion The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97–7.89]%, 4.78 [3.65–7.89]%, 10.24 [8.57–12.20]%, respectively. Maternal iCa levels ≤ 1.31mmol/L significantly increase the odds of having babies with low birth weight, low birth length, low brachial circumference at birth, low Apgar scores at the first and fifth minutes and maternal hypertension in pregnancy. Low maternal albuminaemia is significantly associated with low birth weight, and Apgar score < 7 at the first minute. None f the selected maternofoetal outcomes directly depend on total calcaemia, given that none of the associations was statistically significant. Even though iCa levels remain relatively normal in normal pregnancies, it remains the strongest predictor of foetal outcomes. Calcium supplementation significantly improves the Apgar scores at the first and fifth minute. Routine pregnancy follow-up should include evaluating maternal calcaemic states, particularly the ionised fraction, to detect the low-normal concentrations likely to impact maternal and foetal outcomes. Normal iCa levels for pregnant women need revisiting.

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Serum calcium level among pregnant women and its association with pre-eclampsia and delivery outcomes: A cross-sectional study from North India

Cited by 13 publications

References 24 publications

Selected Trace Elements in Egyptian Females with Preeclampsia

Selected Trace Elements in Egyptian Females with Preeclampsia

Maternal nutritional risk factors for pre-eclampsia incidence: findings from a narrative scoping review

Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting

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