Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy

Dwarkanath, Pratibha; Muhihi, Alfa; Sudfeld, Christopher R.; Wylie, Blair J.; Wang, Molin; Perumal, Nandita; Thomas, Tinku; Kinyogoli, Shabani M.; Bakari, Mohamed; Fernandez, Ryan; Raj, John-Michael; Swai, Ndeniria O.; Buggi, Nirmala; Shobha, Rani; Sando, Mary M.; Duggan, Christopher P.; Masanja, Honorati M.; Kurpad, Anura V.; Pembe, Andrea B.; Fawzi, Wafaie W.

doi:10.1056/nejmoa2307212

N Engl J Med

2024

DOI: 10.1056/nejmoa2307212

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Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy

Pratibha Dwarkanath,

Alfa Muhihi,

Christopher R. Sudfeld

et al.

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Cited by 15 publications

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“…But since then, few countries have added antenatal calcium supplementation to their routine antenatal services. 1 Why not?…”

mentioning

confidence: 99%

Low-Dose Antenatal Calcium Supplementation: An Intervention Ready for Prime Time

Hodgins,

Mathai

2024

Glob Health Sci Pract

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Medicine published an article reporting the results of a non-inferiority study comparing low-vs. high-dose antenatal supplementation in populations with low calcium intake, with the primary endpoints being preeclampsia and preterm birth. 1 This study has important implications for maternal and newborn health programs in low-and lower-middle-income countries where calcium intake is low.Preeclampsia/eclampsia (PE/E) is second only to hemorrhage as a direct cause of maternal deaths and is estimated to account for about 14% of maternal deaths. 2 According to data from a 6-country World Health Organization (WHO) study, 3 PE/E is the primary obstetrical cause for 24% of perinatal deaths. For decades, there has been evidence of an association between low calcium intake and risk of PE/E. 4 Trials in the first decade of this century, notably a large 6-country study by WHO, 5 provided evidence for the efficacy of antenatal calcium supplementation for preventing severe PE/E. The WHO study used a dose of 1.5 g/day of elemental calcium in the form of calcium carbonate. The risk of both severe obstetrical complications and newborn death was reduced by 30%, and risk of early preterm birth (less than 32 weeks' gestation) was reduced by 18%. A Cochrane review, including the results from the WHO study, found the risk of preeclampsia reduced by 55% and of overall preterm birth by 19%. 6 Trials of lower-dose calcium (generally 500 mg of elemental calcium), as summarized in the Cochrane review, showed similar results. However, in the aggregate, they were still inadequately powered to constitute robust evidence for efficacy. 6 Nevertheless, the evidence from the higher-dose trials (generally 1.5 g of elemental calcium) was judged by WHO to be adequate to warrant recommending the use of this intervention in populations with low calcium intake, as reflected in WHO guidance released in 2011. 7 At that point, we had good evidence of efficacy for an intervention addressing an important public health problem-

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“…But since then, few countries have added antenatal calcium supplementation to their routine antenatal services. 1 Why not?…”

mentioning

confidence: 99%

Low-Dose Antenatal Calcium Supplementation: An Intervention Ready for Prime Time

Hodgins,

Mathai

2024

Glob Health Sci Pract

View full text Add to dashboard Cite

show abstract

Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018–2021

Weigel,

Armijos

2024

J Immigrant Minority Health

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Next-generation health benefits of maternal calcium supplementation

Weaver

2024

The American Journal of Clinical Nutrition

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Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy

Cited by 15 publications

References 18 publications

Low-Dose Antenatal Calcium Supplementation: An Intervention Ready for Prime Time

Low-Dose Antenatal Calcium Supplementation: An Intervention Ready for Prime Time

Obstetrical Complications in Venezuelan Refugee and Migrant Women: Analysis of Ecuadorian National Hospital Discharge Data, 2018–2021

Next-generation health benefits of maternal calcium supplementation

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