Conference abstract
Lower-dose calcium supplementation is as effective as WHO-recommended high-dose in reducing the risk of preeclampsia and preterm
Pan African Medical Journal - Conference Proceedings. 2024:21(49).29
Apr 2024.
doi: 10.11604/pamj-cp.2024.21.49.2379
Archived on: 29 Apr 2024
Contact the corresponding author
Keywords: Calcium supplementation, pregnant women, preeclampsia, preterm birth, Tanzania, India
Oral presentation
Lower-dose calcium supplementation is as effective as WHO-recommended high-dose in reducing the risk of preeclampsia and preterm
Pratibha Dwakarnath1, Alfa Muhihi2,&, Christopher R. Sudfeld3, Blair J. Wylie4, Molin Wang3, Nandita Perumal3,5, Tinku Thomas6, Shaban M. Kinyogoli2, Mohamed K. Bakari7, Ryan Fernandez1, John-Michael Raj6, Ndeniria O. Swai8, Nirmala Buggi9, Rani Shoba9, Mary M. Sando2, Christopher P. Duggan3,10, Honorati M. Masanja11, Anura V. Kurpad6, Andrea B. Pembe7, Wafaie Fawzi3
1St. John´s Research Institute, Bangalore, India, 2Africa Academy for Public Health, Tanzania, 3Harvard T.H. Chan School of Public Health, Boston, USA, 4Columbia University Medical Center, New York, NY, United States, 5University of South Carolina, Columbia, United States, 6St. John´s Research Institute, Bangalore, India, 7Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 8Dar es Salaam Regional Medical Office of Health, Dar es Salaam, Tanzania, 9Bruhat Bengaluru Mahanagara Palike, Bangalore India, 10Boston Children´s Hospital, Boston, USA, 11Ifakara Health Institute, Dar es Salaam, Tanzania
&Corresponding author
Introduction: the World Health Organization (WHO) recommends 1500 to 2000mg daily calcium supplementation to pregnant women in populations with low dietary calcium intakes to reduce the risk of preeclampsia. However, the suggested dosing scheme's high cost and complexity are barriers to its implementation.
Methods: two randomized trials were conducted in Tanzania and India to assess the effectiveness of low-dose calcium (500mg given once/day) compared to high-dose calcium (1500mg/day given as 500mg three times/day) in reducing preeclampsia and preterm birth. Analysis was done by country, followed by a meta-analysis of pooled data. Noninferiority margins for the relative risk of preeclampsia and preterm birth were 1.54 and 1.16, respectively.
Results: twenty-two thousand (22,000) nulliparous pregnant women were enrolled and followed in Tanzania and India. The cumulative incidence of preeclampsia was 3.0% in the low-dose and 2.7% in the high-dose calcium group in Tanzania (RR=1.10; 95% CI, 0.88 to 1.36). In India, the incidence of preeclampsia was 3.0% in the low-dose and 3.6% in the high-dose calcium group (RR=0.84; 95% CI, 0.68 to 1.03). The proportion of preterm live births in Tanzania was 10.4% in the low-dose and 9.7% in the high-dose calcium group (RR=1.07; 95% CI, 0.95 to 1.21). In India, the proportion of preterm live births was 11.4% in the low-dose and 12.8% in the high-dose calcium group (RR=0.89; 95% CI, 0.80 to 0.98).
Conclusion: low-dose calcium supplementation was non-inferior to the WHO-recommended high-dose calcium supplementation in reducing the risk of preeclampsia in both Tanzania and India. Low dose was also non-inferior to high dose in reducing the risk of preterm in India but not in Tanzania. A meta-analysis of pooled data indicated that low-dose calcium is non-inferior to high doses in reducing the risk of preeclampsia and preterm births.
Lower-dose calcium supplementation is as effective as WHO-recommended high-dose in reducing the risk of preeclampsia and preterm
Pratibha Dwakarnath1, Alfa Muhihi2,&, Christopher R. Sudfeld3, Blair J. Wylie4, Molin Wang3, Nandita Perumal3,5, Tinku Thomas6, Shaban M. Kinyogoli2, Mohamed K. Bakari7, Ryan Fernandez1, John-Michael Raj6, Ndeniria O. Swai8, Nirmala Buggi9, Rani Shoba9, Mary M. Sando2, Christopher P. Duggan3,10, Honorati M. Masanja11, Anura V. Kurpad6, Andrea B. Pembe7, Wafaie Fawzi3
1St. John´s Research Institute, Bangalore, India, 2Africa Academy for Public Health, Tanzania, 3Harvard T.H. Chan School of Public Health, Boston, USA, 4Columbia University Medical Center, New York, NY, United States, 5University of South Carolina, Columbia, United States, 6St. John´s Research Institute, Bangalore, India, 7Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, 8Dar es Salaam Regional Medical Office of Health, Dar es Salaam, Tanzania, 9Bruhat Bengaluru Mahanagara Palike, Bangalore India, 10Boston Children´s Hospital, Boston, USA, 11Ifakara Health Institute, Dar es Salaam, Tanzania
&Corresponding author
Introduction: the World Health Organization (WHO) recommends 1500 to 2000mg daily calcium supplementation to pregnant women in populations with low dietary calcium intakes to reduce the risk of preeclampsia. However, the suggested dosing scheme's high cost and complexity are barriers to its implementation.
Methods: two randomized trials were conducted in Tanzania and India to assess the effectiveness of low-dose calcium (500mg given once/day) compared to high-dose calcium (1500mg/day given as 500mg three times/day) in reducing preeclampsia and preterm birth. Analysis was done by country, followed by a meta-analysis of pooled data. Noninferiority margins for the relative risk of preeclampsia and preterm birth were 1.54 and 1.16, respectively.
Results: twenty-two thousand (22,000) nulliparous pregnant women were enrolled and followed in Tanzania and India. The cumulative incidence of preeclampsia was 3.0% in the low-dose and 2.7% in the high-dose calcium group in Tanzania (RR=1.10; 95% CI, 0.88 to 1.36). In India, the incidence of preeclampsia was 3.0% in the low-dose and 3.6% in the high-dose calcium group (RR=0.84; 95% CI, 0.68 to 1.03). The proportion of preterm live births in Tanzania was 10.4% in the low-dose and 9.7% in the high-dose calcium group (RR=1.07; 95% CI, 0.95 to 1.21). In India, the proportion of preterm live births was 11.4% in the low-dose and 12.8% in the high-dose calcium group (RR=0.89; 95% CI, 0.80 to 0.98).
Conclusion: low-dose calcium supplementation was non-inferior to the WHO-recommended high-dose calcium supplementation in reducing the risk of preeclampsia in both Tanzania and India. Low dose was also non-inferior to high dose in reducing the risk of preterm in India but not in Tanzania. A meta-analysis of pooled data indicated that low-dose calcium is non-inferior to high doses in reducing the risk of preeclampsia and preterm births.
