Calcium

supplementationin pregnant womenWHO, 2013; Cochrane SR,

2014, ACOG; 2015

Aboubakr ElnasharBenha university, Egypt

ABOUBAKR ELNASHAR

INTRODUCTION

The most abundant mineral in the body

Essential for:

bone formation

muscle contraction

enzyme and hormone functioning

Most of the body’s calcium is found

Bones

Teeth

1% in:

intracellular structures

cell membrane

extracellular fluids

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Absorption

increases during pregnancy and no additional

intake is needed

Recommended dietary intake (WHO)

1200 mg/d of calcium for pregnant women

Inadequate consumption

Mother:Osteopenia

Tremor

Paraesthesia

Muscle cramping

Tetanus

Foetus:Delayed fetal growth

Low birth weight

poor fetal mineralizationABOUBAKR ELNASHAR

Assessment of calcium nutritional status

Serum calcium concentrations are maintained

within narrow limits in the body and thus have

limited use

Calcium intake

useful indicator of status at the population level.

Dietary sources

Milk

dairy products

calcium-set tofu

fortified foods

lime-treated corn meal

Worldwide

low calcium intake at population level occurs

frequently ABOUBAKR ELNASHAR

CALCIUM SUPPLEMENTATION DURING

PREGNANCY

Benefits:

reducing the risk of pregnancy-induced

hypertension

effect on maternal bone mineral density, fetal

mineralization, and preterm birth: less conclusive

Excessive consumption of calcium

increase the risk of

urinary stones

urinary tract infection

reduce the absorption of other essential

micronutrients

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Ca supplements:

Carbonate

Citrate

Lactate

Gluconate

all these forms have good bioavailability

Calcium carbonate

the most common

has the highest content of elemental calcium

(40%)

best efficacy-cost ratio in pregnancy

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Calcium supplements

Capsules.

Tablets

soluble tablets

effervescent tablets

chewable tablets for use in the mouth

modified-release tablets

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Interaction between iron supplements and calcium

supplements may occur

two nutrients should preferably be administered

several hours apart

iron may be consumed between meals rather

than concomitantly.

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Monitoring of women’s total daily calcium intake

Total intake per day should not exceed the locally established upper

tolerable limit.

In the absence of such reference standards, an upper

limit of calcium intake of 3 g/day can be used

Antacids: are not a rich source of calcium, they are not part of

the diet and their use should be limited to the treatment

of heartburn or indigestion.

Supplements:The calcium content of any other vitamin and mineral

supplements that are also being taken should be

considered when recommending calcium

supplementation, to reduce the risk of hypercalcaemia.

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Recommendations

1. WHO, 2013

In populations where calcium intake is low, calcium

supplementation as part of the antenatal care is

recommended for the prevention of preeclampsia

among pregnant women, particularly among those at

higher risk of hypertension

(strong recommendation)

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Dosage

1.5–2.0 g elemental calcium/d

Frequency

Daily, with the total daily dosage divided into

three doses (preferably taken at mealtimes)

Duration

From 20 weeks’ gestation until the end of

pregnancy

Target group

All pregnant women, particularly those at higher

risk of gestational hypertensionb

Settings Areas

with low calcium intakeABOUBAKR ELNASHAR

1 g of elemental calcium equals

2.5 g of calcium carbonate or

4 g of calcium citrate

High risk of developing gestational hypertension

and pre-eclampsia if they have one or more of the

following risk factors: Obesity

previous pre-eclampsia

Diabetes

chronic hypertension

renal disease

autoimmune disease

Nulliparity

advanced maternal age

Adolescent pregnancy

conditions leading to hyperplacentation and large

placentas (e.g. twin pregnancy). ABOUBAKR ELNASHAR

In populations where consumption of calcium on

average meets the recommended dietary calcium

intake, either through calcium-rich foods or fortified

staple foods:

Calcium supplementation is not encouraged

1. may not improve the outcomes related to PET

and hypertensive disorders of pregnancy

2. may increase the risk of adverse effects.

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3. Cochrane SR, 2014

Calcium supplementation (≥ 1 g/d):

significant reduction in

PE particularly for women with low calcium diets.

(Cochrane SR, 2014)

PTLlow risk women with adequate dietary

calcium intake: no benefit [Hofmeyr et al, 2014].

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Calcium supplementation <1 g daily:

Significant reduction in risk of PE

Limitations: : small

most had a high risk of bias(Hofmeyr et al, 2014)

In settings of low dietary calcium where high-

dose supplementation is not feasible: lower-dose

supplements (500 to 600 mg/d) might be

considered in preference to no supplementation.(Cochrane SR, 214)

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3. ACOG, 2015

1000 mg/d in pregnant and lactating women 19

to 50 y of age

1300 mg for girls 14 to 18 y

this is the same for lactating and nonlactating

women of the same age.

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Thank you

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