calcium supplementation in pregnant women
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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
ABOUBAKR ELNASHAR
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
ABOUBAKR ELNASHAR
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
ABOUBAKR ELNASHAR
Calcium supplements
Capsules.
Tablets
soluble tablets
effervescent tablets
chewable tablets for use in the mouth
modified-release tablets
ABOUBAKR ELNASHAR
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.
ABOUBAKR ELNASHAR
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.
ABOUBAKR ELNASHAR
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)
ABOUBAKR ELNASHAR
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.
ABOUBAKR ELNASHAR
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].
ABOUBAKR ELNASHAR
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)
ABOUBAKR ELNASHAR
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.
ABOUBAKR ELNASHAR
Thank you
ABOUBAKR ELNASHAR
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