TY - JOUR
T1 - Calcium for pre-eclampsia prevention
T2 - A systematic review and network meta-analysis to guide personalised antenatal care
AU - the PRECISE Network
AU - Woo Kinshella, Mai Lei
AU - Sarr, Catherine
AU - Sandhu, Akshdeep
AU - Bone, Jeffrey N.
AU - Vidler, Marianne
AU - Moore, Sophie E.
AU - Elango, Rajavel
AU - Cormick, Gabriela
AU - Belizan, José M.
AU - Hofmeyr, G. Justus
AU - Magee, Laura A.
AU - von Dadelszen, Peter
N1 - Funding Information:
The PRECISE Network is funded by the UK Research and Innovation Grand Challenges Research Fund GROW Award Scheme (grant no. MR/P027938/1) and the CAP Trial was funded by the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation (OPP1017337). MWK is supported by the Vanier Canada Graduate Scholarship, funded by the Government of Canada through the Canadian Institutes of Health Research (CIHR)
Publisher Copyright:
© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Calcium supplementation reduces the risk of pre-eclampsia, but questions remain about the dosage to prescribe and who would benefit most. Objectives: To evaluate the effectiveness of high (≥1 g/day) and low (<1 g/day) calcium dosing for pre-eclampsia prevention, according to baseline dietary calcium, pre-eclampsia risk and co-interventions, and intervention timing. Search strategy: CENTRAL, PubMed, Global Index Medicus and CINAHL, from inception to 2 February 2021, clinical trial registries, reference lists and expert input (CRD42018111239). Selection criteria: Randomised controlled trials of calcium supplementation for pre-eclampsia prevention, for women before or during pregnancy. Network meta-analysis (NMA) also included trials of different calcium doses. Data collection and analysis: Two independent reviewers extracted published data. The meta-analysis employed random-effects models and the NMA, a Bayesian random-effects model, to obtain direct and indirect effect estimates. Main results: The meta-analysis included 30 trials (N = 20 445 women), and the NMA to evaluate calcium dosage included 25 trials (N = 15 038). Calcium supplementation prevented pre-eclampsia similarly with a high dose (RR 0.49, 95% CI 0.36–0.66) or a low dose (RR 0.49, 95% CI 0.36–0.65). By NMA, high-dose (vs low-dose) calcium did not differ in effect (RR 0.79, 95% CI 0.43–1.40). Calcium was similarly effective regardless of baseline pre-eclampsia risk, vitamin D co-administration or timing of calcium initiation, but calcium was ineffective among women with adequate average baseline calcium intake. Conclusions: Low- and high-dose calcium supplementation are effective for pre-eclampsia prevention in women with low calcium intake. This has implications for population-level implementation where dietary calcium is low, and targeted implementation where average intake is adequate.
AB - Background: Calcium supplementation reduces the risk of pre-eclampsia, but questions remain about the dosage to prescribe and who would benefit most. Objectives: To evaluate the effectiveness of high (≥1 g/day) and low (<1 g/day) calcium dosing for pre-eclampsia prevention, according to baseline dietary calcium, pre-eclampsia risk and co-interventions, and intervention timing. Search strategy: CENTRAL, PubMed, Global Index Medicus and CINAHL, from inception to 2 February 2021, clinical trial registries, reference lists and expert input (CRD42018111239). Selection criteria: Randomised controlled trials of calcium supplementation for pre-eclampsia prevention, for women before or during pregnancy. Network meta-analysis (NMA) also included trials of different calcium doses. Data collection and analysis: Two independent reviewers extracted published data. The meta-analysis employed random-effects models and the NMA, a Bayesian random-effects model, to obtain direct and indirect effect estimates. Main results: The meta-analysis included 30 trials (N = 20 445 women), and the NMA to evaluate calcium dosage included 25 trials (N = 15 038). Calcium supplementation prevented pre-eclampsia similarly with a high dose (RR 0.49, 95% CI 0.36–0.66) or a low dose (RR 0.49, 95% CI 0.36–0.65). By NMA, high-dose (vs low-dose) calcium did not differ in effect (RR 0.79, 95% CI 0.43–1.40). Calcium was similarly effective regardless of baseline pre-eclampsia risk, vitamin D co-administration or timing of calcium initiation, but calcium was ineffective among women with adequate average baseline calcium intake. Conclusions: Low- and high-dose calcium supplementation are effective for pre-eclampsia prevention in women with low calcium intake. This has implications for population-level implementation where dietary calcium is low, and targeted implementation where average intake is adequate.
KW - calcium
KW - meta-analysis
KW - network meta-analysis
KW - pre-eclampsia
KW - prevention
KW - randomised controlled trials
UR - http://www.scopus.com/inward/record.url?scp=85133808228&partnerID=8YFLogxK
U2 - 10.1111/1471-0528.17222
DO - 10.1111/1471-0528.17222
M3 - Review article
C2 - 35596262
AN - SCOPUS:85133808228
SN - 1470-0328
VL - 129
SP - 1833
EP - 1843
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 11
ER -