Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care
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 (
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| Veröffentlicht in: | BJOG : an international journal of obstetrics and gynaecology 2022-10, Vol.129 (11), p.1833-1843 |
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| creator | Woo Kinshella, Mai‐Lei Sarr, Catherine Sandhu, Akshdeep Bone, Jeffrey N. Vidler, Marianne Moore, Sophie E. Elango, Rajavel Cormick, Gabriela Belizan, José M. Hofmeyr, G. Justus Magee, Laura A. Dadelszen, Peter |
| description | 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 ( |
| doi_str_mv | 10.1111/1471-0528.17222 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2667789330</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2667789330</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3712-e711fc342cee03f3cbd64268ee1d4cf09334188b19c06ba8e96b66831224f7fd3</originalsourceid><addsrcrecordid>eNqFkUtP3DAUha2KqtBp1-yQJTbdZPAj4zjs6Aj6ENJsYG05zg3ykMTBdhiNxIKfwG_kl9Tz6Cy6qTf2PfrO0ZUPQqeUTGk6FzQvaEZmTE5pwRj7gE4OytH2TTLCmTxGn0NYEkIFI_wTOuazWSmYYCfoZa5bY8cON87jwcP76xuYVndDsHozP0Mfresv8RUO6xCh09EanHQLK6z7GvcQV84_4g6iTmbd63YdbMDR4YfR1oAH8MEl1QaokyNCr6NusdEevqCPjW4DfN3fE3R_c303_5ndLn78ml_dZoYXlGVQUNoYnjMDQHjDTVWLnAkJQOvcNKTkPKdSVrQ0RFRaQikqISSnjOVN0dR8gr7tcgfvnkYIUXU2GGhb3YMbg2JCFIVMMSSh5_-gSzf6tH6i0hoyfXpRJupiRxnvQvDQqMHbTvu1okRtilGbGtSmBrUtJjnO9rlj1UF94P82kYDZDljZFtb_y1Pffy92wX8AA32aiw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2711811179</pqid></control><display><type>article</type><title>Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Woo Kinshella, Mai‐Lei ; Sarr, Catherine ; Sandhu, Akshdeep ; Bone, Jeffrey N. ; Vidler, Marianne ; Moore, Sophie E. ; Elango, Rajavel ; Cormick, Gabriela ; Belizan, José M. ; Hofmeyr, G. Justus ; Magee, Laura A. ; Dadelszen, Peter</creator><creatorcontrib>Woo Kinshella, Mai‐Lei ; Sarr, Catherine ; Sandhu, Akshdeep ; Bone, Jeffrey N. ; Vidler, Marianne ; Moore, Sophie E. ; Elango, Rajavel ; Cormick, Gabriela ; Belizan, José M. ; Hofmeyr, G. Justus ; Magee, Laura A. ; Dadelszen, Peter ; PRECISE Network ; the PRECISE Network</creatorcontrib><description>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.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Linked article: This article is commented on by Fields et al., pp. 1844 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17236.</description><identifier>ISSN: 1470-0328</identifier><identifier>EISSN: 1471-0528</identifier><identifier>DOI: 10.1111/1471-0528.17222</identifier><identifier>PMID: 35596262</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Bayes Theorem ; Bayesian analysis ; calcium ; Calcium - therapeutic use ; Calcium, Dietary ; Clinical trials ; Data collection ; Dietary Supplements ; Dosage ; Eclampsia ; Female ; Humans ; Mathematical models ; Meta-analysis ; Network Meta-Analysis ; Pre-Eclampsia - prevention & control ; Preeclampsia ; Pregnancy ; Prenatal Care ; Prevention ; pre‐eclampsia ; randomised controlled trials ; Vitamin D</subject><ispartof>BJOG : an international journal of obstetrics and gynaecology, 2022-10, Vol.129 (11), p.1833-1843</ispartof><rights>2022 The Authors. : An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.</rights><rights>2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3712-e711fc342cee03f3cbd64268ee1d4cf09334188b19c06ba8e96b66831224f7fd3</citedby><cites>FETCH-LOGICAL-c3712-e711fc342cee03f3cbd64268ee1d4cf09334188b19c06ba8e96b66831224f7fd3</cites><orcidid>0000-0003-4136-3070 ; 0000-0002-3080-1007 ; 0000-0001-5846-3014 ; 0000-0002-8412-3010 ; 0000-0001-7704-1677 ; 0000-0002-1355-610X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1471-0528.17222$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1471-0528.17222$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35596262$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Woo Kinshella, Mai‐Lei</creatorcontrib><creatorcontrib>Sarr, Catherine</creatorcontrib><creatorcontrib>Sandhu, Akshdeep</creatorcontrib><creatorcontrib>Bone, Jeffrey N.</creatorcontrib><creatorcontrib>Vidler, Marianne</creatorcontrib><creatorcontrib>Moore, Sophie E.</creatorcontrib><creatorcontrib>Elango, Rajavel</creatorcontrib><creatorcontrib>Cormick, Gabriela</creatorcontrib><creatorcontrib>Belizan, José M.</creatorcontrib><creatorcontrib>Hofmeyr, G. Justus</creatorcontrib><creatorcontrib>Magee, Laura A.</creatorcontrib><creatorcontrib>Dadelszen, Peter</creatorcontrib><creatorcontrib>PRECISE Network</creatorcontrib><creatorcontrib>the PRECISE Network</creatorcontrib><title>Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care</title><title>BJOG : an international journal of obstetrics and gynaecology</title><addtitle>BJOG</addtitle><description>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.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Linked article: This article is commented on by Fields et al., pp. 1844 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17236.</description><subject>Bayes Theorem</subject><subject>Bayesian analysis</subject><subject>calcium</subject><subject>Calcium - therapeutic use</subject><subject>Calcium, Dietary</subject><subject>Clinical trials</subject><subject>Data collection</subject><subject>Dietary Supplements</subject><subject>Dosage</subject><subject>Eclampsia</subject><subject>Female</subject><subject>Humans</subject><subject>Mathematical models</subject><subject>Meta-analysis</subject><subject>Network Meta-Analysis</subject><subject>Pre-Eclampsia - prevention & control</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Prenatal Care</subject><subject>Prevention</subject><subject>pre‐eclampsia</subject><subject>randomised controlled trials</subject><subject>Vitamin D</subject><issn>1470-0328</issn><issn>1471-0528</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNqFkUtP3DAUha2KqtBp1-yQJTbdZPAj4zjs6Aj6ENJsYG05zg3ykMTBdhiNxIKfwG_kl9Tz6Cy6qTf2PfrO0ZUPQqeUTGk6FzQvaEZmTE5pwRj7gE4OytH2TTLCmTxGn0NYEkIFI_wTOuazWSmYYCfoZa5bY8cON87jwcP76xuYVndDsHozP0Mfresv8RUO6xCh09EanHQLK6z7GvcQV84_4g6iTmbd63YdbMDR4YfR1oAH8MEl1QaokyNCr6NusdEevqCPjW4DfN3fE3R_c303_5ndLn78ml_dZoYXlGVQUNoYnjMDQHjDTVWLnAkJQOvcNKTkPKdSVrQ0RFRaQikqISSnjOVN0dR8gr7tcgfvnkYIUXU2GGhb3YMbg2JCFIVMMSSh5_-gSzf6tH6i0hoyfXpRJupiRxnvQvDQqMHbTvu1okRtilGbGtSmBrUtJjnO9rlj1UF94P82kYDZDljZFtb_y1Pffy92wX8AA32aiw</recordid><startdate>202210</startdate><enddate>202210</enddate><creator>Woo Kinshella, Mai‐Lei</creator><creator>Sarr, Catherine</creator><creator>Sandhu, Akshdeep</creator><creator>Bone, Jeffrey N.</creator><creator>Vidler, Marianne</creator><creator>Moore, Sophie E.</creator><creator>Elango, Rajavel</creator><creator>Cormick, Gabriela</creator><creator>Belizan, José M.</creator><creator>Hofmeyr, G. Justus</creator><creator>Magee, Laura A.</creator><creator>Dadelszen, Peter</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4136-3070</orcidid><orcidid>https://orcid.org/0000-0002-3080-1007</orcidid><orcidid>https://orcid.org/0000-0001-5846-3014</orcidid><orcidid>https://orcid.org/0000-0002-8412-3010</orcidid><orcidid>https://orcid.org/0000-0001-7704-1677</orcidid><orcidid>https://orcid.org/0000-0002-1355-610X</orcidid></search><sort><creationdate>202210</creationdate><title>Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care</title><author>Woo Kinshella, Mai‐Lei ; Sarr, Catherine ; Sandhu, Akshdeep ; Bone, Jeffrey N. ; Vidler, Marianne ; Moore, Sophie E. ; Elango, Rajavel ; Cormick, Gabriela ; Belizan, José M. ; Hofmeyr, G. Justus ; Magee, Laura A. ; Dadelszen, Peter</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3712-e711fc342cee03f3cbd64268ee1d4cf09334188b19c06ba8e96b66831224f7fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Bayes Theorem</topic><topic>Bayesian analysis</topic><topic>calcium</topic><topic>Calcium - therapeutic use</topic><topic>Calcium, Dietary</topic><topic>Clinical trials</topic><topic>Data collection</topic><topic>Dietary Supplements</topic><topic>Dosage</topic><topic>Eclampsia</topic><topic>Female</topic><topic>Humans</topic><topic>Mathematical models</topic><topic>Meta-analysis</topic><topic>Network Meta-Analysis</topic><topic>Pre-Eclampsia - prevention & control</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Prenatal Care</topic><topic>Prevention</topic><topic>pre‐eclampsia</topic><topic>randomised controlled trials</topic><topic>Vitamin D</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Woo Kinshella, Mai‐Lei</creatorcontrib><creatorcontrib>Sarr, Catherine</creatorcontrib><creatorcontrib>Sandhu, Akshdeep</creatorcontrib><creatorcontrib>Bone, Jeffrey N.</creatorcontrib><creatorcontrib>Vidler, Marianne</creatorcontrib><creatorcontrib>Moore, Sophie E.</creatorcontrib><creatorcontrib>Elango, Rajavel</creatorcontrib><creatorcontrib>Cormick, Gabriela</creatorcontrib><creatorcontrib>Belizan, José M.</creatorcontrib><creatorcontrib>Hofmeyr, G. Justus</creatorcontrib><creatorcontrib>Magee, Laura A.</creatorcontrib><creatorcontrib>Dadelszen, Peter</creatorcontrib><creatorcontrib>PRECISE Network</creatorcontrib><creatorcontrib>the PRECISE Network</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Woo Kinshella, Mai‐Lei</au><au>Sarr, Catherine</au><au>Sandhu, Akshdeep</au><au>Bone, Jeffrey N.</au><au>Vidler, Marianne</au><au>Moore, Sophie E.</au><au>Elango, Rajavel</au><au>Cormick, Gabriela</au><au>Belizan, José M.</au><au>Hofmeyr, G. Justus</au><au>Magee, Laura A.</au><au>Dadelszen, Peter</au><aucorp>PRECISE Network</aucorp><aucorp>the PRECISE Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care</atitle><jtitle>BJOG : an international journal of obstetrics and gynaecology</jtitle><addtitle>BJOG</addtitle><date>2022-10</date><risdate>2022</risdate><volume>129</volume><issue>11</issue><spage>1833</spage><epage>1843</epage><pages>1833-1843</pages><issn>1470-0328</issn><eissn>1471-0528</eissn><abstract>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.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Tweetable
A network meta‐analysis of 25 trials found that low‐dose calcium supplementation (<1 g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐eclampsia when baseline calcium intake is low.
Linked article: This article is commented on by Fields et al., pp. 1844 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471‐0528.17236.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35596262</pmid><doi>10.1111/1471-0528.17222</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4136-3070</orcidid><orcidid>https://orcid.org/0000-0002-3080-1007</orcidid><orcidid>https://orcid.org/0000-0001-5846-3014</orcidid><orcidid>https://orcid.org/0000-0002-8412-3010</orcidid><orcidid>https://orcid.org/0000-0001-7704-1677</orcidid><orcidid>https://orcid.org/0000-0002-1355-610X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Bayes Theorem Bayesian analysis calcium Calcium - therapeutic use Calcium, Dietary Clinical trials Data collection Dietary Supplements Dosage Eclampsia Female Humans Mathematical models Meta-analysis Network Meta-Analysis Pre-Eclampsia - prevention & control Preeclampsia Pregnancy Prenatal Care Prevention pre‐eclampsia randomised controlled trials Vitamin D |
| title | Calcium for pre‐eclampsia prevention: A systematic review and network meta‐analysis to guide personalised antenatal care |
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