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Calcium supplementation during pregnancy for preventing

hypertensive disorders and related problems (Review)

Hofmeyr GJ, Lawrie TA, Atallah N, Duley L, Torloni MR

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library2014, Issue 6

http://www.thecochranelibrary.com

Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems (Review)

Copyright 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

http://www.thecochranelibrary.com

T A B L E O F C O N T E N T S

1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .6BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Figure 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Figure 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Figure 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Figure 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Figure 8. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Figure 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Figure 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Figure 11. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

26DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27AUTHORS CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Analysis 1.1. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 1 High blood pressure (with or without proteinuria). . . . . . . . . . . . . . . . . . 71

Analysis 1.2. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 2 Pre-eclampsia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Analysis 1.3. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 3 Preterm birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Analysis 1.4. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 4 Admission to neonatal intensive care unit. . . . . . . . . . . . . . . . . . . . . 75

Analysis 1.5. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 5 Stillbirth or death before discharge from hospital. . . . . . . . . . . . . . . . . . 76

Analysis 1.6. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 6 Maternal death/serious morbidity. . . . . . . . . . . . . . . . . . . . . . . 77

Analysis 1.7. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 7 Placental abruption. . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Analysis 1.8. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 8 Caesarean section. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Analysis 1.9. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 9 Proteinuria (gestational with no proteinuria. . . . . . . . . . . . . . . . . . . . 80

Analysis 1.10. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 10 Severe pre-eclampsia. . . . . . . . . . . . . . . . . . . . . . . . . . . 81

Analysis 1.11. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 11 Eclampsia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Analysis 1.12. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 12 HELLP syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Analysis 1.13. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 13 Intensive care unit admission. . . . . . . . . . . . . . . . . . . . . . . . . 84

iCalcium supplementation during pregnancy for preventing hypertensive disorders and related problems (Review)

Copyright 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Analysis 1.14. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 14 Maternal death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Analysis 1.15. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 15 Birthweight < 2500 g. . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Analysis 1.16. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 16 Neonate small-for-gestational age as defined by trial authors. . . . . . . . . . . . . . 87

Analysis 1.17. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 17 Childhood systolic blood pressure > 95th percentile. . . . . . . . . . . . . . . . . 88

Analysis 1.18. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 18 Childhood diastolic blood pressure > 95th percentile. . . . . . . . . . . . . . . . 89

Analysis 1.19. Comparison 1 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium,Outcome 19 Childhood dental caries. . . . . . . . . . . . . . . . . . . . . . . . . . 90

Analysis 2.1. Comparison 2 Routine high-dose calcium supplementation in pregnancy by hypertension risk, Outcome 1High blood pressure (with or without proteinuria). . . . . . . . . . . . . . . . . . . . . . 91

Analysis 2.2. Comparison 2 Routine high-dose calcium supplementation in pregnancy by hypertension risk, Outcome 2Pre-eclampsia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

Analysis 2.3. Comparison 2 Routine high-dose calcium supplementation in pregnancy by hypertension risk, Outcome 3Preterm birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Analysis 2.4. Comparison 2 Routine high-dose calcium supplementation in pregnancy by hypertension risk, Outcome 4Admission to neonatal intensive care unit. . . . . . . . . . . . . . . . . . . . . . . . . 94

Analysis 2.5. Comparison 2 Routine high-dose calcium supplementation in pregnancy by hypertension risk, Outcome 5Stillbirth or death before discharge from hospital. . . . . . . . . . . . . . . . . . . . . . 95

Analysis 3.1. Comparison 3 Routine high-dose calcium supplementation in pregnancy by study sample size, Outcome 1High blood pressure (with or without proteinuria). . . . . . . . . . . . . . . . . . . . . . 96

Analysis 3.2. Comparison 3 Routine high-dose calcium supplementation in pregnancy by study sample size, Outcome 2Pre-eclampsia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Analysis 3.3. Comparison 3 Routine high-dose calcium supplementation in pregnancy by study sample size, Outcome 3Preterm birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98

Analysis 3.4. Comparison 3 Routine high-dose calcium supplementation in pregnancy by study sample size, Outcome 4Admission to neonatal intensive care unit. . . . . . . . . . . . . . . . . . . . . . . . . 99

Analysis 3.5. Comparison 3 Routine high-dose calcium supplementation in pregnancy by study sample size, Outcome 5Stillbirth or death before discharge from hospital. . . . . . . . . . . . . . . . . . . . . . 100

Analysis 4.1. Comparison 4 Routine high-dose calcium supplementation in pregnancy by baseline dietary calcium andstudy sample size (not pre-specified), Outcome 1 Pre-eclampsia. . . . . . . . . . . . . . . . . 101

Analysis 5.1. Comparison 5 Routine calcium supplementation in pregnancy by other outcomes (not pre-specified),Outcome 1 Uterine artery RI at 32 weeks. . . . . . . . . . . . . . . . . . . . . . . . . 102

Analysis 5.2. Comparison 5 Routine calcium supplementation in pregnancy by other outcomes (not pre-specified),Outcome 2 Umbilical artery RI at 32 weeks. . . . . . . . . . . . . . . . . . . . . . . . 103

Analysis 5.3. Comparison 5 Routine calcium supplementation in pregnancy by other outcomes (not pre-specified),Outcome 3 Low platelet count at 35 weeks. . . . . . . . . . . . . . .