This document discusses calcium supplementation during pregnancy. It notes that calcium is essential for bone formation, muscle contraction, and other bodily functions. While absorption increases during pregnancy, the recommended daily intake is 1200 mg according to WHO. Inadequate calcium can cause issues for both mother and fetus. Calcium supplementation of at least 1 g per day is recommended by WHO and Cochrane reviews to reduce risks of preeclampsia, particularly for those in areas with low calcium diets or at high risk of hypertension. Forms like calcium carbonate are commonly used. Monitoring intake to avoid excess is also advised.

1. Calcium
supplementation
in pregnant women
WHO, 2013; Cochrane SR,
2014, ACOG; 2015
Aboubakr Elnashar
Benha university, Egypt
ABOUBAKR ELNASHAR

2. 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

3. 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 mineralization
ABOUBAKR ELNASHAR

4. 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

5. 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

6. 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

7. Calcium supplements
Capsules.
Tablets
soluble tablets
effervescent tablets
chewable tablets for use in the mouth
modified-release tablets
ABOUBAKR ELNASHAR

8. 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

9. 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

10. 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

11. 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 intake
ABOUBAKR ELNASHAR

12. 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

13. 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

14. 3. Cochrane SR, 2014
Calcium supplementation (≥ 1 g/d):
significant reduction in
PE particularly for women with low calcium diets.
(Cochrane SR, 2014)
PTL
low risk women with adequate dietary
calcium intake: no benefit
[Hofmeyr et al, 2014].
ABOUBAKR ELNASHAR

15. 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

16. 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

17. Thank you
ABOUBAKR ELNASHAR