: ROUTINE CALCIUM SUPPLEMENTATION IN PREGNANCY AMONG PRIMIGRAVIDAE FOR PREVENTION OF PRE-ECLAMPSIA: A RANDOMIZED CONTROLLED STUDY

Abstract

BACKGROUND – Pre-eclampsia is associated with high maternal and
perinatal morbidity and mortality especially in the developing countries. It is the
leading cause of iatrogenic prematurity worldwide.
OBJECTIVE – To assess the effect of routine Calcium supplementation during
pregnancy on pre-eclampsia among primigravidae .
METHOD – This is a randomized controlled double blind study involving a total
of 420 healthy eligible primigravidae who were below 20 weeks of pregnancy
and whose written informed consents have been obtained and were
randomized by computer generated number at booking between 27th April,
2010 and 29th July, 2010 into two groups: Calcium group n=210 and placebo
group n=210. Early ultrasound scan was done for them to confirm and date the
pregnancy. Each participant was given 1.2g of elemental calcium or placebo
depending on the group, to be taken daily in two divided doses till delivery. The
medications were prepacked identically and dispensed at the hospital
pharmacy with the routine haematinics. The previous packs were checked in
the next visit to assess compliance. Each subject was seen according to the
routine antenatal clinic schedule.
Blood pressure and proteinuria were evaluated at each visit. Each
patient was followed up till delivery and discharge from the hospital.
RESULTS – The overall incidence of pre-eclampsia was 9.2%. Incidence of
pre-eclampsia was significantly low in the calcium group than in the placebo
group 5.3% Vs 13.1%: Odd ratio (OR) 0.37: 95% confidence interval (Cl), 0.17
– 0.79. There was reduction in the number of preterm birth in the calcium group
4.2% versus 8.8% in the placebo group. However, this was not statistically
significant P=0.06. Among women who developed pre-eclampsia, 3 had
preterm birth in the calcium group while 16 in the placebo group had preterm
birth p=0.06. The mean birth weight and Apgar score at one minute between
the two groups were statistically significant: 3.21+ 0.34 and 3.06 + 0.51 P=0.01,
8.55 + 1.30 and 8.02 + 2.20 P=0.005 respectively. There was also a statistically
significant difference in perinatal death between the two groups (Nil in calcium
group and 4.7% in placebo group) P=0.004.
CONCLUSION – Routine calcium supplementation appears to reduce the
occurrence of pre-eclampsia and improve neonatal outcomes in primigravidae.
KEY WORDS – Primigravidae, Calcium supplementation, Preterm delivery.

ROUTINE CALCIUM SUPPLEMENTATION IN PREGNANCY AMONG PRIMIGRAVIDAE FOR PREVENTION OF PRE-ECLAMPSIA: A RANDOMIZED CONTROLLED STUDY