Beruflich Dokumente
Kultur Dokumente
Justus Hofmeyr, for the Calcium and Pre-eclampsia (CAP) Study Group* *Fernando Althabe, John Anthony, Jos Belizn, Eduardo Bergel, Ana Pilar Betran, Eckhart Buchmann, Gabriela Cormack, David Hall, France Donnay, Sue Fawcus, Justus Hofmeyr, Stephen Munjanja, Natalia Novikova, Adegboyega Oyebajo, Tina Purnat, Jim Roberts, Diane Sawchuck, Mandisa Singata, Kate Teela, Peter von Dadelszen
Outline:
Calcium and pre-eclampsia:
Epidemiology Cochrane review of randomized trials Effects on the neonate New review on low-dose calcium supplementation Implications for practice Research agenda
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Difference in rates of eclampsia between rich and poor countries is spectacular Must be a biological reason . To what extent is this differences due to calcium deficiency? Can we change it?
Daily provisional supply of calcium per capita in developing and developed countries (FAO, 1990)
REGION
World Developed countries Developing countries Africa Latin America Near East Far East Others CALCIUM (mg)
World Health organization randomized trial of calcium supplementation among low calcium intake women.
Villar J, Abdel-Aleem H, Merialdi M, Mathai M, Ali M, Zavaleta N, Purwar M, Hofmeyr GJ, thi Nhu Ngoc N, Campdonico L, Landoulsi S, Carroli G, Lindheimer M et al. Am J Obstet Gynecol 2006;194: 639-649 Revised Systematic Review : Hofmeyr GJ, Lawrie TA, Atallah N, Duley L. Cochrane Database of Syst Reviews 2010
Preterm birth
Perinatal death
Epidemiological association of dietary calcium deficiency with pre-eclampsia/ eclampsia Calcium supplementation in late pregnancy reduces pre-eclamsia by 64% (but only 8% in largest trial) Severe morbidity by 20% Preterm birth by 10% (borderline significance) Perinatal death by 14% (borderline significance) Childhood systolic hypertension by 40% Childhood dental caries by 25% This benefit is sufficient to justify programs to supplement pregnant women with low calcium diets Ongoing research to determine whether pre-pregnancy supplementation will reproduce the more dramatic epidemiological differences
Low dose calcium supplementation for preventing pre-eclampsia: a systematic review and commentary
J Hofmeyr, on behalf of the Calcium and Pre-eclampsia (CAP) Study Group: Jos Belizn, Eduardo Bergel, Ana Pilar Betran, Eckhart Buchmann, Gabriela Cormick, France Donnay, Sue Fawcus, David Hall, Stephen Munjanja, Adegboyega Oyebajo, Tina Purnat, Jim Roberts, Diane Sawchuck, Mandisa Singata, Kate Teela, Peter von Dadelszen
Results
All trials used 500mg daily Consistent 60% reduction in pre-eclampsia across all 9 trials (2234 women) Significant reduction for all high quality trials; and all trials of calcium alone An unexpected finding in one high quality trial of calcium plus antioxidants commencing at 812 weeks of pregnancy was a trend to reduced miscarriage (1/29 versus 8/31, RR 0.06, 95% CI 0.00 to 1.04).
Conclusions
Available evidence supports the probable effectiveness of low-dose calcium supplementation Low quality of evidence requires further research If the WHO recommendation of 1.5 to 2g calcium daily is not achievable, it is reasonable to use a lower dosage (eg 500mg daily)
Randomized trial: calcium 500mg daily vs placebo commencing before conception till 20 weeks All women receive routine calcium in second half of pregnancy Participants: women with previous pre-eclampsia who intend to conceive 366 women recruited to date If effective, next step will be food fortification Our analysis plan includes measuring effect on miscarriage.
Population supplementation: fortification of staple foods Broad population coverage, except people who grow their own food. Population dietary education
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