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Meta-Analysis
. 2015 Feb 25;2015(2):CD007079.
doi: 10.1002/14651858.CD007079.pub3.

Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes

Pranom Buppasiri  1 , Pisake Lumbiganon, Jadsada Thinkhamrop, Chetta Ngamjarus, Malinee Laopaiboon, Nancy Medley
Affiliations
Meta-Analysis

Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes

Pranom Buppasiri et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Maternal nutrition during pregnancy is known to have an effect on fetal growth and development. It is recommended that women increase their calcium intake during pregnancy and lactation, although the recommended dosage varies among professionals. Currently, there is no consensus on the role of routine calcium supplementation for pregnant women other than for preventing or treating hypertension.

Objectives: To determine the effect of calcium supplementation on maternal, fetal and neonatal outcomes (other than for preventing or treating hypertension) as well as any possible side effects.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30th September 2014).

Selection criteria: We considered all published, unpublished and ongoing randomised controlled trials (RCTs) comparing maternal, fetal and neonatal outcomes in pregnant women who received calcium supplementation versus placebo or no treatment. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and cross-over studies were not eligible for inclusion.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: Twenty-five studies met the inclusion criteria, but only 23 studies contributed data to the review. These 23 trials recruited 18,587 women, with 17,842 women included in final analyses. There were no statistically significant differences between women who received calcium supplementation and those who did not in terms of reducing preterm births less than 37 weeks' gestation (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.70 to 1.05; 13 studies, 16,139 women; random-effects model) or less than 34 weeks' gestation (RR 1.04, 95% CI 0.80 to 1.36; four trials, 5669). Most studies were of low risk of bias. We conducted sensitivity analysis for the outcome of preterm birth less than 37 weeks by removing two trials with unclear risk of bias for allocation concealment; the results then favoured treatment with calcium supplementation (RR 0.80, 95% CI 0.65 to 0.99; 11 trials, 15,379 women). There was no significant difference in infant low birthweight between the two treatment groups (RR 0.93, 95% CI 0.81 to 1.07; six trials, 14,162 infants; random-effects model). However, when compared to the control group, women in the calcium supplementation group gave birth to slightly heavier birthweight infants (mean difference 56.40, 95% CI 13.55 to 99.25; 21 trials, 9202 women; random-effects model).Three outcomes were chosen for assessment with the GRADE software: preterm birth less than 37 weeks; preterm birth less than 34 weeks; and low birthweight less than 2500 g. Evidence for these outcomes was assessed as of moderate quality.

Authors' conclusions: This review indicates that there are no clear additional benefits to calcium supplementation in prevention of preterm birth or low infant birthweight. While there was a statistically significant difference of 56 g identified in mean infant birthweight, there was significant heterogeneity identified, and the clinical significance of this difference is uncertain.

PubMed Disclaimer

Conflict of interest statement

Malinee Laopaiboon received an honorarium from the Thailand Research Fund which is a non‐profit organisation.

Figures

1
1
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Funnel plot of comparison: 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), outcome: 1.1 Preterm birth (a) Birth prior to 37 weeks.
1.1
1.1. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 1 Preterm birth (a) Birth prior to 37 weeks.
1.2
1.2. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 2 Preterm birth (a) Birth prior to 37 weeks by dose of calcium.
1.3
1.3. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 3 Preterm birth (a) Birth prior to 37 weeks by started to take calcium.
1.4
1.4. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 4 Preterm birth (a) Birth prior to 37 weeks by type of calcium.
1.5
1.5. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 5 Preterm birth (b) Birth prior to 34 weeks.
1.6
1.6. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 6 Preterm birth (b) Birth prior to 34 weeks ‐ Sensitivity analysis by concealment allocation.
1.7
1.7. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 7 Maternal weight gain (g/w).
1.8
1.8. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 8 Maternal bone mineral density (g/cm2) ‐ First phalanx (calcium 300 mg).
1.9
1.9. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 9 Maternal bone mineral density (g/cm2) ‐ Second metacarpal (calcium 300 mg).
1.10
1.10. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 10 Maternal bone mineral density (g/cm2) ‐ Fourth metacarpal (calcium 300 mg).
1.11
1.11. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 11 Maternal bone mineral density (g/cm2) ‐ First phalanx (calcium 600 mg).
1.12
1.12. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 12 Maternal bone mineral density (g/cm2) ‐ Second metacarpal (calcium 600 mg).
1.13
1.13. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 13 Maternal bone mineral density (g/cm2) ‐ Fourth metacarpal (calcium 600 mg).
1.14
1.14. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 14 Maternal death.
1.15
1.15. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 15 Maternal admission to intensive care unit.
1.16
1.16. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 16 Vaginal birth.
1.17
1.17. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 17 Instrumental vaginal birth.
1.18
1.18. Analysis
Comparison 1 Calcium supplementation versus placebo or no treatment (maternal outcomes), Outcome 18 Caesarean section.
2.1
2.1. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 1 Low birthweight (< 2500 g).
2.2
2.2. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 2 Low birthweight (< 2500 g) by started to take calcium.
2.3
2.3. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 3 Low birthweight (< 2500 g) by type of calcium.
2.4
2.4. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 4 Birthweight (g).
2.5
2.5. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 5 Perinatal mortality.
2.6
2.6. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 6 Stillbirth or fetal death.
2.7
2.7. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 7 Admission to neonatal intensive care unit.
2.8
2.8. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 8 Birth length (cm).
2.9
2.9. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 9 Head circumference (cm).
2.10
2.10. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 10 Intrauterine growth restriction.
2.11
2.11. Analysis
Comparison 2 Calcium supplementation versus placebo or no treatment (infant outcomes), Outcome 11 Neonatal bone mineral density (g/cm2).
3.1
3.1. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 1 Side effects of calcium supplementation ‐ Maternal cholestatic jaundice.
3.2
3.2. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 2 Urinary stones.
3.3
3.3. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 3 Urinary tract infection.
3.4
3.4. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 4 Renal colic.
3.5
3.5. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 5 Impaired renal function.
3.6
3.6. Analysis
Comparison 3 Calcium supplementation versus placebo or no treatment (adverse outcomes), Outcome 6 Maternal anemia.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Kumar 2009 {published data only}
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Lopez‐Jaramillo 1989 {published data only}
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Lopez‐Jaramillo 1997 {published data only}
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Niromanesh 2001 {published data only}
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Purwar 1996 {published data only}
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Raman 1978 {published data only}
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Rogers 1999 {published data only}
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Sanchez‐Ramos 1994 {published data only}
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Taherian 2002 {published data only}
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Villar 1987 {published data only}
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Villar 1990 {published data only}
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References to studies excluded from this review

Almirante 1998 {published data only}
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Asemi 2012 {published data only}
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Chames 2002 {published data only}
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Diogenes 2013 {published data only}
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Galimberti 2001 {published data only}
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Hammar 1981 {published data only}
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Janakiraman 2003 {published data only}
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Mazurkevich 2013 {published data only}
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References to studies awaiting assessment

Aghamohammady 2010 {published data only}
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    1. Aghamohammady A. The effect of calcium supplementation during pregnancy on preterm delivery in primiparous beyond age 35. Journal of Maternal‐Fetal and Neonatal Medicine 2010;23(S1):100.
Sulovic 2013 {published data only}
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References to other published versions of this review

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