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. 2018 Jan;14(1):e12479.
doi: 10.1111/mcn.12479. Epub 2017 Jun 18.

Should women be advised to use calcium supplements during pregnancy? A decision analysis

Linda J E Meertens  1 , Hubertina C J Scheepers  2 , Jessica P M M Willemse  3 , Marc E A Spaanderman  2 , Luc J M Smits  1
Affiliations

Should women be advised to use calcium supplements during pregnancy? A decision analysis

Linda J E Meertens et al. Matern Child Nutr. 2018 Jan.

Abstract

Adequate calcium intake during pregnancy is important in the prevention of pre-eclampsia. A substantial proportion of pregnant women do not meet the recommended daily calcium intake, even in developed countries. Nonetheless, calcium supplementation is not routinely advised to pregnant women in most countries. We aimed to predict the impact of advising pregnant women to use calcium supplements (1,000 mg/day) on the number of cases of pre-eclampsia prevented and related health care costs. By use of a decision-analytic model, we assessed the expected impact of advising calcium supplementation to either (1) all pregnant women, (2) women at high risk of developing pre-eclampsia, or (3) women with a low dietary calcium intake compared with current care. Calculations were performed for a hypothetical cohort of 100,000 pregnant women living in a high-income country, although input parameters of the model can be adjusted so as to fit other settings. The incidence of pre-eclampsia could be reduced by 25%, 8%, or 13% when advising calcium supplementation to all pregnant women, women at high risk of pre-eclampsia, or women with a low dietary calcium intake, respectively. Expected net financial benefits of the three scenarios were of €4,621,465, €2,059,165, or €2,822,115 per 100,000 pregnant women, respectively. Advising pregnant women to use calcium supplements can be expected to cause substantial reductions in the incidence of pre-eclampsia as well as related health care costs. It appears most efficient to advise calcium supplementation to all pregnant women, not subgroups only.

Keywords: calcium supplementation; decision analysis; impact; pre-eclampsia.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Decision tree comparing current care with advising calcium supplementation (1,000 mg/day) to different scenarios in the prevention of pre‐eclampsia. PE = pre‐eclampsia. Legend: The decision tree illustrates the comparison of current care with advising calcium supplementation (1,000 mg/day) to (1) all pregnant women, (2) women at high risk of developing pre‐eclampsia, or (3) women with a low dietary intake (<900 mg/day) in the prevention of pre‐eclampsia
Figure 2
Figure 2
Tornado diagrams of one‐way sensitivity analyses results for prevented cases of pre‐eclampsia and net financial impact, per 100,000 pregnant women. Legend: The vertical line in the center of the chart represents the prevented cases of pre‐eclampsia or net financial impact for the base‐case values. The bars show the variation of input parameters within plausible ranges
See this image and copyright information in PMC

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