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Review
. 2022 Oct;129(11):1833-1843.
doi: 10.1111/1471-0528.17222. Epub 2022 Jun 28.

Calcium for pre-eclampsia prevention: A systematic review and network meta-analysis to guide personalised antenatal care

Mai-Lei Woo Kinshella  1 , Catherine Sarr  2 , Akshdeep Sandhu  1 , Jeffrey N Bone  1 , Marianne Vidler  1 , Sophie E Moore  2   3 , Rajavel Elango  4 , Gabriela Cormick  5 , José M Belizan  5 , G Justus Hofmeyr  6   7 , Laura A Magee  1   2 , Peter von Dadelszen  1   2 ; PRECISE Network
Affiliations
Review

Calcium for pre-eclampsia prevention: A systematic review and network meta-analysis to guide personalised antenatal care

Mai-Lei Woo Kinshella et al. BJOG. 2022 Oct.

Abstract

Background: Calcium supplementation reduces the risk of pre-eclampsia, but questions remain about the dosage to prescribe and who would benefit most.

Objectives: To evaluate the effectiveness of high (≥1 g/day) and low (<1 g/day) calcium dosing for pre-eclampsia prevention, according to baseline dietary calcium, pre-eclampsia risk and co-interventions, and intervention timing.

Search strategy: CENTRAL, PubMed, Global Index Medicus and CINAHL, from inception to 2 February 2021, clinical trial registries, reference lists and expert input (CRD42018111239).

Selection criteria: Randomised controlled trials of calcium supplementation for pre-eclampsia prevention, for women before or during pregnancy. Network meta-analysis (NMA) also included trials of different calcium doses.

Data collection and analysis: Two independent reviewers extracted published data. The meta-analysis employed random-effects models and the NMA, a Bayesian random-effects model, to obtain direct and indirect effect estimates.

Main results: The meta-analysis included 30 trials (N = 20 445 women), and the NMA to evaluate calcium dosage included 25 trials (N = 15 038). Calcium supplementation prevented pre-eclampsia similarly with a high dose (RR 0.49, 95% CI 0.36-0.66) or a low dose (RR 0.49, 95% CI 0.36-0.65). By NMA, high-dose (vs low-dose) calcium did not differ in effect (RR 0.79, 95% CI 0.43-1.40). Calcium was similarly effective regardless of baseline pre-eclampsia risk, vitamin D co-administration or timing of calcium initiation, but calcium was ineffective among women with adequate average baseline calcium intake.

Conclusions: Low- and high-dose calcium supplementation are effective for pre-eclampsia prevention in women with low calcium intake. This has implications for population-level implementation where dietary calcium is low, and targeted implementation where average intake is adequate.

Tweetable abstract: A network meta-analysis of 25 trials found that low-dose calcium supplementation (<1 g/day) is as effective as high-dose calcium supplementation (≥1 g/day) in halving the risk of pre-eclampsia when baseline calcium intake is low.

Keywords: calcium; meta-analysis; network meta-analysis; pre-eclampsia; prevention; randomised controlled trials.

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References

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