Study suggests lower calcium dose for pregnant women

Dar es Salaam. A ground-breaking study suggests a significant shift in how calcium supplementation is prescribed to pregnant women in low- and middle-income countries (LMICs).
The research, titled “Calcium Breakthrough in India-Tanzania,” reveals that a single 500mg calcium tablet daily appears equally effective as the currently recommended 1,500mg (three tablets) in preventing preeclampsia and preterm birth.
The two complications are common during pregnancy and contribute to maternal and newborn deaths. The study involved two trials that enrolled 22,000 pregnant women in India and Tanzania (11,000 in each country) and was conducted by researchers from Muhimbili University of Health and Allied Sciences (MUHAS), Africa Academy for Public Health (AAPH), and Ifakara Health Institute (IHI) in collaboration with colleagues from Harvard TH Chan School of Public Health in the USA and St. John’s Research Institute in India. 
“Since the findings show that providing a single calcium pill to pregnant women is as effective as providing three pills, there is a need to revisit the recommendation of high-dose calcium supplementation to enable most low- and middle-income countries (LMICs) to afford and implement this important intervention for reduction of preeclampsia and preterm birth, which is essential for countries to attain maternal and child mortality targets of the United Nations Sustainable Development Goals by 2030,” said joint first author Alfa Muhihi from the Africa Academy for Public Health, who coordinated the Tanzania trial. 
According to the study, in the Tanzania trial, the incidence of preeclampsia was 3.0 percent among women taking 500mg of calcium per day and 2.7 percent among women taking 1,500mg of calcium per day.
In the India trial, the incidence of preeclampsia was 3.0 percent and 3.6 percent, respectively. 
Commenting on the high calcium supplementation dose, the principal investigator of the study, Andrea Pembe, professor of obstetrics and gynaecology at Muhimbili University of Health and Allied Sciences (MUHAS), said reducing the number of pills will improve uptake by pregnant women and reduce cost for the government, thus enabling pregnant women in low- and middle-income countries (LMICs) to receive the important intervention.
“It has been challenging for most low- and middle-income countries like Tanzania to implement the high calcium supplementation dose recommended by the World Health Organisation (WHO) because of the high cost of the supplements for governments and public health programmes, as well as concern about pill burden as pregnant women are required to take three calcium pills per day in addition to iron-folic acid supplements,” said Prof Pembe. The WHO currently recommends high-dose calcium supplementation (1,500 mg–2,000 mg per day), equivalent to 3–4 calcium pills per day, for pregnant women in populations with low intakes of dietary calcium, predominantly in LMICs. 
Other Tanzania co-authors included Dr Honorati Masanja (Ifakara Health Institute), Dr Mary Mwanyika Sando (Africa Academy for Public Health), Dr Alfa Muhihi (Africa Academy for Public Health), Mr Shabani Kinyogoli (Africa Academy for Public Health), Mr Mohamed Bakari (Muhimbili University of Health and Allied Sciences), and Dr Ndeniria Swai (Dar es Salaam Regional Medical Office of Health).

The study was funded by the Bill & Melinda Gates Foundation, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Canadian Institutes of Health Research Fellowship.