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

• Autores: Woo Kinshella, Mai-Lei; Sarr, Catherine; Sandhu, Akshdeep; Bone, Jeffrey N.; Vidler, Marianne; Moore, Sophie E.; Elango, Rajavel; Cormick, Gabriela; Belizan, Jose; Hofmeyr, G. Justus; Magee, Laura A.; von Dadelszen, Peter
• Año de publicación: 2022
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: CALCIUM; META-ANALYSIS; NETWORK META-ANALYSIS; PRE-ECLAMPSIA; PREVENTION; RANDOMISED CONTROLLED TRIALS
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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.
Fil: Woo Kinshella, Mai-Lei. University of British Columbia; Canadá
Fil: Sarr, Catherine. Kings College London (kcl);
Fil: Sandhu, Akshdeep. University of British Columbia; Canadá
Fil: Bone, Jeffrey N.. University of British Columbia; Canadá
Fil: Vidler, Marianne. University of British Columbia; Canadá
Fil: Moore, Sophie E.. Kings College London (kcl);
Fil: Elango, Rajavel. University of British Columbia; Canadá
Fil: Cormick, Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Hofmeyr, G. Justus. University of the Witwatersrand; Sudáfrica. University of Walter Sisulu; Sudáfrica. University of Fort Hare; Sudáfrica. University of Botswana; Botsuana
Fil: Magee, Laura A.. University of British Columbia; Canadá. Kings College London (kcl);
Fil: von Dadelszen, Peter. University of British Columbia; Canadá. Kings College London (kcl);