Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review

• Autores: Cormick, Gabriela; Moraa, Hellen; Zahroh, Rana Islamiah; Allotey, John; Rocha, Thaís; Peña-Rosas, Juan Pablo; Qureshi, Zahida P; Hofmeyr, G Justus; Mistry, Hema; Smits, Luc; Vogel, Joshua Peter; Palacios, Alfredo; Gwako, George N; Abalos, Edgardo; Larbi, Koiwah Koi; Carroli, Guillermo; Riley, Richard; Snell, Kym IE; Thorson, Anna; Young, Taryn; Betran, Ana Pilar; Thangaratinam, Shakila; Bohren, Meghan A
• Año de publicación: 2023
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: Hypertension; OBSTETRICS; PUBLIC HEALTH
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

Objectives: Daily calcium supplements are recommended for pregnant women from 20 weeks´ gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia.Design: Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach.Data sources: MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022.Eligibility criteria: We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date.Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators.Results: Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium.Conclusion: Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions.Prospero registration number: CRD42021239143.
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. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Moraa, Hellen. University Of Nairobi; Kenia
Fil: Zahroh, Rana Islamiah. University of Melbourne; Australia
Fil: Allotey, John. The University Of Birmingham (tub);
Fil: Rocha, Thaís. The University Of Birmingham (tub);
Fil: Peña-Rosas, Juan Pablo. World Health Organization; Suiza
Fil: Qureshi, Zahida P. University Of Nairobi; Kenia
Fil: Hofmeyr, G Justus. University of the Witwatersrand; Sudáfrica. University of Botswana; Botsuana
Fil: Mistry, Hema. University of Warwick; Reino Unido
Fil: Smits, Luc. Universiteit Maastricht. Faculty Of Health Medicine And Life Sciences.; Países Bajos
Fil: Vogel, Joshua Peter. Burnet Institute; Australia
Fil: Palacios, Alfredo. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Gwako, George N. University Of Nairobi; Kenia
Fil: Abalos, Edgardo. Centro de Estudios de Estado y Sociedad; Argentina
Fil: Larbi, Koiwah Koi. Action On Preeclampsia; Ghana
Fil: Carroli, Guillermo. Centro Rosarino de Estudios Perinatales; Argentina
Fil: Riley, Richard. The University Of Birmingham (tub);
Fil: Snell, Kym IE. Keele University.; Reino Unido
Fil: Thorson, Anna. World Health Organization; Suiza
Fil: Young, Taryn. Stellenbosch University; Sudáfrica
Fil: Betran, Ana Pilar. World Health Organization; Suiza
Fil: Thangaratinam, Shakila. The University Of Birmingham (tub);
Fil: Bohren, Meghan A. University of Melbourne; Australia