Study proposes reduced calcium intake for pregnant mothers

Pregnant women may find a simpler and more affordable solution to protect themselves and their infants from potentially life-threatening complications, according to a study conducted across India and Tanzania.

A single daily calcium pill is just as effective as the current three-pill regimen in preventing complications such as preeclampsia and preterm birth, according to research led by the Harvard T.H. Chan School of Public Health and collaborators in both countries.

Preeclampsia, characterised by high blood pressure and protein in the urine during pregnancy, poses serious risks to both the mother and the baby.

Preterm birth, the delivery before 37 weeks of gestation, can result in increased maternal and infant mortality, along with long-term health problems.

An alarming number of 13.4 million infants globally were born prematurely in 2020, and close to 1 million of these succumbed to early birth complications. This is according to a freshly unveiled report by United Nations affiliates.

The current World Health Organisation (WHO) recommendation for pregnant women with low dietary calcium intake is 1,500 to 2,000 milligrammes of calcium daily in three divided doses. However, adherence to this regimen can be challenging due to the bulkiness of the pills and logistical difficulties.

Christopher Sudfeld, an associate professor at Harvard Chan and the author of the study, emphasised the significance of the findings, stating, "Our findings show that a single pill per day can be as effective as three."

The researchers shared these results on January 19, 2024, during the 5th ARISE Network Annual Scientific Symposium in Dar es Salaam, Tanzania, under the theme "Bridging the Gap: Turning adolescent health and nutrition research into tangible practice and policy in sub-Saharan Africa."

Sudfeld stated that calcium supplementation, with its reduced pill burden for women and lower costs for governments and programmes that purchase calcium pills, should be widely implemented in the areas where it is most needed, ultimately saving thousands of maternal and newborn lives.

Comparison

The study enrolled over 22,000 pregnant women in India and Tanzania and compared the outcomes of those who received the standard three-pill regimen with those who received a single 500-mg pill.

The researchers monitored the participants' health throughout their pregnancies, focusing on the incidence of preeclampsia and preterm birth.

The results were particularly striking. In both India and Tanzania, the single-pill group showed no significant difference in preeclampsia rates compared to the three-pill group.

While the findings on preterm birth varied between the two countries, the overall pooled data showed no significant difference either.

However, the researchers cautioned that confirming these findings in different populations and exploring the long-term effects of varying calcium supplementation levels require additional research.

Policy changes

Key policymakers, including Minister of Health Ummy Mwalimu, members of Parliament, stakeholders from CDC Tanzania, the United States Embassy in Tanzania, and various health organisations received the study results.

The hope is that these findings will pave the way for policy changes that make a single calcium pill a powerful tool for improving maternal and infant health outcomes globally.

Funded by the Bill and Melinda Gates Foundation, the study's collaboration involved St. Johns Institute in India and several institutions in Tanzania, including Muhimbili University of Health and Allied Sciences (MUHAS), Ifakara Health Institute (IHI), and Africa Academy for Public Health (AAPH).

Mary Mwanyika, CEO of the Africa Academy for Public Health (AAPH), highlighted the challenges of calcium uptake, citing the bulkiness and cost of the pills.

The study, conducted over five years due to disruptions caused by the COVID-19 pandemic, demonstrated the potential benefits of a simpler approach to calcium supplementation, as explained by her.

Professor Andrea Pembe, a renowned gynaecologist and former Vice Chancellor of MUHAS, led the study in Tanzania. Presenting the recommendations of the clinical trials at the symposium,

Prof. Pembe urged a reevaluation of high-dose calcium supplementation recommendations to enable developing countries like Tanzania to implement calcium supplementation during pregnancy effectively.

"These are our recommendations, and we expect other institutions such as the WHO and the Ministry of Health to take them forward," said Prof. Pembe.