Calcium plus linoleic acid therapy for pregnancy-induced hypertension. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg) Calcium Supplementation During Pregnancy for Preventing Hypertensive Disorders Is not Associated with Changes in Platelet Count, Urate, and Urinary Protein: a Randomized Control Trial Cluster-Randomized Non-Inferiority Trial to Compare Supplement Consumption and Adherence to Different Dosing Regimens for Antenatal Calcium and Iron-Folic Acid Supplementation to Prevent Preeclampsia and Anaemia: Rationale and Design of the Micronutrient Initiative Study Effects of calcium supplementation on fetal growth in mothers with deficient calcium intake: a randomised controlled trial. Effect of calcium and vitamin D supplementation on toxaemia of pregnancy. Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers: a randomized, placebo-controlled trial. Randomized, placebo-controlled, calcium supplementation study in pregnant Gambian women: effects on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion in the first year of life. Calcium supplementation on normotensive and hypertensive pregnant women. Effect of maternal calcium supplementation on offspring blood pressure in 5- to 10-y-old rural Gambian children123 Gestational calcium supplementation and blood pressure in the offspring. Aspirin plus calcium supplementation to prevent superimposed preeclampsia: a randomized trial Maternal calcium supplementation during pregnancy and dental caries of children at 12 years of age: follow‐up of a randomized controlled trial Calcium supplementation in pre-eclampsia. Prevention of Preeclampsia by Linoleic Acid and Calcium Supplementation: A Randomized Controlled Trial Eclampsia and abnormal QTc. Calcium supplementation for the prevention of pre-eclampsia. Calcium supplementation reduces blood pressure during pregnancy: results of a randomized controlled clinical trial. Randomized, placebo-controlled, calcium supplementation trial in pregnant Gambian women accustomed to a low calcium intake: effects on maternal blood pressure and infant growth1234 Effect of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake123 Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants Calcium Supplementation and the Risk of Preeclampsia in Ecuadorian Pregnant Teenagers Calcium supplementation during pregnancy may reduce preterm delivery in high-risk populations. Prevention of Pregnancy‐Induced Hypertension by Calcium Supplementation in Angiotensin II‐Sensitive Patients World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural gambia: 5 year randomised controlled trial The effect of calcium supplementation on blood pressure in non-pregnant women with previous pre-eclampsia: An exploratory, randomized placebo controlled study. Calcium supplementation and prevention of pregnancy induced hypertension. Preliminary evidence of the effect of calcium supplementation on blood pressure in normal pregnant women. Effects of calcium supplementation on uteroplacental and fetoplacental blood flow in low-calcium-intake mothers: a randomized controlled trial. Maternal preeclampsia is associated with an increased risk of retinopathy of prematurity Bioavailability of enteric-coated microencapsulated calcium during pregnancy: a randomized crossover trial in Bangladesh. Random urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with preeclampsia. Trial of Calcium for Preeclampsia Prevention (CPEP): rationale, design, and methods. The prediction of adverse maternal outcomes in preeclampsia. Supplementary calcium in prevention of pre-eclampsia. Calcium Supplementation in Mild Preeclampsia Remote From Term: A Randomized Double‐Blind Clinical Trial Calcium and low-dose aspirin prophylaxis in women at high risk of pregnancy-induced hypertension. Prevention of hypertensive disorders of pregnancy. ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women Impact of calcium supplementation in the preceding pregnancy on the human milk calcium concentration of Gambian women. Calcium and conjugated linoleic acid reduces pregnancy-induced hypertension and decreases intracellular calcium in lymphocytes. Long term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trial The measuring of blood pressure during pregnancy. Calcium-to-Creatinine Ratio in a Spot Sample of Urine, for Early Prediction of Hypertensive Disorders of Pregnancy: A Prospective Study Calcium supplementation during pregnancy for reducing pregnancy induced hypertension. Lower Rate of Preeclampsia After Antioxidant Supplementation in Pregnant Women with Low Antioxidant Status Calcium supplementation reduces the risk of pregnancy‐induced hypertension in an Andes population Pregnancy-induced hypertension and low birth weight: the role of calcium. Nutritional supplementation during pregnancy and offspring cardiovascular disease risk in The Gambia. Biochemical changes associated with blood pressure reduction induced by calcium supplementation during pregnancy. A Randomized Controlled Trial of the Effect of Third‐Trimester Calcium Supplementation on Maternal Hemodynamic Function [Prevention of gestational hypertension with calcium, linoleic acid, mono and polyunsaturated fatty acid supplements]. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women
OBJECTIVE To determine the effect of dietary supplementation of calcium plus conjugated linoleic acid ( calcium-CLA ) in reducing the incidence of vascular endothelial dysfunction in pregnant women at high risk of developing pregnancy-induced hypertension ( PIH ) . PATIENTS AND METHODS This r and omized , double-blind , placebo-controlled trial conducted at 4 outpatient clinics in 2 developing countries recruited 48 healthy primigravidas younger than 19 years or older than 35 years who had a family history of pre-eclampsia and diastolic notch . Twenty-four participants received daily elemental calcium ( 600 mg ) plus CLA ( 450 mg ) and 24 received placebo from week 18 to 22 of pregnancy until delivery . RESULTS Calcium-CLA supplementation reduced significantly the incidence of PIH ( 2 cases [ 8 % ] in the study group vs. 10 cases [ 42 % ] in the placebo group ; relative risk , 0.20 ; 95 % confidence interval , 0.05 - 0.82 ; P=.01 ) . Endothelial dysfunction was also significantly reduced after calcium-CLA supplementation ( in 18 women [ 75 % ] vs. 4 women [ 17 % ] ; P<.001 ) , compared with the placebo group ( in 15 [ 63 % ] vs. 9 women [ 38 % ] ; P=.08 ) . CONCLUSION In pregnant women at high risk for PIH , calcium-CLA supplementation decreases the incidence of PIH and improves endothelial function Background It has been suggested that a higher calcium intake might favourably modify cardiovascular risk factors . However , findings of an ultimately decreased risk of cardiovascular disease ( CVD ) are limited . Instead , recent evidence warns that taking calcium supplements might increase myocardial infa rct ion ( MI ) risk . Objective To prospect ively evaluate the associations of dietary calcium intake and calcium supplementation with MI and stroke risk and overall CVD mortality . Methods Data from 23 980 Heidelberg cohort participants of the European Prospect i ve Investigation into Cancer and Nutrition study , aged 35–64 years and free of major CVD events at recruitment , were analysed . Multivariate Cox regression models were used to estimate HRs and 95 % CIs . Results After an average follow-up time of 11 years , 354 MI and 260 stroke cases and 267 CVD deaths were documented . Compared with the lowest quartile , the third quartile of total dietary and dairy calcium intake had a significantly reduced MI risk , with a HR of 0.69 ( 95 % CI 0.50 to 0.94 ) and 0.68 ( 95 % CI 0.50 to 0.93 ) , respectively . Associations for stroke risk and CVD mortality were overall null . In comparison with non-users of any supplements , users of calcium supplements had a statistically significantly increased MI risk ( HR=1.86 ; 95 % CI 1.17 to 2.96 ) , which was more pronounced for calcium supplement only users ( HR=2.39 ; 95 % CI 1.12 to 5.12 ) . Conclusions Increasing calcium intake from diet might not confer significant cardiovascular benefits , while calcium supplements , which might raise MI risk , should be taken with caution Objective . To test the hypothesis that calcium supplementation inhibits the underlying pathological processes in women with preeclampsia . Methods . Seven hundred and eight nulliparous women were enrolled in a WHO r and omized double-blind trial , who received 1.5 g of calcium or placebo from 20 weeks of pregnancy or earlier . Platelet count , serum urate , and urinary protein/creatinine ratio were measured at or near 35 gestational weeks . Results . No difference was detected in rates of abnormal platelet count ( relative risk [ RR ] 1.18 ; 95 % confidence interval [ CI ] , 0.63 to 2.18 ) , serum urate level ( 1.0 ; 0.64 to 1.57 ) or urine protein/creatinine ratio ( 1.01 ; 0.76 to 1.34 ) . This was consistent with the main trial finding of no difference in the incidence of ‘ dipstick ’ proteinuria between women receiving calcium and those receiving placebo ( 8312 women ; RR , 1.01 ; 95 % CI , 0.88 to 1.15 ) . Conclusions . An effect of calcium supplementation in the second half of pregnancy on the rate of abnormal laboratory measures associated with preeclampsia was not demonstrated Background : To prevent pre-eclampsia in population s with insufficient dietary calcium ( Ca ) intake , the World Health Organisation ( WHO ) recommends routine Ca supplementation during antenatal care ( ANC ) . WHO guidelines suggest a complex dosing regimen , requiring as many as 5 pill-taking events per day when combined with iron and folic acid ( IFA ) supplements . Poor adherence may undermine public health effectiveness , so simpler regimens may be preferable . This trial will compare the effect of the WHO-recommended ( higher-dose ) regimen vs. a simpler , lower-dose regimen on supplement consumption and pill-taking behaviours in Kenyan ANC clients . Design and methods : This is a parallel , non-inferiority , cluster-r and omized trial ; we examined 16 primary care health facilities in Kenya , 1047 pregnant women between 16 - 30 weeks gestational age . Higher-dose regimen : 1.5 g elemental calcium in 3 separate doses ( 500 mg Ca/pill ) and IFA ( 60 mg Fe + 400 µg folic acid ) taken with evening dose . Lower-dose regimen : 1.0 g calcium in 2 separate doses ( 500 mg Ca/pill ) with IFA taken as above . Measurements : Primary outcome is Ca pills consumed per day , measured by pill counts . Secondary outcomes include IFA pills consumed per day , client knowledge , motivation , social support , and satisfaction , measured at 4 to 10 weeks post-enrolment . Statistical analyses : Unit of r and omization is the healthcare facility ; unit of analysis is individual client . Intent-to-treat analysis will be implemented with multi-level models to account for clustering . Expected public health impact : If pregnant women prescribed lower doses of Ca ingest as many pills as women prescribed the WHO-recommended regimen , developing a lower-dose recommendation for antenatal Ca and IFA supplementation programs could save re sources . Significance for public health Pre-eclampsia is a leading cause of maternal mortality . Based on clinical evidence of significant reduction in risk of pre-eclampsia , the WHO recommends including calcium ( Ca ) supplementation in antenatal care services in setting s with inadequate dietary Ca intakes . A high daily amount of Ca administered in a complex dosing regimen is recommended to maximize efficacy and bioavailability . Factors such as client adherence , motivation , cost and logistical complexities may undermine effectiveness when implemented in public health programs . This cluster-r and omized trial will compare Ca supplement consumption between higher and lower-dose regimens delivered through antenatal care in Kenya , integrated with iron-folic acid supplementation . If a lower-dose regimen improves adherence , women ’s Ca supplement consumption may be comparable to that achieved under a complex , higher-dose regimen . Evidence gained from this trial will guide public health planning for antenatal calcium supplementation programs to maximize benefits through reducing logistical , cost and adherence barriers Calcium supplementation in mothers with low calcium intake has been of interest recently because of its association with optimal fetal growth and improved pre-eclampsia-related outcomes . While the effects of calcium supplementation have demonstrated benefits in prolonging gestation and subsequently improving birthweight , no specific studies have identified the longitudinal effects of supplementation on fetal growth in utero . Data were analysed in the context of the World Health Organization trial of calcium supplementation in calcium-deficient women . Five hundred and ten healthy , primiparous pregnant Argentinean women were r and omised ( at < 20 weeks gestation ) to either placebo  ( n = 230 ) or  calcium supplements ( 1500 mg calcium/day in 3 divided doses ; n = 231 ) . Growth parameters in utero were assessed with serial ultrasound scans . Birthweight , length , head , abdominal and thigh circumferences were recorded at delivery . No differences were found in fetal biometric measurements recorded at 20 , 24 , 28 , 32 and 36 weeks gestation between fetuses of women who were supplemented with calcium and those who were not . Similarly , neonatal characteristics and anthropometric measurements recorded at delivery were comparable in both groups . We conclude that calcium supplementation of 1500 mg calcium/day in pregnant women with low calcium intake does not appear to impact on fetal somatic or skeletal growth To study the effect of calcium and vitamin D supplementation on the incidence of toxaemia of pregnancy , 200 r and omly selected pregnant women ( supplemented group ) , were put on calcium ( 375 mg/day ) and vitamin D ( 1,200 IU/day ) supplements at 20 - 24 weeks of pregnancy onwards . Another 200 pregnant women constituted the non-supplemented group . At 32 and 36 weeks of pregnancy the systolic and diastolic blood pressure of non-toxemic women was significantly lower in the supplemented group than in the non-supplemented group . However , the incidence of toxaemia in the supplemented group ( 6 % ) was not significantly different from that in the non-supplemented group ( 9 % ) BACKGROUND Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass . OBJECTIVE We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets ( ∼600 mg/d ) . DESIGN Pregnant adolescents ( 14 - 19 y ) r and omly received daily calcium ( 600 mg ) plus vitamin D3 ( 200 IU ) ( n = 30 ) or a placebo ( n = 26 ) from 26 wk of pregnancy ( baseline ) until parturition . The bone mineral content ( BMC ) , bone area ( BA ) , and bone mineral density ( BMD ) at the total body , lumbar spine , and hip ( total and femoral neck ) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum . Serum hormones and 25-hydroxyvitamin D [ 25(OH)D ] were measured . Group comparisons were adjusted for significant covariates . RESULTS The mean serum 25(OH)D concentration was 59 nmol/L at baseline . In comparison with the placebo , 25(OH)D tended to be 14 - 15 nmol/L higher postpartum in the supplemented group ( P = 0.08 ) . Total body and hip BMC and BMD decreased over time ( P ≤ 0.005 ) in both groups with a group × time interaction at the femoral neck ( P < 0.04 ) . Supplemented mothers had higher lumbar spine BA ( 6.7 % ; P = 0.002 ) and lumbar spine BMC ( 7.9 % , P = 0.08 ) than did mothers who consumed the placebo at 5 wk postpartum . At 20 wk postpartum , differences between groups were more evident , with higher lumbar spine BMC ( 13.9 % ) , lumbar spine BA ( 6.2 % ) , and lumbar spine BMD ( 10.6 % ) in the supplemented group ( P ≤ 0.008 ) . CONCLUSIONS Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake  results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation . Additional studies are required to determine whether bone effects are temporary or long-lasting . This trial was registered at clinical trials.gov as NCT01732328 BACKGROUND Growth and bone mineral accretion in Gambian infants are poorer than those in Western population s. The calcium intake of Gambian women is low , typically 300 - 400 mg Ca/d , and they have low breast-milk calcium concentrations , which result in low calcium intakes for their breastfed infants . A low maternal calcium supply in pregnancy may limit fetal mineral accretion and breast-milk calcium concentrations and thereby affect infant growth and bone mineral accretion . OBJECTIVE We investigated the effects of calcium supplementation in Gambian women during pregnancy on breast-milk calcium concentrations and infant birth weight , growth , and bone mineral accretion . DESIGN A r and omized , double-blind , placebo-controlled supplementation study was conducted in 125 Gambian women who received 1500 mg Ca/d ( as calcium carbonate ) or placebo from 20 wk of gestation until delivery . Infant birth weight and gestational age were recorded . Breast milk was collected , and infant anthropometric and bone measurements were performed at 2 , 13 , and 52 wk after delivery . Infant bone mineral status was assessed by using single-photon absorptiometry of the radius and whole-body dual-energy X-ray absorptiometry . RESULTS Compliance with the supplement was high . No significant differences were detected between the groups in breast-milk calcium concentration , infant birth weight , or growth or bone mineral status during the first year of life . A slower rate of increase in infant whole-body bone mineral content and bone area was found in the supplement group than in the placebo group ( group x time interaction : P = 0.03 and 0.02 , respectively ) . CONCLUSION Calcium supplementation of pregnant Gambian women had no significant benefit for breast-milk calcium concentrations or infant birth weight , growth , or bone mineral status in the first year of life Normotensive and hypertensive pregnant women participated in a study to determine the effects of calcium supplementation on  blood pressure .  Subjects were r and omly assigned to control or supplemented groups ( 1000 mg Ca/d ) . Blood pressure and serum total and ionic calcium were measured during the 20-wk supplementation period . Calcium supplementation had a significant lowering effect on diastolic blood pressure over the course of the study in the hypertensive group only . The hypertensive control subjects ' mean serum ionic calcium value decreased significantly ( P less than 0.05 ) over the course of the experiment . A significant ( P less than 0.05 ) inverse relationship was observed between dietary calcium intake and blood pressure ( r = -0.386 for systolic pressure and -0.359 for diastolic pressure ) Background : Evidence suggests that increased maternal calcium intake during pregnancy may result in lower offspring blood pressure , prompting calls for more robust data in this field , particularly in setting s of habitually low calcium intake . Objective : The objective was to investigate the effect of maternal calcium supplementation on blood pressure in offspring by recruiting children born after a r and omized , double-blind , placebo-controlled trial of  calcium  supplementation during pregnancy . Design : Children ( n = 389 ) from a rural area of The Gambia ( mean age : 7.4 ± 1.2 y ; range : 5–10 y ) , whose mothers received a calcium supplement ( 1500 mg Ca/d from 20 wk of gestation until delivery )  or placebo , were followed up in West Africa . Blood pressure was assessed under st and ardized conditions with use of the Omron 705IT automated oscillometric device ( Morton Medical Ltd , London , United Kingdom ) , and anthropometric and body composition ( bioelectrical impedance ) measurements were also made . Results : The analysis was restricted to 350 children born at term , which represented 64 % of original trial births . There was no difference in systolic ( adjusted mean difference : −0.04 mm Hg ; 95 % CI : −1.78 , 1.69 mm Hg ) or diastolic ( adjusted mean difference : 0.25 mm Hg ; 95 % CI : −1.27 , 1.77 mm Hg ) blood pressure between children whose mothers had received calcium and those who received placebo . No interaction between childhood body mass index ( in kg/m2 ; mean : 14.0 ) and maternal calcium supplementation was observed in this study . Conclusion : Calcium supplementation in the second half of pregnancy in Gambian women with very low habitual calcium intakes may not result in lower offspring blood pressure at 5–10 y of age BACKGROUND The current study examined the relationship between calcium supplementation  during pregnancy and blood pressure ( BP ) in the mother and offspring at 3 months and at 2 years postpartum . METHODS Nulliparous pregnant women were assigned to either receive 2 g of calcium or placebo daily beginning between weeks 13 to 21 of gestation and continuing until delivery . Blood pressure was measured in children and their mothers at 3 months ( n = 260 ) and ( n = 57 ) at 2 years postpartum . Systolic BP was measured in the infants using a sphygmomanometer with ultrasonic amplification . For the toddlers , three supine BP measurements were taken from the right arm using a Critikon automated sphygmomanometer just after measurement of left ventricular wall thickness . RESULTS Systolic BP in the calcium-supplemented infants was 2.2 mm Hg lower than in the placebo group ( P > .05 ) . At 2 years of age , systolic BP was 4.8 mm Hg lower in the calcium supplemented group ( P < .05 ) , whereas diastolic BP was 3 mm Hg lower ( P > .05 ) . There was no difference in left ventricular mass index between groups , although there was a significant correlation between systolic BP and wall thickness ( P < .05 ) . Maternal BP was positively correlated with circulating 1,25(OH)(2)D3 ( P < .001 ) but did not differ between calcium groups at 3 months postpartum . CONCLUSIONS The data on BP in the children are in agreement with previous studies and argue strongly for additional research into the effects of prenatal calcium supplementation on BP regulation in the offspring Preeclampsia is an important cause of maternal and perinatal morbidity and mortality . Previous studies have tested calcium supplementation and aspirin separately to reduce the incidence of preeclampsia but not the effects of combined supplementation . The objective of this study was to investigate the effectiveness of aspirin combined with calcium supplementation to prevent preeclampsia in women with chronic hypertension . A double-blind , placebo-controlled r and omized clinical trial was carried out at the antenatal clinic of a large university hospital in São Paulo , SP , Brazil . A total of 49 women with chronic hypertension and abnormal uterine artery Doppler at 20 - 27 weeks gestation were r and omly assigned to receive placebo ( N = 26 ) or 100 mg aspirin plus 2 g calcium ( N = 23 ) daily until delivery . The main outcome of this pilot study was development of superimposed preeclampsia . Secondary outcomes were fetal growth restriction and preterm birth . The rate of superimposed preeclampsia was 28.6 % lower among women receiving aspirin plus calcium than in the placebo group ( 52.2 vs 73.1 % , respectively , P=0.112 ) . The rate of fetal growth restriction was reduced by 80.8 % in the supplemented group ( 25 vs 4.8 % in the placebo vs supplemented groups , respectively ; P=0.073 ) . The rate of preterm birth was 33.3 % in both groups . The combined supplementation of aspirin and calcium starting at 20 - 27 weeks of gestation produced a nonsignificant decrease in the incidence of superimposed preeclampsia and fetal growth restriction in hypertensive women with abnormal uterine artery Doppler Objectives . To evaluate if calcium supplementation during pregnancy could have any influence on primary dentition measured as the reduction of  dental caries of the child . Design . Individual r and omized controlled trial . Setting . One hospital in Rosario , Argentina . Population . R and om sample of 195 12‐year‐old children from a follow‐up study of 614 women who were r and omized during pregnancy to calcium supplementation or placebo .  Methods . An independent research er blinded to the group where the mothers were assigned performed a dental examination of the children . Main outcome measures . Proportion of children with at least one decayed , missing or filled teeth ( DMFT/dmft ) and mean number of decayed , missing or filled surfaces ( DMFS/dmfs ) per children . Results . Ninety‐eight children were assessed in the calcium supplementation group and 97 in the placebo group . 63.3 % of the children whose mother took calcium supplementation had at least one DMFT/dmft compared to 86.6 % in the placebo group ( < 0.001 ) . The children whose mother received the intervention had a 27 % reduction in the risk of developing at least one DMFT/dmft ( RR : 0.73 , CI 95 % : [ 0.62 ; 0.87 ] ) . Conclusions . This study shows a modeling effect of calcium intake during pregnancy on dental caries of the offspring . At around 12 years of age children whose mothers received calcium supplementation when pregnant showed a significant reduction in dental caries OBJECTIVE The objective of this prospect i ve , open , r and omised trial was to determine the role of calcium supplementation in preventing pre-eclampsia . METHODS One hundred uncomplicated normotensive primigravidae were enrolled in the study before 20 weeks of pregnancy . Fifty each were r and omised to receive either two gram elemental calcium daily from 20 weeks of gestation to delivery ( study group ) or no calcium supplementation ( control group ) . Prior to 20 weeks of gestation each underwent a complete clinical and laboratory evaluation . Serum and urine calcium was measured first at 20 weeks of gestation and then at 24 - 28 weeks and at 32 - 36 weeks of pregnancy . RESULTS Patient characteristics at the start of therapy were similar in the two groups .  Blood pressure profile was similar throughout pregnancy in the groups . The incidence of pre-eclampsia was similar ( 18 % in the study group and 16 % in the control group ) , but severe pre-eclampsia was significantly less in the study group . There was no significant difference between the two groups with regards to intra- and postpartum characteristics , perinatal outcome and maternal or fetal side effects . Serum and urinary calcium levels did not differ between the two groups . CONCLUSION While calcium supplementation did not lower the incidence of pre-eclampsia it did reduce its severity Objective To determine the effect of low doses of linoleic acid and calcium on prostagl and in ( PG ) levels and the efficacy of this treatment in the prevention of preeclampsia . Methods In a r and omized , double-blind , placebo-controlled study we treated 86 primigravidas with risk factors for preeclampsia ( high biopsychosocial risk [ above 3 points ] , positive roll-over test , and high mean blood pressure [ above 85 mmHg ) ] with daily doses of either 450 mg linoleic acid and 600 mg calcium ( n = 43 ) or 450 mg starch and 600 mg lactose placebo ( n = 43 ) during the third trimester of pregnancy . Results Four women in the experimental group ( 9.3 % ) developed preeclampsia compared with 16 ( 37.2 % ) controls ( relative risk 0.25 , 95 % confidence interval 0.09 , 0.69 , P < .001 ) . The median serum levels of PGE2 after 4 weeks of treatment increased by 106 % in the experimental group ( P = .03 ) and decreased by 33 % in the control group ( P = .02 ) . The median ratio between thromboxane B2 and PGE2 decreased by 40 % in the experimental group ( P = .02 ) and increased by 18 % in the control group ( P = .14 ) . No significant differences were observed in the median ratio between thromboxane B2 and 6-keto PGF1α in either group . No serious maternal or neonatal side effects of treatment occurred in either group . Conclusion The administration of low daily doses of linoleic acid and calcium during the third trimester of pregnancy reduced the incidence of preeclampsia significantly in women at high risk , possibly by correcting the PGE2 levels BACKGROUND Abnormalities of calcium and magnesium metabolism are known risk factors for QT interval prolongation and have been reported in eclampsia . OBJECTIVE To determine if eclampsia is associated with QT abnormalities METHODS In a prospect i ve study , the  QT interval corrected for heart rate ( QTc ) , serum calcium , magnesium and potassium  were compared among 30 intrapartum eclamptics and 30 age , parity and gestational age-matched women with uncomplicated pregnancy RESULTS Primigravidae made up 93.3 % of patients . Mean age was 19.5+/-4.2 years Blood pressure was significantly higher among patients than controls ( 163.0+/-34.7mmHg versus 120.4+/-18.6mmHg systolic , p<0.05 ) and ( 104.7+/-15.2mmHg versus 79.6+/-10.7mmHg , p<0.05 ) . Heart rate ranged from 76 to 163 beats per minute ( bpm ) and 65 to 112bpm among patients and controls respectively . The corresponding QTc were 390 - 572 and 390 - 460 respectively . Compared to the controls , patients had significantly higher mean heart rate ( 121.1+/-24.9bpm versus 89.3+/-12.9bpm , p<0.05 ) and higher QTc ( 470.4+/-42.4 versus 436.3+/-17.7 ; p<0.05 ) . Compared to the controls , the eclamptics also had higher frequency of sinus tachycardia ( 90 % versus , 13.3 % ) Odd Radio ( OR ) = 29.57 ; 95 % Confidence Interval ( CI ) = 5,87 - 174.08 , p=0.00 ) , abnormal QTc ( 46.7 % versus 6.6 % , OR = 9.2 ; 95 % CI = 1.61 - 68.48 , p=0.01 ) and T-axis deviation ( 26.6 % versus 3.3 % , OR=10.55 , 95 % CI=1.2 - 244.3 , p=0.03 ) Serum calcium level was significantly lower among patients than controls ( 2.0+/-0.4mmol/L versus 2.3+/-0.2mmol/L , p<0.05 ) . The eclamptics had higher frequency of hypocalcaemia than the controls ( 40 % versus 6.6 % ; OR = 14 , 95 % Cl = 1.58 - 316.9 , p=0.01 ) . Serum magnesium , potassium , urea and creatinine levels were similar between the two groups . CONCLUSION Eclampsia is associated with abnormal QTc that may be related to maternal hypocalcaemia . Correction of electrolyte abnormalities and caution s about agents that have potential for QT prolongation are vital in the care of eclamptics OBJECTIVE To study the effect of calcium supplementation during pregnancy on blood pressure and maternal and neonatal outcomes . METHOD A total of 524 healthy primigravidas with a blood pressure less than 140/90 mm Hg were r and omly assigned between the 12th and 25th weeks to receive 2 g of elemental calcium or placebo and were followed-up until delivery . RESULTS The incidence of pre-eclampsia was significantly less in the calcium than in the placebo group ( 4.0 % vs 12.0 % ; odds ratio [ OR ] , 0.31 ; 95 % confidence interval [ CI ] , 0.15 - 0.63 ) ; the mean systolic and diastolic blood pressures at study completion were different in the calcium and placebo group ( P=0.007 and P=0.02 ) . The risk for preterm delivery was less in the calcium ( 7.0 % ) than in the placebo ( 12.7 % ) group ( OR , 0.51 ; 95 % CI , 0.28 - 0.93 ) . The mean baseline calcium intake was 313.83+/-203.25 mg/day ( range , 85.71 - 910.71 mg/day ) , which is lower than the recommended dietary intake of 1000 mg , and the 24-hour urinary calcium excretion was 130.82+/-67.44 mg/dL ( range , 40.5 - 387 mg/dL ) . CONCLUSION Calcium supplementation appears to reduce the occurrence of pre-eclampsia and preterm delivery in primigravidas who have a daily dietary calcium intake less than the recommended dietary allowances Fifty-two healthy pregnant women were enrolled in a double-blind , r and omized , controlled clinical trial . After the 26th week of gestation , the women were given either 1.5 g of elemental calcium per day or a placebo . Subjects in the calcium group , after adjustment for race and initial blood pressure ( BP ) , had a term mean systolic and diastolic BP value of 4 - 5 mmHg lower than those in the placebo group ( P less than .05 ) . The incidence of pregnancy-induced hypertension was 11.1 % in the placebo group and 4.0 % in the calcium group , a nonsignificant difference . Combining these values with previous data , we found a dose-effect relationship between calcium intake and BP reduction during the third trimester of pregnancy . Further research should be directed at underst and ing the mechanism of this effect and trying to demonstrate a reduction in pregnancy-induced hypertension with calcium supplementation in a larger population Background : Dietary calcium intake in rural Gambian women is very low ( ∼350 mg/d ) compared with international recommendations . Studies have suggested that calcium supplementation of women receiving low-calcium diets significantly reduces risk of pregnancy hypertension . Objective : We tested the effects on blood pressure ( BP ) of calcium carbonate supplementation ( 1500 mg Ca/d ) in pregnant , rural Gambian women . Design : The study was a r and omized , double-blind , parallel , placebo-controlled supplementation trial from 20 wk of gestation ( P20 ) until delivery ( calcium : n = 330 ; placebo ; n = 332 ) . BP and anthropometric measures were taken at P20 and then 4 weekly until 36 wk of gestation ( P36 ) , and infant anthropometric measures were taken at 2 , 13 , and 52 wk postdelivery . Results : A total of 525 ( calcium : n = 260 ; placebo : n = 265 ) women had BP measured at P36 and subsequently delivered a healthy term singleton infant . Mean compliance was 97 % , and urinary calcium measures confirmed the group allocation . At P20 , the mean ( ±SD ) systolic blood pressure ( SBP ) was 101.2 ± 9.0 and 102.1 ± 9.3 mm Hg , and diastolic blood pressure ( DBP ) was 54.5 ± 7.3 and 55.8 ± 7.8 mm Hg , in the calcium and placebo groups , respectively . The intention-to-treat analysis that was adjusted for confounders showed no significant effect of calcium supplementation on the change between P20 and P36 ( calcium compared with placebo ; mean ± SEM ) in SBP ( −0.64 ± 0.65 % ; P = 0.3 ) or DBP ( −0.22 ± 1.15 % ; P = 0.8 ) . There was no significant effect of supplementation on BP , pregnancy weight gain , weight postpartum , or infant weight , length , and other measures of growth . However , the comparability of the original r and omly assigned groups may have been compromised by the exclusion of 20.7 % of women from the final analysis . Conclusions : Calcium supplementation did not affect BP in pregnancy . This result may have been because the Gambian women were adapted to a low dietary calcium intake , and /or obesity , high gestational weight gain , high underlying BP , tobacco use , alcohol consumption , and sedentary lifestyles were rare . This trial was registered at the International St and ard R and omized Controlled Trial Register ( www.controlled-trials.com/m rct / ) as IS RCT N96502494 Background : Mobilization of maternal bone mineral partly supplies calcium for fetal and neonatal bone growth and development . Objective : We investigated whether pregnant women with low calcium intakes may have a more extensive skeletal response postpartum that may compromise their short- or long-term bone health . Design : In a subset of participants ( n = 125 ) in a double-blind , r and omized , placebo-controlled trial ( International Trial Registry : IS RCT N96502494 ) in pregnant women in The Gambia , West Africa , with low calcium intakes ( ≈350 mg Ca/d ) , we measured bone mineral status of the whole body , lumbar spine , and hip by using dual-energy X-ray absorptiometry and measured bone mineral status of the forearm by using single-photon absorptiometry at 2 , 13 , and 52 wk lactation . We collected blood and urine from the subjects at 20 wk gestation and at 13 wk postpartum . Participants received calcium carbonate ( 1500 mg Ca/d ) or a matching placebo from 20 wk gestation to parturition ; participants did not consume supplements during lactation . Results : Women who received the calcium supplement in pregnancy had significantly lower bone mineral content ( BMC ) , bone area ( BA ) , and bone mineral density ( BMD ) at the hip throughout 12 mo lactation ( mean ± SE difference : BMC = −10.7 ± 3.7 % , P = 0.005 ; BA = −3.8 ± 1.9 % , P = 0.05 ; BMD = −6.9 ± 2.6 % , P = 0.01 ) . The women also experienced greater decreases in bone mineral during lactation at the lumbar spine and distal radius and had biochemical changes consistent with greater bone mineral mobilization . Conclusions : Calcium supplementation  in pregnant women with low calcium intakes may disrupt metabolic adaptation and may not benefit maternal bone health . Further study is required to determine if such effects persist long term or elicit compensatory changes in bone structure Maternal vitamin D deficiency during pregnancy is a recognized risk factor for rickets and osteomalacia in infancy ( 1 ) . The circulating plasma concentration of 25-hydroxyvitamin D ( 25OHD ) , a long-lived metabolite of vitamin D , is used to judge vitamin D status ; values below 25 nmol/L are associated with an increased risk of rickets and osteomalacia ( 1 ) . There is evidence that a low maternal plasma 25OHD in pregnancy may influence the growth and bone mineral accrual of the offspring during foetal life , infancy and childhood . Positive associations have been reported between maternal  vitamin D  status in pregnancy and birthweight , birth length , length at 1 year and bone mineral accretion at 9 years ( 2–6 ) , although evidence is conflicting ( 7,8 ) . These relationships have been observed at concentrations of 25OHD higher than those associated with rickets and osteomalacia , and there are calls to raise the accepted lower threshold of vitamin D sufficiency for pregnant women , most recently to 80 nmol/L ( 9 ) . On a population basis , plasma 25OHD concentrations above 80 nmol/L are relatively uncommon in countries at temperate latitudes but are more common among people living in the tropics who have abundant skin sunshine exposure ( 10 ) . To contribute to the debate on the definition of vitamin D sufficiency in pregnancy , we have investigated the influence of maternal plasma 25OHD concentration on foetal and infant growth in a rural area of The Gambia , West Africa ( 13 ° N ) . In this region , there is tropical sunshine all year , the women are farmers who work out-of-doors for much of each day , and local female dress does not restrict regular sunshine exposure to the face , neck , shoulders , arms and feet , especially during farm work and gardening . The study was a secondary analysis of biochemical , anthropometric and bone data from a subset of 125 women and infants collected during a calcium supplementation study of blood pressure in pregnant Gambian women ( International Trial Registry : IS RCT N96502494 ) . No significant benefits for foetal and infant growth of maternal calcium supplementation were identified despite the low customary calcium intake in The Gambia ( 11 ) . The protocol , methods , maternal characteristics and infant data from the detailed study have been published ( 11 ) . Briefly , women from the rural villages of Keneba and M and uar , West Kiang , The Gambia were recruited at 20 weeks of pregnancy ( P20 ) and r and omized to a daily calcium supplement or a matching placebo tablet until parturition ( 1500 mg Ca as calcium carbonate and microcellulose-lactose , respectively ; Nycomed Pharma AS , Asker , Norway ) . Fasting , early morning blood was collected and anthropometry performed at P20 and 36 weeks of pregnancy ( P36 ) . The mean ( ± SD ) age , weight , height and dietary calcium intake of the women at P20 were 27.4 ± 7.5 years , 56.3 ± 6.7 kg , 1.61 ± 0.05 m and 356 ± 190 mg/day , respectively . The median parity ( range ) was 3 ( 0–10 ) . Infant birthweight was measured within 24 h of delivery . Weight , crown-heel length and head circumference were measured at 2 , 13 and 52 weeks postpartum . In addition , infant bone mineral content ( BMC ) , bone mineral density ( BMD ) and bone width ( BW ) or bone area ( BA ) , were measured by single photon absorptiometry of the midshaft radius ( Lunar SP2 , Lunar Corporation , Madison , WI , USA ) and , for a subset ( n = 44 , 47 and 52 at 2 , 13 and 52 weeks , respectively ) , by whole-body dual-energy X-ray absorptiometry ( Lunar DPX+ , software version 4.7b , Lunar Corporation ) . Plasma 25OHD was measured a using radioimmunometric assay ( Diasorin Ltd , Wokingham , Berks , UK ) , with assay performance monitored through the Vitamin D External Quality Assessment Scheme ( DEQAS ; Endocrine/Oncology Laboratory , Charing Cross Hospital , London , UK ) . The intra- and inter-assay coefficients of variation were 4 % and 100 ) ; possible trends in the data with p = 0.01–0.1 were noted . The analysis was conducted on 123 mother – infant pairs ; blood sample s from two subjects were not available . Mean ± SD 25OHD ( range ) was : P20 = 103 ± 25 ( 53–167 ) nmol/L ; P36 = 111 ± 27 ( 51–189 ) nmol/L. No subject had a 25OHD value < 50 nmol/L , 20 % and 16 % had 25OHD < 80 nmol/L , at P20 and P36 , respectively . There was a high degree of within-subject consistency in 25OHD at P20 and P36 ( 25OHDP36 = 33.2 + [ 0.79 ± 0.07] × 25OHDP20 , p ≤ 0.001 , R2 adjusted 51.5 % , n = 121 ) ; 11 % of women had 25OHD < 80 nmol/L at both P20 and P36 . The mean birthweight of the infants was 2.99 ± 0.36 kg . The infant anthropometric and bone measures during the first year are given in Table 1 . No significant relationships or trends in the data were observed between maternal 25OHD concentration using the values at P20 , P36 or the mean of the two and any of the following infant measures : birthweight , infant weight , length , head circumference , BMC , BW ( or BA ) , BMD and size-adjusted BMC of the midshaft radius and whole body at any time postpartum . This is illustrated in Figure 1 for birthweight as a function of maternal 25OHD concentration at P20 . Comparing the results for mothers with 25OHD above and below 80 nmol/L did not alter this finding . Table 1 Anthropometric and bone measures  of Gambian infants Figure 1 Lack of a significant relationship between infant birthweight and maternal vitamin D status at 20 weeks of pregnancy ( p = 0.8 ) . Multiple regression model included season , maternal height , weight , weight gain , supplement group and sex of the infant . No significant interaction between supplement group and maternal 25OHD concentration was observed for any infant variable . Trends in the data were observed in a few instances for a supplement group × 25OHD interaction among the bone measures but no consistent picture emerged and they were considered to have arisen by chance . We conclude that there is no evidence for an influence of vitamin D status during pregnancy on infant growth and bone mineral accrual in the conditions prevailing in The Gambia . The children in this study , as is common in this region of The Gambia ( 13 ) , were born small , grew well for the first months of life but experienced growth faltering during later infancy compared to Western children ( 11,14 ) , as demonstrated by their weight and length SDS . The 25OHD concentrations of the women were > 50 nmol/L in the second half of pregnancy , and no distinction could be drawn in infant outcomes between mothers with concentrations above or below 80 nmol/L. Thus , our study suggests that , for women with regular , adventitious UVB sunshine exposure and in situations where foetal and infant growth may be constrained by multiple factors , there would be no benefit for foetal and infant growth or bone mineral accrual in aim ing to increase the vitamin D status of individual mothers during pregnancy above 50 or 80 Objective To determine whether increased calcium intake ( 2 g/day ) in pregnancy is effective in reducing the risk of preeclampsia in pregnant teenagers . Methods The present study was a prospect i ve , r and omized , double-blind , controlled clinical trial . Two hundred sixty teenaged pregnant girls attending the Hospital Gíneco-Obstétrico Isidro Ayora in Quito , Ecuador , were included . Selection criteria were age less than 17.5 years , nulliparity , first prenatal visit before 20 weeks ' gestation , and residency in Quito ( 2800-m altitude ) . We used a table of r and om numbers to assign 125 girls to receive 2000 mg of elemental calcium daily , beginning at 20 weeks of gestation and continuing until delivery ; 135 women in the control group received a placebo .  Blood pressure ( BP ) was measured twice every 4 weeks until delivery and at 48 hours after delivery . The diagnosis of preeclampsia was defined as BP greater than 140/90 mmHg on at least two occasions more than 6 hours apart and proteinuria greater than 30 mg/dL ( over one cross by dipstick on two occasions 4 - 24 hours apart ) . Results The average daily calcium intake in this population was approximately 51 % of the Recommended Dietary Allowance . Calcium supplementation was associated with a significantly decreased risk of preeclampsia ( risk reduction 12.35 % ; P < .001 ) , with 3.2 % ( n = 4 ) developing preeclampsia in the treatment group versus 15.5 % ( n = 21 ) in the placebo group . Moreover , calcium supplementation led to a reduction in systolic BP of 9.1 mmHg and in diastolic BP of 6.0 mmHg . Conclusion These results suggest that calcium supplementation during pregnancy in population s with low calcium intake is a safe , effective , and inexpensive preventive measure that significantly reduces the risk of preeclampsia Results are presented of a r and omized , double-blinded controlled clinical trial of calcium supplementation ( 2.0 gm of elemental calcium as calcium carbonate ) and a placebo .  All participants were 17 years of age or less and clinical ly healthy . Patients were enrolled by the twenty third week of gestation . The mean duration of calcium supplementation or placebo was approximately 14 weeks . Treatment consisted of 2.8 ( + /- 1.5 ) tablets per day in the placebo group ( N = 95 ) and 3.0 ( + /- 1.4 ) tablets per day in the calcium group ( N = 94 ) . Dietary calcium intake was similar in both groups at about 1200 mg/day . The calcium group had a lower incidence of preterm delivery ( less than 37 weeks ; 7.4 % vs 21.1 % ; p = 0.007 ) ; spontaneous labor and preterm delivery ( 6.4 % vs 17.9 % ; p = 0.01 ) ; and low birth weight ( 9.6 % vs 21.1 % ; p = 0.03 ) . This effect was also present after stratified analysis by level of treatment compliance , urinary tract infection , and chlamydial infection . Life-table analysis demonstrated an overall shift to a higher gestational age in the calcium group compared with the placebo group ( log-rank test , p = 0.02 ) . As suggested previously , the observed effect could be mediated by a reduction in uterine smooth muscle contractibility . If confirmed by future research , these results could represent an important preventive intervention for prematurity in high-risk population Objective To evaluate the efficacy of oral supplemental calcium in reducing the incidence of pregnancy-induced hypertension ( gestational hypertension or preeclampsia ) in angiotensin-sensitive nulliparas OBJECTIVE The purpose of this trial was to determine whether calcium supplementation of pregnant women with low calcium intake reduces  preeclampsia and preterm delivery . STUDY DESIGN R and omized placebo-controlled , double-blinded trial in nulliparous normotensive women from population s with dietary calcium < 600 mg/d . Women who were recruited before gestational week 20 received supplements ( 1.5 g calcium/d or placebo ) throughout pregnancy . Primary outcomes were preeclampsia and preterm delivery ; secondary outcomes focused on severe morbidity and maternal and neonatal mortality rates . RESULTS The groups comprised 8325 women who were assigned r and omly . Both groups had similar gestational ages , demographic characteristics , and blood pressure levels at entry . Compliance were both 85 % and follow-up losses ( calcium , 3.4 % ; placebo , 3.7 % ) . Calcium supplementation was associated with a non-statistically significant small reduction in preeclampsia ( 4.1 % vs 4.5 % ) that was evident by 35 weeks of gestation ( 1.2 % vs 2.8 % ; P = .04 ) . Eclampsia ( risk ratio , 0.68 : 95 % CI , 0.48 - 0.97 ) and severe gestational hypertension ( risk ratio , 0.71 ; 95 % CI , 0.61 - 0.82 ) were significantly lower in the calcium group . Overall , there was a reduction in the severe preeclamptic complications index ( risk ratio , 0.76 ; 95 % CI , 0.66 - 0.89 ; life-table analysis , log rank test ; P = .04 ) . The severe maternal morbidity and mortality index was also reduced in the supplementation group ( risk ratio , 0.80 ; 95 % CI , 0.70 - 0.91 ) . Preterm delivery ( the neonatal primary outcome ) and early preterm delivery tended to be reduced among women who were < or = 20 years of age ( risk ratio , 0.82 ; 95 % CI , 0.67 - 1.01 ; risk ratio , 0.64 ; 95 % CI , 0.42 - 0.98 , respectively ) . The neonatal mortality rate was lower ( risk ratio , 0.70 ; 95 % CI , 0.56 - 0.88 ) in the calcium group . CONCLUSION A 1.5-g calcium/day supplement did not prevent preeclampsia but did reduce its severity , maternal morbidity , and neonatal mortality , albeit these were secondary outcomes Abstract Objective : To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system . Design : 5 year controlled trial of all pregnant women in 28 villages r and omised to daily  supplementation with high energy groundnut biscuits ( 4.3MJ/day ) for about 20 weeks before delivery ( intervention ) or after delivery ( control ) . Setting : Rural Gambia . Subjects : Chronically undernourished women ( twin bearers excluded ) , yielding 2047 singleton live births and 35 stillbirths . Main outcome measures : Birth weight ; prevalence of low birth weight ( < 2500 g ) ; head circumference ; birth length ; gestational age ; prevalence of stillbirths ; neonatal and postneonatal mortality . Results : Supplementation increased weight gain in pregnancy and significantly increased birth weight , particularly during the nutritionally debilitating hungry season ( June to October ) . Weight gain increased by 201 g ( P<0.001 ) in the hungry season , by 94 g ( P<0.01 ) in the harvest season ( November to May ) , and by 136 g ( P<0.001 ) over the whole year . The odds ratio for low birthweight babies in supplemented women was 0.61 ( 95 % confidence interval 0.47 to 0.79 , P<0.001 ) . Head circumference was significantly increased ( P<0.01 ) , but by only 3.1 mm . Birth length and duration of gestation were not affected . Supplementation significantly reduced perinatal mortality : the odds ratio was 0.47 ( 0.23 to 0.99 , P<0.05 ) for stillbirths and 0.54 ( 0.35 to 0.85 , P<0.01 ) for all deaths in first week of life . Mortality after 7 days was unaffected . Conclusion : Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers . This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality . The intervention can be successfully delivered through a primary healthcare system . Key messages In developing countries chronic maternal undernutrition is a prime contributor to the birth of over 25 million low birthweight babies annually and to high rates of neonatal mortality . An absence of well design ed field trials has created uncertainty about the potential efficacy of maternal feeding programmes This large scale r and omised controlled trial shows that dietary supplementation in pregnancy can be highly effective in reducing the proportion of low birthweight babies and perinatal mortality Incorporating supplementary feeding into a rural primary healthcare system is feasible Late pregnancy is the period most amenable to BACKGROUND Epidemiological findings suggest that the link between poverty and pre-eclampsia might be dietary calcium deficiency . Calcium supplementation has been associated with a modest reduction in pre-eclampsia , and also in blood pressure ( BP ) . METHODS This exploratory sub- study of the WHO Calcium and Pre-eclampsia ( CAP ) trial aims to determine the effect of 500mg/day elemental calcium on the blood pressure of non-pregnant women with previous pre-eclampsia . Non-pregnant women with at least one subsequent follow-up trial visit at approximately 12 or 24weeks after r and omization were included . RESULTS Of 836 women r and omized by 9 September 2014 , 1st visit data were available in 367 women of whom 217 had previously had severe pre-eclampsia , 2nd visit data were available in 201 women . There was an overall trend to reduced BP in the calcium supplementation group ( 1 - 2.5mmHg ) although differences were small and not statistically significant . In the subgroup with previous severe pre-eclampsia , the mean diastolic BP change in the calcium group ( -2.6mmHg ) was statistically larger than in the placebo group ( + 0.8mmHg ) , ( mean difference -3.4 , 95 % CI -0.4 to -6.4 ; p=0.025 ) . The effect of calcium  on diastolic BP at 12weeks was greater than in those with non-severe pre-eclampsia ( p=0.020 , ANOVA analysis ) . CONCLUSIONS There is an overall trend to reduced BP but only statistically significant in the diastolic BP of women with previous severe pre-eclampsia . This is consistent with our hypothesis that this group is more sensitive to calcium supplementation , however results need to be interpreted with caution In a r and omized controlled trial 201 healthy nulliparous women were r and omly allocated by means of a computer generated r and omization list . From 20 weeks of gestation until delivery they received either 2 g of oral elemental calcium ( n = 103 ) per day or an identical placebo ( n = 98 ) . Eleven women ( 5.47 % ) were lost to follow-up after r and omization . The study groups were very similar at the time of r and omization ; with respect to several clinical and demographic variables . Treatment compliance was very similar in both groups as was determined by pill count . The rate of pregnancy induced hypertension was lower in the calcium group than in the placebo group 8.24 % ; vs 29.03 % ; ( RR = 0.28 ; 95 % CI 0.14 - 0.59 ) . The incidence of gestational hypertension was 6.18 % in the calcium group and 17.20 % in the placebo group ( RR = 0.28 ; 95 % CI 0.08 - 0.80 ) , and the incidence of preeclampsia was 2.06 % in the calcium group and 11.82 % in the placebo group ( RR = 0.13 ; 95 % CI 0.01 - 0.64 ) . In conclusion calcium supplementation given in pregnancy to nulliparous women reduces the incidence of pregnancy induced hypertension In this study the hypothesis that calcium supplementation during pregnancy can modify blood pressure patterns in a population of normal pregnant women was tested . Thirty-six women with normal single pregnancies , between 20 and 35 years of age , in the second trimester of gestation ( 15 weeks ) , were r and omly assigned to receive 1 gm of calcium per day ( n = 11 ) , 2 gm per day ( n = 11 ) , or a placebo ( n = 14 ) . No differences were observed at the times of admission into the study ( baseline ) in demographic and clinical variables or in the calcium intake of each group . Baseline blood pressure measures in several positions also were not different . After the initial blood pressure measures ( fifteenth week ) , five follow-up blood pressure measures were obtained . The supplemented groups had significantly lower diastolic blood pressure than the control subjects between the twentieth and twenty-fourth weeks of gestation . Thereafter , an increase in the control group and the group receiving 1 gm of calcium was observed , but levels were similar at term . On the contrary , patients receiving 2 gm of calcium had blood pressure values that remained significantly lower throughout the third trimester . No differences or clear patterns were observed in the blood levels of calcium , magnesium , phosphorus , and proteins between and within groups during gestation . A possible explanation involving parathyroid hormone is attempted OBJECTIVE We postulated that calcium supplementation of calcium-deficient pregnant women would lower vascular resistance in uteroplacental and fetoplacental circulations . STUDY DESIGN Pulsatility index ( PI ) and resistance index ( RI ) ( uterine and umbilical arteries ) and presence of bilateral uterine artery diastolic notching were assessed by Doppler ultrasound between 20 - 36 weeks ' gestation in 510 healthy , nulliparous Argentinean women with deficient calcium intake in a r and omized , placebo-controlled , double-blinded trial . RESULTS Average umbilical and uterine artery RI and PI tended to be lower in the supplemented group at each study week . Differences became statistically significant for umbilical artery RI and PI from 32 and 36 weeks , respectively . Estimated probabilities of bilateral uterine artery diastolic notching trended toward lower values in calcium-supplemented women . CONCLUSION Calcium supplementation of pregnant women with deficient calcium intake may affect uteroplacental and fetoplacental blood flow by preserving the vasodilation of normal gestation Abstract Objective : To determine the effect of maternal preeclampsia on development and severity of retinopathy of prematurity ( ROP ) in preterm infants . Methods : This prospect i ve study consisted of two groups : the study group , which is composed of preterm infants ( ≤32 weeks ) born to a mother with preeclampsia , and the comparison group , which is composed of preterm infants ( ≤32 gestational age ) born to normotensive mothers . We used the International Classification of Retinopathy of Prematurity Revisited for classifying ROP . The  first eye examination  was performed at postnatal age of 4 weeks . Results : A total of 385 infants were included in the study . ROP was diagnosed in 109 infants ( 28 % ) . The incidence of ROP in infants born to preeclamptic mothers ( 40.5 % ) was significantly higher compared with those born to normotensive mothers ( 22.4 % ) ( P<0.05 ) . The number of infants with stage 1 , 2 , and 3 ROP was significantly higher in infants born to preeclamptic mothers compared with the control group ( P<0.05 ) . In multiple logistic regression model , preeclampsia was found to predict ROP ( odds ratio 1.78 , 95 % confidence interval 0.66–1.90 ) . Conclusion : Maternal preeclampsia was found to be associated with increased ROP development risk in premature infants . ROP was also more severe in infants born to pre-eclamptic mothers . The role of maternal preeclampsia in the occurrence and severity of ROP remains to be eluci date BACKGROUND Prenatal calcium and iron supplements are recommended in setting s of low dietary calcium intake and high prevalence of anemia . However , calcium administration may inhibit iron absorption . To overcome calcium-iron interactions , we developed a multi-micronutrient powder containing iron ( 60 mg ) , folic acid ( 400 μg ) , and calcium carbonate granules microencapsulated with a pH-sensitive enteric coating to delay intestinal release . OBJECTIVES We aim ed to establish in vivo evidence that enteric-coated ( EC ) calcium is bioavailable in pregnant women and to explore the dose-responsiveness of fractional calcium absorption ( FCA ) in pregnancy . DESIGN This was a r and omized crossover trial in pregnant women ( 26 - 28 wk of gestation ) in Dhaka , Bangladesh . Participants were allocated to 1 of 3 dose groups ( 500 , 1000 , or 1500 mg elemental Ca ) . FCA was estimated in r and om order for EC and non-EC ( control ) granules by a dual-stable-isotope method ( (44)Ca-labeled granules and intravenous (42)Ca ) on the basis of the relative recovery of (44)Ca compared with (42)Ca in urine over 48 h. RESULTS Forty-nine participants with FCA for both EC and non-EC granules were included in the primary analyses . FCA geometric means were as follows : 21.8 % ( 500 mg ) , 9.2 % ( 1000 mg ) , and 11.7 % ( 1500 mg ) for non-EC granules compared with 3.3 % ( 500 mg ) , 1.2 % ( 1000 mg ) , and 2.1 % for EC granules . Cumulative 48-h FCA of EC calcium was 85 % lower ( P < 0.001 ) than that of non-EC calcium , after adjustment for dose . In comparison to 500 mg , the FCA for the 1000-mg dose was 61 % lower ( P < 0.001 ) and was 42 % lower ( P = 0.002 ) for the 1500-mg dose , after adjustment for formulation . CONCLUSIONS A pH-sensitive enteric coating substantially reduced calcium absorption from a prenatal multi-micronutrient powder . In its current formulation , this novel supplement is not suitable for clinical use . FCA was highly dose-dependent , such that doses of 1000 and 1500 mg delivered only negligibly more bioavailable calcium than the 500-mg dose . This trial was registered at clinical trials.gov as NCT01678079 OBJECTIVE To evaluate the accuracy of r and om urinary protein-to-creatinine ratio for prediction of significant proteinuria in women with suspected preeclampsia . METHODS A prospect i ve study was conducted in hospitalized pregnant women with a suspicion of preeclampsia .  R and om mid-stream urine specimens were obtained for protein-to-creatinine ratio determination , and then participants were instructed to collect 24-h urine sample s for protein measurement . With the criterion of 24-h proteinuria of at least 300 mg as a significant proteinuria , the sensitivity and specificity of a r and om urinary protein-to-creatinine ratio of > or = 0.19 for prediction of significant proteinuria were analyzed and a receiver operating characteristic curve was constructed to determine the optimal cutoff value . RESULTS Forty-two patients completed the study . Sixty-nine percent of the study population had significant proteinuria . A cutoff of 0.19 demonstrated a sensitivity of 100 % and a specificity of 53.8 % . A ratio below 0.22 could rule out a significant proteinuria . The optimal cutoff value is 0.25 which yielded sensitivity , specificity and accuracy of 96.6 % , 92.3 % and 95.2 % respectively . CONCLUSION In hospitalized preeclamptic patients , the r and om urinary protein-to-creatinine ratio at a cutoff of > or = 0.25 revealed a highly accurate prediction of significant proteinuria and could be a more practical alternative for assessment of proteinuria The results of ten clinical trials suggest that supplemental calcium may prevent  preeclampsia .  However , method ologic problems and differences in study design limit the acceptance of the results and their relevance to other patient population s. Many of the trials were conducted in countries where , unlike the United States , the usual daily diet contained little calcium . Moreover , none of the trials has reported the outcome of systematic surveillance for urolithiasis , a potential complication of calcium supplementation . In response to the need for a thorough evaluation of the effects of calcium supplementation for the prevention of preeclampsia in the United States , the trial of Calcium for Preeclampsia Prevention ( CPEP ) was undertaken at five university medical centers . Healthy nulliparous patients were r and omly assigned to receive either 2 g supplemental calcium daily  ( n = 2295 ) or placebo  ( n = 2294 ) in a double-blind study . Study tablets were administered beginning from 13 to 21 completed weeks of gestation and continued until the termination of pregnancy . CPEP employed detailed diagnostic criteria , st and ardized techniques of measurement , and systematic surveillance for the major study endpoints and for urolithiasis . The nutrient intake of each patient was assessed at r and omization and at 32 - 33 weeks gestation . This report describes the study rationale , design , and methods OBJECTIVES ( 1 ) To evaluate whether clinical variables reflecting the multiorgan dysfunctions of preeclampsia can predict adverse maternal outcomes of preeclampsia ; ( 2 ) to determine the usefulness of the mean platelet volume (MPV):platelet ratio as a novel measure of platelet consumption in predicting the severity of preeclampsia . METHOD A retrospective chart review was conducted of cases of preeclampsia seen in 3 tertiary level units from January 2001 to December 2001 . C and i date predictors of adverse maternal outcome were gestational age  ( GA ) on admission to hospital , blood pressure , proteinuria , urine output , uric acid , creatinine , aspartate transaminase ( AST ) , lactate dehydrogenase , bilirubin , albumin , fraction of inspired oxygen : oxygen saturation ( FIO2:SaO2 ) ratio , platelet count , MPV , MPV : platelet ratio , fibrinogen , and seizures . The combined adverse maternal outcomes included maternal death ; 1 or more of hepatic failure , hematoma , or rupture ; Glasgow coma scale < 13 ; stroke ; 2 or more seizures ; cortical blindness ; positive inotrope support ; myocardial infa rct ion ; infusion of any third antihypertensive ; dialysis ; renal transplantation ; > or = 50 % FIO2 for > 1 hour ; intubation ; or transfusion of > or = 10 units of blood products . Descriptive , univariable , and multivariable analyses were performed , with significance set at P < .05 . RESULTS Of a total of 594 women with preeclampsia , 60 ( 10.1 % ) developed at least 1 element of the combined adverse outcome ; 1 of these 60 women died . The most common outcomes were increased oxygen requirements , the use of a third infused antihypertensive , and transfusion > 10 units . In women who developed an adverse outcome , GA and fibrinogen were lower , and total leukocyte count , creatinine , and AST were greater . Multivariable logistic regression revealed that admission GA ( odds ratio [ OR ] , 0.91 ) , dipstick protein ( OR , 1.31 ) , and MPV : platelet ratio ( OR , 391.0 ) independently predicted the outcome . CONCLUSIONS Several promising markers were identified : admission GA , dipstick proteinuria , and the MPV : platelet ratio . MPV : platelet ratio also showed promise as a marker of platelet consumption . A prospect i ve study is required to develop a clinical prediction model for preeclampsia OBJECTIVE To study the effect of calcium supplementation on reduction of pre-eclampsia in Iranian women at high risk of pre-eclampsia . METHODS Thirty pregnant women at high risk of developing pre-eclampsia were r and omized to 2 g of daily calcium and placebo . Subjects and investigators were blinded to treatment allocation . The inclusion criteria were positive rollover test , having at least one risk factor for pre-eclampsia , between 28 and 32 weeks of pregnancy , and blood pressure less than 140/90 ( mm Hg ) . Exclusion criteria were having any chronic condition . Pre-eclampsia was defined as systolic/diastolic blood pressure over 140/90 plus proteinuria . All the subjects were followed up to delivery . RESULT A sevenfold reduction in the occurrence of pre-eclamsia were seen among the calcium group compared with the placebo group ( 7 out of 15 developed pre-eclampsia in control group vs. 1 out of 15 in calcium group , P=0.014 ) . No major effect on pregnancy induced hypertension was seen ( 66 % in placebo and 76 % in calcium group developed hypertension ) but the onset of hypertension was delayed 3 weeks in the calcium group . A longer duration of pregnancy was seen in calcium than placebo ( mean+/-S.D.=37+/-2 for calcium and 34+/-2 for placebo , P<0.05 ) . Infants born to the calcium group , on average , were 552 g heavier than infants born to the placebo group , P<0.05 . CONCLUSION Calcium supplementation is beneficial for preventing pre-eclampsia among Iranian women at high risk of developing pre-eclampsia Objective To determine whether calcium supplementation prevents progression to severe disease in preterm nulliparous women with mild preeclampsia . Methods Seventy-five women hospitalized at 24–36 weeks ' gestation because of mild preeclampsia were r and omized to receive either 2 g/day of elemental calcium ( 36 women ) or placebo ( 39 ) . Both groups had similar demographic characteristics , initial blood pressure measurements , and amount of proteinuria . Diagnostic criteria and clinical management for severe preeclampsia were applied consistently . Results Eighteen of 36 calcium-treated subjects ( 50 % , 95 % confidence interval [ CI ] 33–67 ) developed severe preeclampsia , compared with 19 of 39 ( 48.7 % , 95 % CI 32–65 ) in the placebo group ( relative risk 1.03 , 95 % CI 0.64–1.03 ; P = 1.00 ) . Blood pressure values , gestational age at delivery , newborn weights , incidence of low Apgar scores , and umbilical arterial blood gases were similar for the two groups . Conclusion Calcium supplementation does not prevent severe preeclampsia in preterm patients with mild disease OBJECTIVE The objectives of the study were to confirm the validity of using oscillometric measurement of MAP in the left lateral position to identify those at high risk for developing pregnancy-induced hypertension ( PIH ) , and to assess and compare the efficacy of prophylaxis with low-dose aspirin or calcium supplementation in high-risk patients . STUDY DESIGN A prospect i ve study in pregnancy ; 500 normotensive , primigravid Chinese women were recruited in the second trimester of pregnancy on the basis of 80 mm Hg > or = MAP < 106 mm Hg in the antenatal clinic . They were then screened by Dinamap in a research setting , measuring MAP in the left lateral position after rest and using a cutoff value of 60 mm Hg for inclusion in the r and omized study . R and omization was divided into three groups : control , low-dose aspirin , and calcium supplementation . After delivery , patients were classified as either having remained normotensive or having developed PIH , with or without proteinuria . RESULTS The incidence of both proteinuric and nonproteinuric PIH was significantly lower in patients screened out as low risk than in those selected as high risk using a critical value of 60 mm Hg for left lateral MAP ( p < 0.05 ) . The incidence of proteinuric PIH was significantly lower in patients given low-dose aspirin than in the control group ( p < 0.05 ) . However , the confidence intervals for the effect were wide , comparable with aspirin having no effect or leading to a 16-fold reduction in the risk of preeclampsia . For those given calcium supplementation , the reduction was not significant . There was no significant difference in the incidence of nonproteinuric PIH between the control group and the two groups receiving prophylaxis . CONCLUSION Oscillometric measurement of second-trimester left lateral MAP is a valid predictor of proteinuric PIH . Low-dose aspirin may offer a degree of protection from proteinuric PIH in these high-risk women . Calcium supplementation was not shown to significantly reduce the incidence of PIH A prospect i ve r and omised clinical trial comprising 510 pregnant patients was performed to determine whether supplementation with calcium , low-dose aspirin or a combination of calcium and low-dose aspirin can lower the incidence of hypertension in pregnancy . Greatest benefits were obtained with calcium .  Perinatal mortality was lowest in the aspirin group Objective To determine the effectiveness of low dose aspirin in women at high risk of adverse outcomes associated with pre‐eclampsia Following our detailed studies of human milk calcium concentration , we hypothesized that calcium intake in pregnancy may determine human milk calcium concentration and hence the calcium intake of breastfed infants ( Prentice et al. 1994 ) . To test this , we conducted a controlled calcium supplementation study in pregnant women accustomed to a low calcium intake BACKGROUND The aim of the present study was to determine whether the beneficial effect of oral supplementation with calcium and conjugated linoleic acid ( CLA ) in the reduction of the incidence of  pregnancy-induced hypertension ( PIH ) is related with changes in plasma levels of prostanoids , renin , angiotensin II , calciotropic hormones , and plasma and intracellular ionized free calcium . METHODS These mediators were determined using the blood sample s obtained from a r and omized , double-blind , placebo-controlled trial that included 48 healthy primigravidas with a family history of preeclampsia and with diastolic notch , recruited from four outpatient clinics from two developing countries . Participants were r and omized to daily oral doses of elemental calcium and CLA or lactose-starch placebo from week 18 to week 22 of gestation until delivery . RESULTS The incidence of PIH was significantly reduced in women receiving the supplement ( 2 women [ 8.3 % ] ) compared with placebo ( 10 women [ 41.7 % ] ) ( relative risk = 0.20 , 95 % confidence interval 0.05 - 0.82 , P = .01 ) . There were no significant differences in the plasma concentrations of ionized calcium , prostagl and in E(2 ) , renin , angiotensin II , parathormone , and calcitonine . The concentration of intracellular ionized free calcium presented a significant reduction after interventions ( 92.0 nmol/L [ range 62.5 to 220 nmol/L ] v 62.5 nmol/L [ range 28 to 200 nmol/L ; P = .01 ) in the supplemented group but not in the placebo group . The women who developed PIH ( n = 12 ) presented a significant increase in the concentrations of intracellular calcium after interventions ( 120 nmol/L [ range 89.2 to 240 nmol/L ] v 137.5 nmol/L [ range 89.2 to 138 nmol/L ; P = .02 ) . CONCLUSIONS Calcium and CLA supplementation during pregnancy reduces the incidence of PIH , and decreases the intracellular concentration of ionized free calcium in peripheral blood lymphocytes Abstract Objective : To explore the long term effect of calcium supplementation during pregnancy on the offspring 's blood pressure during childhood . Design : Follow up of a population enrolled in a double blind , r and omised , placebo controlled trial . Setting : Perinatal research unit , World Health Organisation 's collaborative research centre . Subjects : 591 children at a mean age of 7 years whose mothers were r and omly assigned during pregnancy to receive 2 g/day of elemental calcium ( n=298 ) or placebo ( n=293 ) . Main outcome measures : Mean blood pressure and rate of high blood pressure of children . Results : Overall , systolic blood pressure was lower in the calcium group ( mean difference -1.4 mm Hg ; 95 % confidence interval -3.2 to 0.5 ) than in the placebo group . The effect was found predominantly among children whose body mass index at assessment was above the median for this population ( mean difference in systolic blood pressure -5.8 mm Hg ( -9.8 mm Hg to -1.7 mm Hg ) for children with an index > 17.5 and -3.2 mm Hg ( -6.3 mm Hg to -0.1 mm Hg ) for those with an index of > 15.7 to 17.5 ) . The risk of high systolic blood pressure was also lower in the calcium group than in the placebo group ( relative risk 0.59 ; 0.39 to 0.90 ) and particularly among children in the highest fourth of body mass index ( 0.43 ; 0.26 to 0.71 ) . Conclusion : Calcium supplementation during pregnancy is associated with lower systolic blood pressure in the offspring , particularly among overweight children . Key messages Impaired fetal and maternal nutrition seem to be associated with childhood blood pressure , but most of the evidence comes from uncontrolled studies Systolic blood pressure of children aged between 5 and 9 years was lower when mothers took calcium rather than placebo during pregnancy The effect is found predominantly among children with a body mass index above the median for this population Fetal life seems to be a period for programming blood pressure ; the magnitude of the effect observed has health implication s among overweight This is an evaluation of the methodology of blood pressure measurement in a high-risk obstetric clinic .  Blood pressure values were obtained from 149 patients by the clinic staff and the research project coordinator . The project coordinator using the r and om-zero sphygmomanometer measured lower systolic and higher diastolic values . The diastolic and systolic values increased after 30 weeks of pregnancy up to term . Agreement among observers is low for diastolic blood pressure . The clinic staff measured about 50 % of the values with a zero terminal digit as compared with only 14 % by the project coordinator . The fourth Korotkoff sound can be recorded in 83 % of the patients . The mean diastolic blood pressures obtained with the fourth sound are significantly higher than when the fifth sound is used . Recommendations are offered for blood pressure measuring during pregnancy , and it is strongly suggested that the same method ologic rigor be used as in any other medical procedure Abstract Background Hypertensive disorders complicate 5–10 % of all pregnancies . Various methods for screening have been studied to identify pregnant women at risk of development of preeclampsia , but no ideal screening test has been identified so far . The objective of this study was to determine the efficacy of urinary calcium-to-creatinine ratio , in a spot urine sample , for the prediction of preeclampsia in asymptomatic pregnant women between 18 and 24 weeks of gestation . Methods This study was done on 112 patients presenting to the antenatal clinic in the Department of Obstetrics and Gynecology at Bangalore Baptist Hospital . A r and om urinary calcium-to-creatinine ratio of all the patients was analyzed . The urinary calcium level was analyzed by Arezano method , while creatinine was estimated by Jaffes method . A value of ≤0.04 was considered positive . Results 116 patients were recruited in the study . Out of the 11 subjects with urinary CCR < 0.04 , 7 developed gestational hypertension , 3 developed preeclampsia , and 1 remained normotensive . In 101 patients with CCR > 0.04 , 1 developed gestational hypertension , none preeclampsia and 100 were normotensive . Four were lost to follow-up . Interpretation and Conclusion On statistical analysis , it was found that when CCR alone is taken as high-risk factor for prediction of preeclampsia , P < 0.001 was statistically significant , sensitivity was 80 % , specificity 98.04 % , PPV 80 % , NPV 98.04 % , and diagnostic accuracy 96.43 % . So this test was satisfactory as an early predictor for the development of preeclampsia Pregnancy induced hypertension ( PIH ) is a common complication in pregnancy and prenatal stage . Because the direct and indirect relationship between low calcium intake and many diseases , such as rachitis , young age myopia and hypertension , calcium supplementation has been a hot topic among nutritionists . R and omized trials of calcium supplementation during pregnancy were conducted in 212 healthy primipara . They were divided into 4 groups and gave 120 mg , 240 mg , 1 g or 2 g of calcium daily from 20 to 28 wks of gestation up to delivery respectively . As a result , the incidence of PIH was 8.9 % , 7.5 % , 8 % and 4 % respectively in these groups . The control group ( 106 pregnant women ) who did not receive calcium gave an incidence of 18 % . Supplementation of 2 g of calcium daily showed significant results in lowering the incidence of PIH ( P < 0.05 ) without any adverse effects . In 1992 calcium supplementation was widely used in antenatal-clinic . 200 cases with intake of 2 g calcium  were compared with corresponding non-calcium supplementation cases , and the incidence of PIH was 7.5 % and 16.5 % ( P < 0.005 ) respectively . Mediating parathyroid hormone and renin activity are thought to be the effect of calcium on decreasing the incidence of PIH Objective : To investigate maternal and neonatal outcomes after antioxidant supplementation relatively early in pregnancy ( 8 to 12 weeks ) for pregnant women with low antioxidant status . Methods : A r and omized , double-blind , placebo-controlled trial of daily antioxidant supplementation was performed on pregnant women screening positive for low antioxidant status at 8 to 12 weeks of gestation . Low antioxidant status was defined as a superoxidedismutase ( SOD ) level below 1102 U/g Hb or 164 U/mL. The supplementation group received the following antioxidants daily : vitamins A ( 1000 IU ) , B6 ( 2.2 mg ) , B12 ( 2.2 μg ) , C ( 200 mg ) , and E ( 400 IU ) , folic acid ( 400 μg ) , N-acetylcysteine ( 200 mg ) , Cu ( 2 mg ) , Zn ( 15 mg ) , Mn ( 0.5 mg ) , Fe ( 30 mg ) , calcium ( 800 mg ) , and selenium ( 100 μg ) . The control group received Fe ( 30 mg ) and folic acid ( 400 μg ) . Maternal ( preeclampsia , abortion , and hypertension ) and perinatal outcomes were assessed . Results : In the supplementation group ( 29 subjects ) , we observed 2 cases of preeclampsia ( 6.8 % , 1 mild and 1 severe ) , 1 of IUGR ( birth weight 2300 g at 38 weeks ) , and 1 preterm delivery . In the control group ( 31 subjects ) , there were 8 abortions , 9 cases of preeclampsia ( 29 % , 6 mild and 3 severe ) with perinatal outcome : 3 preterm delivery cases and 1 IUGR ( birth weight 2030 g at 39 weeks ) . Preeclampsia was significantly less frequent in the supplementation group when compared to the control group ( 2 vs. 9 cases , p = 0.043 , OR = 0.18 [ 95 % CI : 0.03 , 0.92 ] ) . Finally we focused on the prediction of preeclampsia at 8 to 12 weeks . Combined sensitivity of markers of antioxidant status ( SOD slutathione peroxidase , [ GPx ] , and total anti-oxidant status [ TAS ] ) was 33 % ( false-positive rate of 4.5 % ) . Conclusion : Antioxidant supplementation was associated with better maternal and perinatal outcome in pregnant women with low antioxidant status  than control supplementation with iron and folate alone . In a selected population already screened positive for low SOD , preeclampsia can be detected in 33 % of asymptomatic cases in the first trimester using SOD , GPx , and TAS . It seems feasible that panels of both biochemical and molecular markers may be clinical ly useful in the prediction of this disease Summary . Previous studies have suggested that increased dietary calcium is associated with a decreased occurrence of pregnancy‐induced hypertension  . In this study 106 young healthy nulliparous women , residing in Quito , Ecuador , were enrolled in a double‐blind , r and omized , controlled clinical trial . From 24 weeks gestation until delivery they received either 2 g of elemental calcium per day or a placebo . Calcium supplementation was associated with a significantly decreased risk of pregnancy‐induced hypertension , with 4.1 % developing pregnancy‐induced hypertension in the treatment group versus 27.9 % in the placebo group . Treatment was associated with a decrease in both systolic and diastolic blood pressure over the course of pregnancy . In addition , there was a small but significant increase in serum ionized calcium levels in the calcium‐supplemented group during the treatment period Considerable interest has developed regarding the role of calcium in the regulation of blood pressure . Epidemiologic investigations , laboratory evaluations , and clinical trials all confirm that the relationship between calcium and blood pressure extends to include the pregnant state . On the basis of current information it is clear that calcium supplementation during pregnancy lowers blood pressure . Additionally , the effect of calcium on blood pressure may influence the incidence and /or gestational age of development of preeclampsia . Additionally , the effect on smooth-muscle relaxation detected in calcium-supplemented patients may affect the incidence of prematurity . Although the mechanism for these effects has not been entirely eluci date d , calcium supplementation appears to affect circulating concentrations of parathyroid hormone and renin , which may modulate intracellular ionized calcium , result ing in the observed effect on smooth-muscle relaxation . This effect may also be responsible for reduced uterine activity and for a lowering of the incidence of prematurity BACKGROUND Maternal nutritional intake during pregnancy may have important consequences for long-term health in offspring . OBJECTIVE The objective was to follow up the offspring in 2 r and omized trials of nutrient supplementation during pregnancy to investigate the effect on cardiovascular disease ( CVD ) risk  in offspring . DESIGN We recruited offspring born during 2 trials in The Gambia , West Africa . One trial provided protein-energy-dense food supplements ( 1015 kcal and 22 g protein/d ) to pregnant ( intervention , from 20 wk gestation until delivery ) or lactating ( control , for 20 wk from birth ) women and was r and omized at the village level . The second was a double-blind , individually r and omized , placebo-controlled trial of calcium supplementation ( 1.5 g/d ) , which was also provided from 20 wk gestation until delivery . RESULTS Sixty-two percent ( n = 1267 ) of children ( aged 11 - 17 y ) born during the protein-energy trial were recruited and included in the analysis , and 64 % ( n = 350 ) of children ( aged 5 - 10 y ) born during the calcium trial were recruited and included in the analysis . Fasted plasma glucose was marginally lower in children born to mothers receiving protein-energy supplements during pregnancy than in those children of the lactating group ( adjusted mean difference : -0.05 mmol/L ; 95 % CI : -0.10 , -0.001 mmol/L ) . There were no other differences in CVD risk factors , including blood pressure , body composition , and cholesterol , between children born to intervention and control women from the protein-energy trial . Maternal calcium supplementation during pregnancy was unrelated to offspring blood pressure . CONCLUSION These data suggest that providing supplements to pregnant women in the second half of pregnancy may have little effect on the CVD risk of their offspring , at least in this setting and at the ages studied here . This trial was registered at www.controlled-trials.com as IS RCT N96502494 In a study population that comprised 34 normal black pregnant women , biochemical changes are compared between a group of women who received 1.5 gm of calcium supplementation a day and a group of women who received placebos . The blood pressure-lowering effect of calcium supplementation appears to involve a mechanism that relates parathyroid hormone and plasma renin activity . Other alterations in calcium and magnesium metabolism , as reflected by increased urinary calcium excretion and serum magnesium levels , may also contribute to this effect . Subgroups of study participants with initial ( less than 26 weeks ' gestation ) low levels of serum calcium and plasma renin activity are the ones with the largest reductions in blood pressure . Whether these alterations can produce a reduction in the incidence of pregnancy-induced hypertension is the next question to be answered in this area Objective To determine the effect of third-trimester  calcium supplementation on maternal hemodynamic function . Methods Pregnant women were r and omized to receive either 1.5 g of elemental calcium or placebo for 6 weeks during the third trimester . Using Doppler technique , maternal hemodynamic characteristics were measured at baseline , at 2 hours after the first dose of study drug , and at the completion of 6 weeks . Serum , dietary , and urinary calcium levels were also assessed . Power calculation indicated the need to study ten subjects in each group to detect a 1.2 L ( 20 % ) difference in cardiac output between groups , assuming a mean of 6.2 ± 1.0 L/minute . Data were analyzed by analysis of variance for repeated measures , Student t test , Mann-Whitney U test , and Fisher exact test . Results Twenty-three women enrolled , and 18 completed the study . There were no statistically significant differences in demographic characteristics or in serum , dietary , or urinary calcium levels between the two groups . There were also no statistically significant differences in hemodynamic function over time within the calcium supplementation or placebo group ( P > .05 ; analysis of variance for repeated measures ) . After 6 weeks , there were no significant differences between the calcium- and placebo-treated subjects in any hemodynamic measurement . Specifically , there was not a statistically significant difference in cardiac output ( 7.3 ± 1.2 L/minute versus 8.0 ± 0.9 L/minute ; P = .09 ) between the calcium- and placebo-treated groups . Conclusions These findings suggest that third-trimester calcium supplementation does not significantly alter cardiac output . The mechanism by which calcium supplementation lowers blood pressure remains to be eluci date BACKGROUND The aim of this study was to evaluate the benefits of calcium , linoleic acid and mono- and polyunsaturated fatty acids in the prevention of gestational hypertension . METHODS Between January 1999 and June 2000 , 65 primagravidas with a risk of gestational hypertension between the 20th and 24th week of pregnancy were recruited using Doppler velocimetry of the uterine arteries and Holter 24-h pressure monitoring .  Patients with diabetes , hypertensive gestosis and previous renal pathologies were excluded . The patients were divided into 2 unequal groups : Group A ( 40 patients ) was treated with calcium , linoleic acid , and mono and polyunsaturated fatty acid supplements ; Group B ( 25 patients ) received no treatment . The patients in both groups underwent Doppler velocimetry of the uterine arteries and Holter pressure monitoring at 28 - 30 - 32 - 35 weeks of gestation . RESULTS Calcium linoleic acid and mono and polyunsaturated fatty acid supplements were effective in significantly reducing the incidence of gestational hypertension ( p>0.05 ) ; in fact 90 % of patients in Group A underwent a physiological evolution of pregnancy compared to only 10 % affected by gestational hypertension . In the control group the incidence of this pathology was much higher ( 32 % ) . CONCLUSIONS The authors conclude that calcium linoleic acid and mono and polyunsaturated fatty acid supplements are useful and effective in the prevention of gestational hypertension in women at risk for this pathology Pre-eclampsia is a common and serious complication of pregnancy that affects both mother and child . Review of previous small trials of antiplatelet therapy , particularly low-dose aspirin , suggested reductions of about three-quarters in the incidence of pre-eclampsia and some avoidance of intrauterine growth retardation ( IUGR ) , but larger trials have not confirmed these results . In our multicentre study 9364 women were r and omly assigned 60 mg aspirin daily or matching placebo . 74 % were entered for prophylaxis of pre-eclampsia , 12 % for prophylaxis of IUGR , 12 % for treatment of pre-eclampsia , and 3 % for treatment of IUGR . Overall , the use of aspirin was associated with a reduction of only 12 % in the incidence of proteinuric pre-eclampsia  , which was not significant . Nor was there any significant effect on the incidence of IUGR or of stillbirth and neonatal death .  Aspirin did , however , significantly reduce the likelihood of preterm delivery ( 19.7 % aspirin vs 22.2 % control ; absolute reduction of 2.5 [ SD 0.9 ] per 100 women treated ; 2p = 0.003 ) . There was a significant trend ( p = 0.004 ) towards progressively greater reductions in proteinuric pre-eclampsia the more preterm the delivery . Aspirin was not associated with a significant increase in placental haemorrhages or in bleeding during preparation for epidural anaesthesia , but there was a slight increase in use of blood transfusion after delivery . Low-dose aspirin was generally safe for the fetus and newborn infant , with no evidence of an increased likelihood of bleeding . Our findings do not support routine prophylactic or therapeutic administration of antiplatelet therapy in pregnancy to all women at increased risk of pre-eclampsia or IUGR . Low-dose aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia severe enough to need very preterm delivery . In such women it seems appropriate to start low-dose aspirin prophylactically early in the second trimester
BACKGROUND Pre-eclampsia and eclampsia are common causes of serious morbidity and death .
Calcium supplementation may reduce the risk of pre-eclampsia , and may help to prevent preterm birth .
OBJECTIVES To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child outcomes .