WHO recommendations
In populations with low dietary calcium intake, daily calcium supplementation (1.5 g–2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia.
Remarks
- This recommendation is consistent with recommendations in the 2016 WHO recommendations on antenatal care for a positive pregnancy experience (1) and 2011 WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia (2), and supersedes the WHO recommendation found in the 2013 Guideline: calcium supplementation in pregnant women (3).
- Dietary counselling of pregnant women should promote adequate calcium intake through locally available, calcium-rich foods.
- Dividing the dose of calcium may improve acceptability. The suggested scheme for calcium supplementation is 1.5–2 g daily, with the total dose divided into three doses, preferably taken at mealtimes.
- Negative interactions between iron and calcium supplements may occur. Therefore, the two nutrients should preferably be administered several hours apart rather than concomitantly (3).
- As there is no clear evidence on the timing of initiation of calcium supplementation, stakeholders may wish to commence supplementation at the first antenatal care contact, in order to improve compliance to the regimen.
- To reach the most vulnerable populations and ensure a timely and continuous supply of supplements, stakeholders may wish to consider task shifting the provision of calcium supplementation in community settings with poor access to healthcare professionals (4).
- The implementation and impact of this recommendation should be monitored at the health service, regional and country levels based on clearly defined criteria and indicators associated with locally agreed targets. Barriers, enablers and pathways should be evaluated to inform integration of this recommendation into the antenatal care package.
References
1. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/
anc-positive-pregnancy-experience/en/).
2. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: World Health Organization; 2011 (https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548335/en/).
3. Guideline: Calcium supplementation in pregnant women. Geneva: World Health Organization; 2013 (https://www.who.int/nutrition/publications/micronutrients/guidelines/calcium_supplementation/en/).
4. WHO Recommendations: Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions Through Task Shifting. Geneva: World Health Organization; 2012 (https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/978924504843/en/).
5. WHO recommendation: calcium supplementation during pregnancy for prevention of pre-eclampsia and its complications. Geneva: World Health Organization; 2018 (https://www.who.int/nutrition/publications/guidelines/calcium-supplementation-recommendation-2018/en/).
