Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes.

IF 8.8 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Cochrane Database of Systematic Reviews Pub Date : 2024-11-19 DOI:10.1002/14651858.CD007079.pub4
Kiattisak Kongwattanakul, Chatuporn Duangkum, Chetta Ngamjarus, Pisake Lumbiganon, Anna Cuthbert, Jo Weeks, Jen Sothornwit
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Currently, there is no consensus on the role of routine calcium supplementation for pregnant women other than for preventing or treating hypertension.</p><p><strong>Objectives: </strong>To determine the effect of calcium supplementation on maternal, fetal and neonatal outcomes, excluding women with multiple gestation (other than for preventing or treating hypertension), including the occurrence of adverse effects.</p><p><strong>Search methods: </strong>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (which includes results of comprehensive searches of CENTRAL, MEDLINE, Embase, CINAHL, two trials registers and relevant conference proceedings) on 3 December 2022. We also searched the reference lists of retrieved studies.</p><p><strong>Selection criteria: </strong>We considered all published, unpublished and ongoing randomised controlled trials (RCTs) comparing maternal, fetal and neonatal outcomes in pregnant women who received calcium supplementation versus placebo or no treatment. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and cross-over studies were not eligible for inclusion.</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed trials for inclusion. At least one review author assessed trials meeting the inclusion criteria for trustworthiness, consulting another review author in cases that were not immediately clear. Two review authors independently assessed the studies for risk of bias, extracted data, and checked trials for accuracy. We assessed the certainty of the evidence using GRADE.</p><p><strong>Main results: </strong>Twenty-one studies met the inclusion criteria, but only 19 studies contributed data to the review. These 19 trials recruited 17,370 women, with 16,625 women included in the final analyses. The trials were generally at low risk of bias for randomisation and allocation concealment. We chose three outcomes for GRADE assessment: preterm birth less than 37 weeks, preterm birth less than 34 weeks and low birthweight (less than 2500 g). All trials compared calcium supplementation with placebo or no treatment with 17 trials comparing high-dose calcium (greater than 1000 mg/day). Calcium supplementation probably slightly reduces the risk of preterm birth less than 37 weeks (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.65 to 0.99; 11 trials, 15,379 women; moderate-certainty evidence), but probably has little effect on the risk of preterm birth less than 34 weeks (average RR 1.03, 95% CI 0.79 to 1.35; 3 trials, 5569 women; moderate-certainty evidence), and may have little or no effect on low birthweight (less than 2500 g) (average RR 0.93, 95% CI 0.81 to 1.07; 6 trials, 14,162 women; low-certainty evidence; 1 study reported low birthweight (less than 2500 g) but recorded 0 events in both groups. Thus, the RR and CIs were calculated from 5 studies rather than 6). We downgraded the evidence for imprecision (wide CIs crossing the line of no effect) and inconsistency (high levels of heterogeneity between the studies). There was no evidence that calcium supplementation had any effect on maternal weight gain during pregnancy; increasing bone mineral density in pregnant women; rate of intrauterine growth restriction; perinatal mortality; stillbirth or fetal death rate; increase birth length or fetal head circumference; and adverse effects such as postpartum haemorrhage, gall stones, gastrointestinal symptoms, headache, urinary stones, urinary tract infection or impaired renal function.</p><p><strong>Authors' conclusions: </strong>This review indicates that calcium supplementation probably reduces preterm birth before 37 weeks. There are no clear additional benefits to calcium supplementation in preterm birth before 34 weeks or prevention of low birthweight. Large multicentre trials to detect the effect of calcium supplementation on fetal birthweight and preterm birth before 34 weeks as the primary outcomes are needed. Further research into the short- and long-term effects of calcium supplementation would also be beneficial.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD007079"},"PeriodicalIF":8.8000,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cochrane Database of Systematic Reviews","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/14651858.CD007079.pub4","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Maternal nutrition during pregnancy is known to have an effect on fetal growth and development. It is recommended that women increase their calcium intake during pregnancy and lactation, although the recommended dosage varies among professionals. Currently, there is no consensus on the role of routine calcium supplementation for pregnant women other than for preventing or treating hypertension.

Objectives: To determine the effect of calcium supplementation on maternal, fetal and neonatal outcomes, excluding women with multiple gestation (other than for preventing or treating hypertension), including the occurrence of adverse effects.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (which includes results of comprehensive searches of CENTRAL, MEDLINE, Embase, CINAHL, two trials registers and relevant conference proceedings) on 3 December 2022. We also searched the reference lists of retrieved studies.

Selection criteria: We considered all published, unpublished and ongoing randomised controlled trials (RCTs) comparing maternal, fetal and neonatal outcomes in pregnant women who received calcium supplementation versus placebo or no treatment. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and cross-over studies were not eligible for inclusion.

Data collection and analysis: Two review authors independently assessed trials for inclusion. At least one review author assessed trials meeting the inclusion criteria for trustworthiness, consulting another review author in cases that were not immediately clear. Two review authors independently assessed the studies for risk of bias, extracted data, and checked trials for accuracy. We assessed the certainty of the evidence using GRADE.

Main results: Twenty-one studies met the inclusion criteria, but only 19 studies contributed data to the review. These 19 trials recruited 17,370 women, with 16,625 women included in the final analyses. The trials were generally at low risk of bias for randomisation and allocation concealment. We chose three outcomes for GRADE assessment: preterm birth less than 37 weeks, preterm birth less than 34 weeks and low birthweight (less than 2500 g). All trials compared calcium supplementation with placebo or no treatment with 17 trials comparing high-dose calcium (greater than 1000 mg/day). Calcium supplementation probably slightly reduces the risk of preterm birth less than 37 weeks (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.65 to 0.99; 11 trials, 15,379 women; moderate-certainty evidence), but probably has little effect on the risk of preterm birth less than 34 weeks (average RR 1.03, 95% CI 0.79 to 1.35; 3 trials, 5569 women; moderate-certainty evidence), and may have little or no effect on low birthweight (less than 2500 g) (average RR 0.93, 95% CI 0.81 to 1.07; 6 trials, 14,162 women; low-certainty evidence; 1 study reported low birthweight (less than 2500 g) but recorded 0 events in both groups. Thus, the RR and CIs were calculated from 5 studies rather than 6). We downgraded the evidence for imprecision (wide CIs crossing the line of no effect) and inconsistency (high levels of heterogeneity between the studies). There was no evidence that calcium supplementation had any effect on maternal weight gain during pregnancy; increasing bone mineral density in pregnant women; rate of intrauterine growth restriction; perinatal mortality; stillbirth or fetal death rate; increase birth length or fetal head circumference; and adverse effects such as postpartum haemorrhage, gall stones, gastrointestinal symptoms, headache, urinary stones, urinary tract infection or impaired renal function.

Authors' conclusions: This review indicates that calcium supplementation probably reduces preterm birth before 37 weeks. There are no clear additional benefits to calcium supplementation in preterm birth before 34 weeks or prevention of low birthweight. Large multicentre trials to detect the effect of calcium supplementation on fetal birthweight and preterm birth before 34 weeks as the primary outcomes are needed. Further research into the short- and long-term effects of calcium supplementation would also be beneficial.

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补钙(预防或治疗高血压除外)以改善妊娠和婴儿的预后。
背景:众所周知,孕期母体营养对胎儿的生长发育有影响。建议妇女在孕期和哺乳期增加钙的摄入量,但不同专业人士推荐的剂量各不相同。目前,除了预防或治疗高血压外,对于孕妇常规补钙的作用还没有达成共识:目的:确定补钙对孕产妇、胎儿和新生儿结局的影响,不包括多胎妊娠妇女(预防或治疗高血压除外),包括不良反应的发生:我们于 2022 年 12 月 3 日检索了 Cochrane 妊娠与分娩组的试验登记册(包括 CENTRAL、MEDLINE、Embase、CINAHL、两个试验登记册和相关会议论文集的全面检索结果)。我们还检索了检索到的研究的参考文献列表:我们考虑了所有已发表、未发表和正在进行的随机对照试验(RCT),这些试验比较了接受钙补充剂与安慰剂或无治疗的孕妇的母体、胎儿和新生儿结局。集群随机对照试验符合纳入条件,但没有发现。数据收集与分析:两位评审作者对纳入的试验进行了独立评估。至少有一位综述作者对符合纳入标准的试验进行了可信度评估,在不明确的情况下,会咨询另一位综述作者。两位综述作者独立评估研究的偏倚风险、提取数据并检查试验的准确性。我们使用 GRADE 评估了证据的确定性:21项研究符合纳入标准,但只有19项研究为综述提供了数据。这 19 项试验招募了 17,370 名女性,最终分析包括 16,625 名女性。这些试验在随机化和分配隐藏方面的偏倚风险普遍较低。我们选择了三个结果进行 GRADE 评估:37 周以内的早产、34 周以内的早产和低出生体重(2500 克以下)。所有试验都对补钙与安慰剂或不补钙进行了比较,其中有 17 项试验对高剂量钙(大于 1000 毫克/天)进行了比较。补钙可能会略微降低 37 周以内早产的风险(平均风险比 (RR) 0.80,95% 置信区间 (CI) 0.65 至 0.99;11 项试验,15379 名妇女;中等确定性证据),但可能对 34 周以内早产的风险影响不大(平均 RR 1.平均 RR 1.03,95% CI 0.79 至 1.35;3 项试验,5569 名妇女;中度确定性证据),对低出生体重(小于 2500 克)的影响可能很小或没有影响(平均 RR 0.93,95% CI 0.81 至 1.07;6 项试验,14162 名妇女;低度确定性证据;1 项研究报告了低出生体重(小于 2500 克),但两组中都没有记录。因此,RR 和 CI 是根据 5 项研究而非 6 项研究计算得出的)。由于证据不精确(CI 值较宽,越过了无影响线)和不一致(研究之间存在高度异质性),我们对证据进行了降级。没有证据表明补钙对孕期孕妇体重增加、孕妇骨质密度增加、宫内生长受限率、围产期死亡率、死胎率或胎儿死亡率、出生身长或胎儿头围增加以及产后出血、胆结石、胃肠道症状、头痛、尿路结石、尿路感染或肾功能受损等不良反应有任何影响:本综述表明,补钙可能会减少 37 周前的早产。对于 34 周前的早产或预防低出生体重,补钙没有明显的额外益处。需要进行大型多中心试验,以检测补钙对胎儿出生体重和 34 周前早产的影响。进一步研究补钙的短期和长期效果也将有所裨益。
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来源期刊
CiteScore
10.60
自引率
2.40%
发文量
173
审稿时长
1-2 weeks
期刊介绍: The Cochrane Database of Systematic Reviews (CDSR) stands as the premier database for systematic reviews in healthcare. It comprises Cochrane Reviews, along with protocols for these reviews, editorials, and supplements. Owned and operated by Cochrane, a worldwide independent network of healthcare stakeholders, the CDSR (ISSN 1469-493X) encompasses a broad spectrum of health-related topics, including health services.
期刊最新文献
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