Calcium Supplementation for Preeclampsia Prevention: Estimated Risk of Excessive Intake in Ethiopian Women

Abstract

The WHO recommends supplementation with 1.5–2.0 g/d elemental calcium (Ca) for pregnant women in settings with low dietary Ca intake, to help prevent preeclampsia. There is insufficient guidance on implementing this recommendation and avoiding risk of excessive Ca intake at the population level. We investigated usual dietary Ca intake of Ethiopian women of childbearing age and simulated the impact of different supplementation doses. In a nationally‐representative sample (n= 7834), 24‐hr dietary recall data was analyzed to estimate usual dietary Ca intake and the proportions of women below the estimated average requirement (EAR ) or above the upper tolerable limit (UL) at different supplementation dosages. An EAR of 1.1 and 0.8 g/d and UL of 3.0 and 2.5 g/d was used for women 15‐18 and 19‐45 y, respectively. Mean Ca intake was 506.4 mg/d ± 263.6; 96.6% of women 15‐18y and 88.4% overall had inadequate intake. In simulations, supplementing with 1.0, 1.5, and 2.0 g/d would allow >99% of women to meet the EAR. The 1.5 and 2.0 g/d supplemental doses would result in intakes above the UL in 4.9% and 38.4% of all women, respectively. At 1.5g/d, only 0.6% of women aged 15‐18y would exceed the UL. At the 1.0g/d dose of Ca, the overall prevalence of excessive intake would be below the target of 2.5% (0.74%). Thus, with high adherence, a lower dose of 1.0 g/d would allow >99 % of Ethiopian women meet the EAR and could be safer than the recommended 1.5‐2.0 g/d. Similar investigation of potential risks of Ca supplementation using 1.5‐2.0 g/d is warranted in countries considering this intervention. Funded by The Micronutrient Initiative.