Clinical Study of High Dose Calcium to Prevent Pregnancy Specific Hypertensive Disorders, Their Severity, Still A Research Agenda!

Abstract

Background: Worldwide hypertensive disorders of pregnancy (HDsP) continue to be leading causes of maternal, perinatal severe morbidity mortality, long term disabilities. Prevention of HDsP, their severity through high dose calcium supplementation is being suggested. However, whether calcium really helps is still not established. So, research continues. Objectives: Present study was carried out to know the efficacy of high dose daily calcium from midpregnancy on reduction in occurrence of HDsP, their severity and perinatal outcome. Material Methodology: Study was done with 1200 women, (600 cases, 600 controls) of 18-39 years with, 20 + 2 weeks pregnancy, no obvious medical disorders in mothers, no ultra sonographically diagnosed anomaly in fetus at entry to study. Study cases (S) received 2 gms oral calcium daily, similar controls (C) were not given calcium. Research assistant was not part of the care providers, but kept track of everything. Women got antenatal care, clinicians not knowing which women got extra calcium. Desired information, pregnancy outcome, complications during pregnancy, birth weight, neonatal outcome, admission of baby to neonatal intensive care unit and compliance to calcium tablets in study subjects was collected by research assistant using pretested tool. Results: HDsP occurred in 7.5% S cases, 7.33% C group. Amongst group S9.43% Primigravida, 4.3% Multigravida developed HDsP (gestational hypertension 6%, preeclampsia 1.16%, eclampsia 0.33%). In group C 8.04% primigravida, 3.08% multigravida developed HDsP, (6%GH, 1% preeclampsia, 0.33% eclampsia), Total 8.8% perinatal deaths occurred in S cases who had HDsP, 2.27% in C, with HDsP and no maternal death. Conclusion: No benefit was found with high dose calcium. On the contrary, perinatal outcome was poorer. More research is needed about high dose calcium for HDsP, their severity, perinatal outcome. Keywords: Hypertensive Disorders of Pregnancy; Occurrence; Severity; Perinantal outcome