Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis

CORMICK, GABRIELA; BETRÁN, ANA PILAR; ROMERO, IRIS B; LOMBARDO, CRISTIAN F; GÜLMEZOGLU, A METIN; CIAPPONI, AGUSTÍN; BELIZÁN, JOSÉ M

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY

WILEY-BLACKWELL PUBLISHING, INC

Año: 2018

1470-0328

BACKGROUND:Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low-and-middle-income countries (LMICs) daily calcium intake is well below recommendations. To map calcium intakes during pregnancy worldwide and identify populations with low calcium intake will provide the evidence base to more targeted actions to improve intakes.OBJECTIVE:to assess dietary calcium intake during pregnancy worldwide.SEARCH STRATEGY:MEDLINE and EMBASE (July 2004 to November 2017).SELECTION CRITERIA:cross sectional, cohort and intervention studies reporting calcium intake during pregnancy.DATA COLLECTION AND ANALYSIS:Five reviewers working in pairs independently performed screening, extraction, and quality assessment. We reported summary measures of calcium intake and calculated the weighted arithmetic mean for high-income-countries (HICs) and LMICs independently and for geographic regions among those studies reporting country of recruitment, mean intake and total number of participants. When available inadequate intakes were reported.MAIN RESULTS:From 1880 citations 105 met the inclusion criteria providing data for 73958 women in 37 countries. The mean calcium intake was 948,3 (95% CI: 872,1 - 1024,4) mg/day for HICs and for 647,6 (95% CI: 568,7 - 726,5) mg/day LMICs. Calcium intakes below 800 mg/day were reported in 5 (29%) countries from HICs and 14 (82%) from LMICs.CONCLUSION:These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HICs and LMICs with alarmingly low intakes in pregnant women in LMICs. From the public health perspective, in absence of specific local data, calcium supplementation of pregnant women in these countries should be universal.FUNDING:HRP, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.