Effects of Calcium Supplementation During Pregnancy on Maternal, Fetal and Birth Outcomes
Effects of Calcium Supplementation During Pregnancy on Maternal, Fetal and Birth Outcomes
复制标题
DOI：
10.1111/j.1365-3016.2012.01274.x
复制
发表时间：
2012-07-01
影响因子：
2.8
通讯作者：
Bhutta, Zulfiqar A.
中科院分区：
文献类型：
--
作者：
Imdad, Aamer;Bhutta, Zulfiqar A.
妊娠期高血压疾病是全世界孕产妇死亡的第二大原因。流行病学和临床研究表明，钙的摄入量与妊娠期高血压的发生呈反比关系。本综述的目的是评估孕期补钙对妊娠期高血压疾病及相关孕产妇和新生儿发病率和死亡率的预防作用。在PubMed、whois、PAHO和Cochrane图书馆进行文献检索。本综述仅纳入随机试验。数据被提取到标准化的Excel表格中。主要结局为先兆子痫、早产和出生体重。其他新生儿结局，如新生儿死亡率，小胎龄和低出生体重也进行了评估。本综述共纳入15项随机对照试验。合并分析显示，孕期补钙可使先兆子痫风险降低52%[相对危险度（RR） 0.48；95%可信区间（CI） 0.34, 0.67)，重度先兆子痫的发生率为25% （RR为0.75 [95% CI 0.57, 0.98]）。对子痫的发生率无影响（RR 0.73 [95% CI 0.41, 1.27]）。孕产妇死亡/严重发病率的风险显著降低（RR 0.80 [95% CI 0.65, 0.97]）。怀孕期间补钙也与早产风险显著降低相关（RR 0.76 [95% CI 0.60, 0.97]）。与对照组相比，干预组的体重增加了85 g（平均差85 g [95% CI 37, 133]）。补钙对围产期死亡率没有影响（RR 0.90 [95% CI 0.74, 1.09]）。干预组尿石症发生风险较对照组增加，差异无统计学意义（RR 1.52 [95% CI 0.06, 40.67]）。总之，孕期补钙与妊娠期高血压疾病和早产风险的降低以及出生体重的增加有关。没有增加患肾结石的风险。
Gestational hypertensive disorders are the second leading cause of maternal death worldwide. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy. The purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal morbidity and mortality. A literature search was carried out on PubMed, WHOLIS, PAHO and Cochrane Library. Only randomised trials were included in the review. Data were extracted into a standardised Excel sheet. Primary outcomes were pre-eclampsia, preterm birth and birthweight. Other neonatal outcomes such as neonatal mortality, small-for-gestational age and low birthweight were also evaluated. A total of 15 randomised controlled trials were included in this review. Pooled analysis showed that calcium supplementation during pregnancy reduced risk of pre-eclampsia by 52% [relative risk (RR) 0.48; 95% confidence interval (CI) 0.34, 0.67] and that of severe pre-eclampsia by 25% (RR 0.75 [95% CI 0.57, 0.98]). There was no effect on incidence of eclampsia (RR 0.73 [95% CI 0.41, 1.27]). There was a significant reduction for risk of maternal mortality/severe morbidity (RR 0.80 [95% CI 0.65, 0.97]). Calcium supplementation during pregnancy was also associated with a significant reduction in risk of pre-term birth (RR 0.76 [95% CI 0.60, 0.97]). There was an extra gain of 85 g in the intervention group compared with control (mean difference 85 g [95% CI 37, 133]). There was no effect of calcium supplementation on perinatal mortality (RR 0.90 [95% CI 0.74, 1.09]). There was a statistically non-significant increased risk of urolithiasis in the intervention group compared with control (RR 1.52 [95% CI 0.06, 40.67]). In conclusion, calcium supplementation during pregnancy is associated with a reduction in risk of gestational hypertensive disorders and pre-term birth and an increase in birthweight. There is no increased risk of kidney stones.