Effect of Vitamin D Supplementation and Calcium in Reducing the Risk of Preeclampsia: Meta-Analysis
Abstract
Background: Preeclampsia (PE) is a major complication in pregnancy and a major cause of maternal and fetal morbidity and mortality. Analysis of risk factors and prevention of preeclampsia are needed to reduce the adverse effects of preeclampsia. Important supplements during pregnancy to prevent the increase in blood pressure of pregnant women are Vitamin D and calcium. This study aimed to analyze the effect of vitamin D and calcium supplementation on reducing the risk of preeclampsia.
Subjects and Method: This study is a meta-analysis of a number of randomized controlled trials. The articles used in this study were obtained from several databases including PubMed, Google Scholar, Springerlink, and Sciencedirect. The articles used in this study were those published from 2002-2020. The article search was carried out by considering the eligibility criteria defined using the PICO model. P: Pregnant women, I: vitamin D and calcium, C: placebo, and O: preeclampsia. The keywords to find articles are as follows: "Vitamin D" OR "Calcium" OR "Vitamin D and Calcium" AND "preeclampsia" AND "Randomized Controll Trials". The articles included in this study are full text articles with Cross-sectional study design. Articles were collected using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3.
Results: A total of 9 articles were reviewed in this study. The meta-analysis showed that vitamin D supplementation reduced the risk of preeclampsia in pregnant women (RR= 0.45, 95% CI 0.32-0.63, p<0.001). The meta-analysis of 8 articles also showed that calcium supplementation reduced the risk of preeclampsia in pregnant women with calcium (RR= 0.42; 95% CI= 0.31 - 0.57; p<0.001). This meta-analysis combines primary research from Iran, India, Bangladesh, South Africa, Cameroon, and Saudi Arabia.
Conclusion: Vitamin D and calcium supplementation reduces the risk of preeclampsia.
Keywords: vitamin D, Calcium, preeclampsia, randomized controlled trial
Correspondence: Fanny Kartika Fajriyani. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: fannykfa9@gmail.com.
Indonesian Journal of Medicine (2020), 05(04): 308-320
https://doi.org/10.26911/theijmed.2020.05.04.06.
References
Ali AM, Alobaid A, Malhis TN, Khattab AF (2019). Effect of vitamin D3 supple-mentation in pregnancy on risk of pre-eclampsia - Randomized controlled trial. Clin Nutr. 38(2):557-563. https://doi.org/10.1016/j.clnu.2018.02.023.
Aghamohammadi A, Zafari M (2015). Cal-cium supplementation in pregnancy and prevention of hypertensive dis-orders in elderly women. Science Asia, 41(4): 259–262. http://dx.doi.org/10-.2306/scienceasia1513-1874.2015.41.-259.
Asemi Z, Hashemi T, Karamali M, Samimi M, Esmaillzadeh A (2013). Effects of vitamin D supplementation on glu-cose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: A double-blind randomized controlled clinical trial. Am J Clin Nutr. 98(6): 1425–1432. https://doi.org/10.3945/-ajcn.113.072785.
Asemi Z, Tabassi Z, Heidarzadeh Z, Kho-rammian H, Sabihi SS, Samimi M (2012). Effect of calcium-vitamin D supplementation on metabolic profiles in pregnant women at risk for pre-eclampsia: A randomized plasebo-controlled trial. Pak J Biol Sci. 15(7): 316–324. https://doi.org/10.-3923/pjbs.2012.316.324.
Bhutta ZA, Jai KD, Arjumand R, Michelle FG (2013). Evidence-based interven-tions for improvement of maternal and child nutrition: what can be done and at what cost. Lancet, 88(2): 599-605. https://doi.org/10.1016/S0140-6736(13)60996-4.
Dodd JM, O’Brien C, Grivell RM (2014). Preventing pre-eclampsia are dietary factors. BMC Med, 12(7): 176. https:-//doi.org/10.1186/s12916-014-0176-4
Dror K, Daphna KCJ, Bellen F (2012). Evi-dence of association between feto-maternal vitamin D status, cord para-thyroid hormone and bone- specific alkaline phosphatase, and newborn whole body mineral content. J Nutr, 4(9): 68−77. https://doi.org/10.3390-/nu4020068.
Hofmeyr GJ, Betrán AP, Madliki MS, Cor-mick G, Stephen P, Fawcus S, Mose S, et al. (2015). Prepregnancy and early pregnancy calcium supplementation among women at high risk of pre-eclampsia: A multicentre, double-blind, randomised, plasebo-controlled trial. The Lancet. 393(1): 330-339. https://doi.org/10.1016/S0140-6736-(18)31818-X.
Imdad A, Bhutta Z (2012). Effects of kal-sium supplementation during preg-nancy on maternal, fetal and birth outcomes. Paediatr perinat epidemiol, 26(4): 138-152. https://doi.org/10.11-11/j.1365-3016.2012.01274.x.
Jamilian M, Amirani E, Asemi Z (2019). The effects of vitamin D and probiotic co-supplementation on glucose home-ostasis, inflammation, oxidative stress and pregnancy outcomes in gestatio-nal diabetes: A randomized, double-blind, plasebo-controlled trial. Am J Clin Nutr. 38(5): 209–2105. https://doi.org/10.1016/j.clnu.2018.10.028.
Kanagal DV, Rajesh A, Rao K, Devi UH, Shetty H, Kumari S, Shetty PK. (2014). Levels of serum kalsium and magnesium in pre-eclamptic and nor-mal pregnancy: a study from coastal. India. J Clin Diagn Res. 8(7): OC01–OC04. https://dx.doi.org/10.7860%2-FJCDR%2F2014%2F8872.4537.
Karamali M, Beihaghi E, Mohammadi AA, Asemi Z (2015). Effects of high-dose Vitamin D supplementation on meta-bolic status and pregnancy outcomes in pregnant women at risk for pre-eclampsia. Horm Metab Res, 47(12): 867–872. https://doi.org/10.1055/s-0035-1548835.
Khan A, Mandal SK, Pal A. (2013). Role of high dose calcium in the prevention of preeclampsia. Bangladesh Journal of Obstetrics and Gynecology, 28(2), 66–70. https://doi.org/10.3329/bjog-.v28i2.30092.
Kumar A, Devi SG, Batra S, Singh C, Shukla DK (2009). Calcium supplementation for the prevention of pre-eclampsia. Int J Gynaecol Obstet, 104(1): 32–36. https://doi.org/10.1016/j.ijgo.2008.08.027.
Naghshineh E, Sheikhaliyan S (2016). Effect Vitamin D supplementation in the reduce risk ofpre eclampsia in nulliparous women. Adv Biomed, 95(1): 7–7. https://dx.doi.org/10.410-3%2F22779175.175239.
Niromanesh S, Laghaii S, Mosavi JA (2001). Supplementary calcium in prevention of pre-eclampsia. Int J Gynaecol Obstet, 74(1): 17–21. https:-//doi.org/10.1016/S0140-6736(18)31-818-X.
Roth DE, Al Mahmud A, Raqib R, Akhtar E, Perumal N, Pezzack B, Baqui AH (2013). Randomized plasebo-control-led trial of high-dose prenatal third-trimester vitamin D3 supplementation in Bangladesh: the AViDD trial. Int J Obes. 12(1): 1–16. https://doi.-org/10.1186/1475-2891-12-47.
Sablok A, Batra A, Thariani K, Batra A, Bharti R, Aggarwal AR, Kabui BC, et al. (2015). Supplementation of Vitamin D in pregnancy and its correlation with feto-maternal outcome. J Clin Endocrinol. 83(4): 536–541. https://doi.org/10.1111/cen.12751.
Santorelli G, Whitelaw D, Farrar D, West J, Lawlor DA (2019). Associations of maternal vitamin D, PTH and calcium with hypertensive disorders of preg-nancy and associated adverse peri-natal outcomes: Findings from the Born in Bradford cohort study.
Sci Rep. 9(1):1205. https://doi.org/10.-1038/s41598018-37600-9.
Samimi M, Kashi M, Foroozanfard F, Karamali M, Bahmani F, Asemi Z, Hami-dian Y, et al. (2016). The effects of vitamin D plus calcium supplementa-tion on metabolic profiles, biomarkers of inflammation, oxidative stress and pregnancy outcomes in pregnant
women at risk for pre-eclampsia. J Hum Nutr Diet, 29(4): 505–515. https://doi.org/10.1111/jhn.12339.
Taherian AA, Taherian A, Shirvani A (2002). Prevention of preeklampsia with low-dose aspirin or calcium sup-plementation. Arch Iran Med, 5(3): 151–156. https://doi.org/10.1111/tog.-12111.
WHO. (2017). Maternal Mortality Rate. World Health Organization, https://apps.who.int/iris/handle/10665/43444.
