ROLE OF 2 GRAM CALCIUM SUPPLEMENTATION IN PREVENTION OF PRE-ECLAMPSIA IN HIGH RISK CASES

OBJECTIVE: To select high risk cases which are more prone to develop pre-eclampsia, to study the effect of 2 gram calcium on reduction of pre-eclampsia in high risk patients & to assess the beneficial and adverse effect of calcium on foetal & maternal outcome. MATERIAL & METHODS:Two hundred women at high risk of developing pre-eclampsia were randomized to 2 gram of daily calcium & placebo.Subjects & investigators were blinded to treatment allocation.The inclusion criteria were positive roll over test, having at least one high risk factor for pre-eclampsia, between 24 weeks to 32 weeks of pregnancy & blood pressure less than 140/90 mm of Hg.Exclusion criteria were having any chronic condition leading to hypertension.Pre-eclampsia was defined as systolic/diastolic BP over 160/100 mm of Hg plus proteinuria.All subjects were followed up to delivery.RESULTS: A statistically significant reduction in the occurrence of pre-eclampsia was seen among the calcium group.16%cases developed pre-eclampsia out of which 3 were eclampsia,10% developed uncomplicated gestational hypertension & 74% cases had no hypertension (p= 0.014).In control group, 54% had no hypertension, 21% had uncomplicated gestational hypertension & 25% had pre-eclampsia out of which 10 patients had eclampsia.Infants born to calcium group on average were 552 gm heavier than Infants born to the control group.(P=<0.05).CONCLUSION: 2 gram calcium supplementation is beneficial for preventing pre-eclampsia in women at high risk for developing pre-eclampsia.No adverse effect in mother or neonate was observed in calcium treated group.KEY WORDS: Pre-eclampsia, calcium supplementation, high risk pregnancy, roll over test INTRODUCTION: Pre-eclampsia is a common and serious complication of pregnancy that affects both mother and neonate.It occurs in 7-10% of pregnancies with a case fatality rate of 6-10 %. (1) It relatively more common in developing countries and it probably accounts for more than 40,000 maternal deaths worldwide each year.( 2)Pre-eclampsia is seen more among nulliparous women, with multiple pregnancy, diabetics, women with chronic hypertension, maternal age before 20 or above 35 years, low socioeconomic class, with history of hypertension, with vesicular mole, poly-hydramnios and underlying renal disease.(3)Several preventive measures have been proposed to decrease morbidity and mortality among pregnant women at high risk of developing pre-eclampsia.The proposed prophylactic measures were antiplatelet therapy (low dose Aspirin), magnesium sulphate and calcium supplementation (4, 5)Calcium supplementation has been used as a prophylactic measure for pre-eclampsia.Daily supplementation of 2 gram calcium results in overall lowering of blood pressure and overall reduction in the incidence of hypertensive disorder of pregnancy.