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Global inequities in dietary calcium intake during pregnancy: a systematic review and meta‐analysis
Author(s) -
Cormick G,
Betrán AP,
Romero IB,
Lombardo CF,
Gülmezoglu AM,
Ciapponi A,
Belizán JM
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15512
Subject(s) - pregnancy , medicine , calcium , environmental health , cohort study , cohort , physiology , biology , genetics
Background Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low‐ and middle‐income countries ( LMIC s) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide the evidence base for more targeted actions to improve calcium intake. Objective To assess dietary calcium intake during pregnancy worldwide. Search strategy MEDLINE and EMBASE (from 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 ( HIC s) and LMIC s independently, and for geographic regions, among studies reporting country of recruitment, mean intake, and total number of participants. When available, inadequate intakes were reported. Main results From 1880 citations 105 works met the inclusion criteria, providing data for 73 958 women in 37 countries. The mean calcium intake was 948.3 mg/day (95% CI 872.1–1024.4 mg/day) for HIC s and 647.6 mg/day (95% CI 568.7–726.5 mg/day) for LMIC s. Calcium intakes below 800 mg/day were reported in five (29%) countries from HIC s and in 14 (82%) countries from LMIC s. Conclusion These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HIC s and LMIC s, with alarmingly low intakes recorded for pregnant women in LMIC s. From the public health perspective, in the absence of specific local data, calcium supplementation of pregnant women in these countries should be universal. Tweetable abstract Despite dietary recommendations, women in LMIC s face pregnancy with diets low in calcium.