Effect of maternal calcium intake during pregnancy on children's blood pressure: a systematic review of the literature.
BACKGROUND
Calcium supplementation during pregnancy has been shown to reduce the incidence of hypertension in the mother, but the effects on the offspring are uncertain. Assessing the impact on the offspring is very important given the now large body of evidence indicating that blood pressure levels in childhood and young adulthood can be influenced by factors operating during fetal life. We conducted a systematic review of the literature to summarize the evidence supporting an association between maternal dietary calcium intake during pregnancy and blood pressure in the offspring.


METHODS
A systematic review was performed to identify randomized, quasi-randomized and cohort studies reporting the relationship between offspring blood pressure or incidence of hypertension and levels of maternal dietary calcium intake during pregnancy, either from supplements (i.e. pills) or food. MEDLINE, EMBASE and the Cochrane Library Registry were searched for relevant trials.


RESULTS
Two randomized trial and three observational studies were identified and included in this review. In 4 of the 5 studies, loss to follow-up was a serious concern. There was heterogeneity between the studies, particularly those conducted on children below 12 month of age. Results were more consistent among the studies including older children (1 to 9 years) where a higher maternal calcium intake was associated with a reduction of -1.92 mm Hg (95% CI -3.14 to -0.71) in offspring systolic blood pressure. One large randomized trial found a clinically and statistically significant reduction in the incidence of hypertension in 7-year-old children (RR = 0.59, 95% CI 0.39 to 0.90).


CONCLUSIONS
There is evidence in the literature to support an association between maternal calcium intake during pregnancy and offspring blood pressure. However, more research is needed to confirm these finding given the small sample sizes and the methodological problems in many of the studies conducted so far. More studies on populations with calcium deficit are also needed. If confirmed, these findings could have important public health implications. Calcium supplementation during pregnancy is simple and inexpensive and may be a way to reduce the risk of hypertension and its sequels in the next generation.
Bergel
Eduardo
E
Department of Mother & Child Health Research, Institute for Clinical Effectiveness and Health Policy, School of Public Health, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. bergel@allstat.org
Barros
Aluisio J D
AJ
D001794:Blood Pressure / Q000502:physiology*; D002136:Calcium, Dietary / Q000008:administration & dosage*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health; D006801:Humans; D015994:Incidence; D007223:Infant; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D039401:Prenatal Nutritional Physiological Phenomena
D002136:Calcium, Dietary