Survey of calcium supplementation to prevent preeclampsia: the gap between evidence and practice in Brazil.
BACKGROUND
Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and especially in Latin America. High quality evidence indicates that calcium supplementation during pregnancy significantly reduces the incidence of preeclampsia and its consequences, including severe maternal morbidity and death. Few studies have assessed the implementation of this intervention in clinical practice. The study aimed to assess the proportion of pregnant women who received calcium supplements in Brazilian public antenatal care clinics.


METHODS
This cross-sectional study interviewed women waiting for antenatal care visits in 9 public clinics in 4 Brazilian cities in 2010-2012. Trained interviewers used a standardized anonymous questionnaire to collect socio demographic and obstetric data, information on ingestion of dairy products and on prescriptions received during current pregnancy.


RESULTS
A total of 788 valid questionnaires were analyzed. Participants were young (mean age 25.9), mostly multiparous (71.3%) and in the 2nd or 3rd trimesters of pregnancy at the time of interview (87.6%). Only 5.1% (40/788) had received a prescription for calcium supplements. Based on their reported ingestion of dairy products, the mean daily dietary calcium intake of the participants was 210 (+ 265) mg/day and over 90% consumed less than 1 g of calcium/day.


CONCLUSIONS
Despite good quality evidence indicating the benefits of this practice especially for women with low calcium diets, less than 6% of a sample of women receiving antenatal care in Brazilian public clinics received a prescription for calcium supplements. There is an urgent need to upscale the implementation of this life-saving intervention.
Erika Barbosa
EB
Camargo
Luci Fabiane Scheffer
LF
Moraes
Celsa Moura
CM
Souza
Rita
R
Akutsu
Jorge Maia
JM
Barreto
Edina Mariko Koga
EM
da Silva
Ana Pilar
AP
Betrán
Internal Medicine Department, São Paulo Federal University (UNIFESP), São Paulo, Brazil. ginecologia@terra.com.br.
Maria Regina
MR
Torloni
D000328:Adult; D001938:Brazil; D002136:Calcium, Dietary / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003611:Dairy Products / Q000706:statistics & numerical data; D004032:Diet; D019587:Dietary Supplements; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
D002136:Calcium, Dietary