CALCIUM SUPPLEMENTATION AND THE RISK OF PREECLAMPSIA IN ECUADORIAN PREGNANT TEENAGERS

Objective: To determine whether increased calcium intake (2 g/day) in pregnancy is effective in reducing the risk of preeclampsia in pregnan t teenagers. Methods: The present study was a prospective, randomized, double-blind, controlled clinical trial. Two hundred sixty teenaged p regnant girls attending the Hospital Gineco-Obstetrico Isidro Ayora in Quito, Ecuador, were included. Selection criteria were age less than 17.5 years, nulliparity, first prenatal visit before 20 weeks' gestati on, and residency in Quito (2800-m altitude). We used a table of rando m numbers to assign 125 girls to receive 2000 mg of elemental calcium daily, beginning at 20 weeks of gestation and continuing until deliver y; 135 women in the control group received a placebo. Blood pressure ( BP) was measured twice every 4 weeks until delivery and at 48 hours af ter delivery. The diagnosis of preeclampsia was defined as BP greater than 140/90 mmHg on at least two occasions more than 6 hours apart and proteinuria greater than 30 mg/dL (over one cross by dipstick on two occasions 4-24 hours apart). Results: The average daily calcium intake in this population was approximately 51% of the Recommended Dietary A llowance. Calcium supplementation was associated with a significantly decreased risk of preeclampsia (risk reduction 12.35%; P < .001), with 3.2% (n = 4) developing preeclampsia in the treatment group versus 15 .5% (n = 21) in the placebo group. Moreover, calcium supplementation l ed to a reduction in systolic BP of 9.1 mmHg and in diastolic BP of 6. 0 mmHg.Conclusion: These results suggest that calcium supplementation during pregnancy in populations with low calcium intake is a safe, eff ective, and inexpensive preventive measure that significantly reduces the risk of preeclampsia. ((C) 1997 by The American College of Obstetr icians and Gynecologists.)