Cited by 634Pregnancy and preeclampsia studiesNeurological Complications and SyndromesBlood Pressure and Hypertension Studies

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Trial of Calcium to Prevent Preeclampsia

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Levine, Richard J., Hauth, John C., Curet, Luis B., Sibai, Baha M., Catalano, Patrick M., Morris, Cynthia D., DerSimonian, Rebecca, Esterlitz, Joy R., Raymond, Elizabeth G., Bild, Diane E., Clemens, John D., Cutler, Jeffrey A., Ewell, Marian G., Friedman, Steven A., Goldenberg, Robert L., Jacobson, Sig-Linda, Joffe, Gary M., Klebanoff, Mark A., Petrulis, Alice S.·1997·New England Journal of Medicine

DOI 10.1056/nejm199707103370201

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Abstract

BACKGROUND: Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations studied limit acceptance of the data. METHODS: We randomly assigned 4589 healthy nulliparous women who were 13 to 21 weeks pregnant to receive daily treatment with either 2 g of elemental calcium or placebo for the remainder of their pregnancies. Surveillance for preeclampsia was conducted by personnel unaware of treatment-group assignments, using standardized measurements of blood pressure and urinary protein excretion at uniformly scheduled prenatal visits, protocols for monitoring these measurements during the hospitalization for delivery, and reviews of medical records of unscheduled outpatient visits and all hospitalizations. RESULTS: Calcium supplementation did not significantly reduce the incidence or severity of preeclampsia or delay its onset. Preeclampsia occurred in 158 of the 2295 women in the calcium group (6.9 percent) and 168 of the 2294 women in the placebo group (7.3 percent) (relative risk, 0.94; 95 percent confidence interval, 0.76 to 1.16). There were no significant differences between the two groups in the prevalence of pregnancy-associated hypertension without preeclampsia (15.3 percent vs. 17.3 percent) or of all hypertensive disorders (22.2 percent vs. 24.6 percent). The mean systolic and diastolic blood pressures during pregnancy were similar in both groups. Calcium did not reduce the numbers of preterm deliveries, small-for-gestational-age births, or fetal and neonatal deaths; nor did it increase urolithiasis during pregnancy. CONCLUSIONS: Calcium supplementation during pregnancy did not prevent preeclampsia, pregnancy-associated hypertension, or adverse perinatal outcomes in healthy nulliparous women.

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Authors: Levine, R. J., Hauth, J. C., Curet, L. B., Sibai, B. M., Catalano, P. M., Morris, C. D., DerSimonian, R., Esterlitz, J. R., Raymond, E. G., Bild, D. E., Clemens, J. D., Cutler, J. A., Ewell, M. G., Friedman, S. A., Goldenberg, R. L., Jacobson, S.-L., Joffe, G. M., Klebanoff, M. A., & Petrulis, A. S.
Affiliations: National Institutes of Health (US)
University of Alabama at Birmingham (US)
University of New Mexico (US)
University of Tennessee Health Science Center (US)
MetroHealth Medical Center (US)
Oregon Health & Science University (US)
National Heart, Lung, and Blood Institute (US)
ORCID: Catalano, Patrick M.
Morris, Cynthia D.
Clemens, John D.
Goldenberg, Robert L.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1997-07-10
Volume: 337
Issue: 2
Pages: 69-77
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199707103370201
OpenAlex: W2084688828
Cited by: 634
References: 33
Citations by year: 2026: 6 · 2025: 6 · 2024: 11 · 2023: 11 · 2022: 14 · 2021: 17 · 2020: 13 · 2019: 11 · 2018: 19 · 2017: 12 · 2016: 11 · 2015: 16 · 2014: 26 · 2013: 22 · 2012: 34
FWCI: 45.62
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: Eunice Kennedy Shriver National Institute of Child Health and Human Development (N01-HD-5-3122, N01-HD-5-3121, N01-HD-5-3123)
Topics: Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Health Sciences › Medicine › Clinical Neurology › Neurological Complications and Syndromes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords: calcium supplementation, preeclampsia prevention, pregnancy, nulliparous women, gestational hypertension, hypertensive disorders of pregnancy, blood pressure in pregnancy, urinary protein excretion, urolithiasis, perinatal outcomes, preterm birth, small for gestational age
MeSH terms: Adult, Calcium, Female, Humans, Hypertension, Parity, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Cardiovascular, Pregnancy Outcome, Proteinuria, United States, Urinary Calculi, Incidence, Case-Control Studies

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