Calcium Supplements During Pregnancy

Calcium supplements in pregnancy

Dietary requirements during pregnancy and lactation are increased. In India, many women, especially from the lower socio-economic strata and rural areas, may have intakes far below the recommended daily allowance. That is why it is important to include a calcium supplements during pregnancy.

Are calcium supplements necessary during pregnancy?

National data from 10 Indian states shows that most pregnant and lactating women in India have low dietary calcium intake. It is about 30% of RDA (which means it is only 400 mg/d).

There is enough scientific proof that adequate calcium intake in pregnancy can play an important role in the prevention of pre-eclampsia (high blood pressure in pregnancy and related disorders) and preterm birth and therefore influence the maternal and neonatal health.

How much calcium is required during pregnancy?

The daily recommended dietary allowances (RDA) for calcium in pregnancy and lactation is 1200 mg per day.

The daily intake of at least one gm/day of calcium in pregnancy after the first trimester reduces the risk of pre-eclampsia by at least 50%, with an additional 24% reduction in the risk of pre-term birth. This ensures that pregnant women focus on calcium supplements during pregnancy.

WHO – 2013 guidelines recommend routine prenatal calcium supplementation in high doses (>1gm/day), especially in areas where dietary calcium intake is low.

The present national guidelines advise

To give calcium supplements during pregnancy to all pregnant.
All pregnant and lactating women to be counseled about the intake of calcium-rich foods.
Oral swallowable calcium tablets to be taken twice a day (total 1gm calcium/day) starting from 14 weeks of pregnancy up to six months postpartum.
One calcium tablet should be taken with the morning/afternoon meal and the second tablet with the evening/night meal.
It is not advisable to take both calcium tablets together as > 800 mg calcium interferes with iron absorption.
Calcium tablets should not be taken on an empty stomach since it causes gastritis.
Calcium and Iron Folic Acid (IFA) tablets should not be taken together since calcium inhibits iron absorption. IFA tablets should be taken preferably two hours after a meal.
Each calcium tablet should contain 500 mg elemental calcium and 250 IU vitamin D3. The preferred formulation for calcium is calcium carbonate.
The rationale for the inclusion of Vitamin D is to enhance the absorption of calcium.
There are no side effects & contraindications, within the recommended limit (1gm/d). A small proportion of women may experience mild gastritis so calcium tablets should be taken with meals. Excessive consumption of calcium (>3 gm/d) may increase the risk of urinary stones and Urinary Tract Infection (UTI) and reduce the absorption of essential micronutrients.