Pregnancy Related
Conditions
Brief summary
The World Health Organization currently recommends that pregnant women in populations with low calcium intake receive daily calcium supplementation (1500 - 2000 mg) divided into three doses which are preferably taken at mealtimes, in addition to daily iron folic-acid supplements. Despite proven efficacy and the WHO recommendation, calcium supplementation in pregnancy is not standard of care in the vast majority of low-income and middle-income countries. Two important barriers to implementation are the cost of the supplements and complexity of the suggested calcium dosing schedule. A lower dose of calcium (500 mg) administered as a single dose has been shown to be beneficial in several trials, and if found to be as effective as the 1500 mg supplementation regimen, it may help overcome these barriers and increase individual and health system adoption. The Investigators will conduct two parallel, individually randomized, double blind non-inferiority trials in India and Tanzania. Participating pregnant woman will be randomized to either 1500 mg or 500 mg calcium supplementation. The India and Tanzania trials are independently powered for the primary outcomes of i) preeclampsia and ii) preterm birth. The India and Tanzania sites will each enroll 11,000 participants.
Interventions
DIETARY_SUPPLEMENTDaily 500 mg elemental calcium as calcium carbonate
Pregnant women in this arm will be provided and counselled to take three tablets, one containing 500 mg elemental calcium as calcium carbonate and 2 placebo supplements daily (total of 500 mg daily). The supplements in India will also contain 83.3 IU each of vitamin D3, for a total of 250 IU daily. No vitamin D3 will be given in Tanzania.
DIETARY_SUPPLEMENTDaily1500 mg elemental calcium as calcium carbonate
Pregnant women in this arm will be provided and counselled to take three tablets each containing 500 mg elemental calcium as calcium carbonate daily (total of 1500 mg daily) as currently recommended by the World Health Organization. The supplements in India will also contain 83.3 IU each of vitamin D3, for a total of 250 IU daily. No vitamin D3 will be given in Tanzania.
Sponsors
St. John's Research Institute
Ifakara Health Institute
Africa Academy for Public Health
Harvard School of Public Health (HSPH)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Nulliparous * Attending first ANC visit at study clinics * Pregnant women \<20 weeks * ≥ 18 years old * Intending to stay in study area until 6 weeks post delivery * Provides informed consent
Exclusion criteria
* History or signs and/or symptoms of nephrolithiasis * Prior diagnosis of parathyroid disorder or thyroidectomy * Diseases that require digoxin, phenytoin, or tetracycline therapy
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Proportion of pregnant women with incident preeclampsia | Gestational week 20 to Delivery |
| Proportion of preterm birth | Birth |
Countries
India, Tanzania
Outcome results
None listed