Bibliographic Info
GuidelineWHO recommendations on maternal health: guidelines approved by the WHO Guidelines Review Committee, second edition. Geneva: World Health Organization; 2025
Year of Publication2023
Issuing InstitutionWorld Health Organization
Recommendation
Status
Updated
Recommendation in research context
Only in research contexts
Certainty of evidence
Low
Pre-pregnancy calcium supplementation for the prevention of pre-eclampsia and its complications is recommended only in the context of rigorous research
Notes and Remarks
- 1.The GDG noted that in 2018 WHO revalidated the recommendation that in populations with low dietary calcium intake, daily calcium supplementation (1.5–2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia (1). However, there is insufficient evidence to determine with precision at what gestational age calcium supplementation should be commenced in order to confer this benefit. The 2018 recommendation specified that stakeholders may wish to commence calcium supplementation at the first antenatal care contact, in order to optimize compliance with this regimen. Evidence review on initiation of calcium supplementation before pregnancy and continuing through pregnancy, however, shows that it remains uncertain whether this will confer additional health benefits, and further research is required.
- 2.Food fortification of staple foods with calcium may be an important public health intervention in settings where dietary calcium intake is low. Dietary counselling of all women who are considering pregnancy should promote adequate calcium intake through locally available, calcium-rich foods. Adequate calcium intake could be easily achieved by the incorporation of dairy products in the diet on a daily basis. However, dairy products are not part of all regular diets, or are not available in certain populations. Likewise, a high-salt diet decreases bodycalcium retention compared to a diet that is low in salt. Caffeine and protein can also induce hypercalciuria, but to a much lesser extent. This has become more important in recent years due to the consumption of caffeine-containing beverages such as soda and energy drinks.