Calcium Management in Medical Termination of Pregnancy
Rationale for Calcium Supplementation
- The World Health Organization strongly recommends calcium supplementation for pregnant women to prevent preeclampsia, which is a leading cause of maternal mortality globally 3
- Calcium supplementation during pregnancy reduces the risk of preeclampsia by approximately 50%, particularly in populations with low calcium intake 3
Optimal Formulation
- Calcium carbonate is the preferred formulation for supplementation during pregnancy due to its higher cost-effectiveness, better bioavailability, and more calcium by weight compared to other calcium salts 1
Dosage Recommendations
- The World Health Organization recommends 1.5-2.0g elemental calcium daily during pregnancy, but a lower dose of 1.0-1.5g elemental calcium daily is likely sufficient and offers better adherence 4, 5, 2
- Calcium should be administered in divided doses of ≤500mg per administration to maximize absorption 4
Timing of Administration
- Calcium supplementation should be initiated at the earliest contact in pregnancy and continued until delivery, and for medical termination of pregnancy, calcium should be administered throughout the procedure to maintain maternal calcium homeostasis 2, 7
Co-administration with Other Supplements
- Iron and folic acid supplementation is commonly recommended during pregnancy, and calcium can be taken together with iron and folic acid pills to simplify the regimen and facilitate adherence 5, 8
Special Considerations for MTP
- During medical termination of pregnancy, calcium supplementation should continue as it may help reduce the risk of complications, particularly for prostaglandin-induced terminations 7
Potential Side Effects and Precautions
- Calcium supplementation is generally safe but has been associated with rare side effects, including increased risk of HELLP syndrome and postnatal bone resorption, though the benefits outweigh the risks 8