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Kuthamanga kwa magazi panthawi yomwe ali ndi pakati kungayambitse eclampsia ndi kubadwa kwa mwana asanakwane ndipo ndizomwe zimayambitsa matenda a amayi ndi akhanda ndi imfa. Monga muyeso wofunikira paumoyo wa anthu, bungwe la World Health Organisation (WHO) limalimbikitsa kuti amayi apakati omwe ali ndi zakudya zosakwanira za calcium awonjezere 1000 mpaka 1500 mg wa calcium tsiku lililonse. Komabe, chifukwa chakuchulukirachulukira kwa calcium supplement, kukhazikitsidwa kwa malingaliro awa sikokwanira.

Mayesero olamulidwa mwachisawawa omwe anachitika ku India ndi ku Tanzania ndi Pulofesa Wafie Fawzi wa ku Harvard School of Public Health ku United States anapeza kuti mlingo wochepa wa calcium supplementation pa nthawi ya mimba unali woipa kuposa mlingo waukulu wa calcium supplementation pochepetsa chiopsezo cha pre-eclampsia. Ponena za kuchepetsa chiopsezo cha kubadwa msanga, mayesero a Indian ndi Tanzania anali ndi zotsatira zosagwirizana.

Mayesero awiriwa adaphatikizapo otenga nawo gawo 11,000 azaka ≥18 zaka, zaka zoyembekezera < kuyambira Novembala 2018 mpaka February 2022 (India) ndi Marichi 2019 mpaka Marichi 2022 (Tanzania). Amayi a nthawi yoyamba pa masabata a 20 omwe amayenera kukhala m'dera la mayesero mpaka masabata a 6 atatha kubereka anapatsidwa 1: 1 kutsika kwa calcium supplementation (500 mg tsiku + 2 mapiritsi a placebo) kapena calcium supplementation (1500 mg tsiku lililonse) mpaka kubereka. Mapeto oyambilira anali preeclampsia ndi kubadwa kwanthawi yayitali (mapeto apawiri). Mapeto achiwiri anali ndi matenda oopsa okhudzana ndi mimba, preeclampsia yokhala ndi zizindikiro zoopsa, imfa yokhudzana ndi mimba, kubereka mwana wakufa, kubereka, kubadwa kochepa, kuchepa kwa msinkhu, ndi imfa ya mwana mkati mwa masiku 42. Mapeto achitetezo adaphatikizira kugonekedwa m'chipatala kwa amayi apakati (zifukwa zina osati kubereka) komanso kuchepa kwa magazi m'thupi lachitatu. Mitsinje yopanda malire inali yowopsa ya 1.54 (preeclampsia) ndi 1.16 (kubadwa msanga), motsatira.

Kwa preeclampsia, chiwerengero cha 500 mg motsutsana ndi 1500 mg gulu mu mayesero a Indian chinali 3.0% ndi 3.6%, motero (RR, 0.84; 95% CI, 0.68 ~ 1.03); Pakuyesa kwa Tanzania, zochitikazo zinali 3.0% ndi 2.7%, motero (RR, 1.10; 95% CI, 0.88 ~ 1.36). Mayesero onsewa adawonetsa kuti chiopsezo cha preeclampsia sichinali choyipa kwambiri mu gulu la 500 mg kuposa gulu la 1500 mg.

Kwa kubadwa msanga, mu mayesero a ku India, chiwerengero cha 500 mg motsutsana ndi 1500 mg gulu chinali 11.4% ndi 12.8%, motero (RR, 0.89; 95% CI, 0.80 ~ 0.98), osakhala otsika anakhazikitsidwa mkati mwa mtengo; wa 154; M'mayesero a ku Tanzania, chiwerengero cha kubadwa kwa nthawi yayitali chinali 10.4% ndi 9.7%, motsatira (RR, 1.07; 95% CI, 0.95 ~ 1.21), kuposa chiwerengero chopanda malire cha 1.16, ndipo kusakhala pansi sikunatsimikizidwe.

Pamapeto onse achiwiri ndi otetezeka, panalibe umboni wakuti gulu la 1500 mg linali bwino kuposa gulu la 500 mg. Meta-kufufuza zotsatira za mayesero awiriwa sanapeze kusiyana pakati pa magulu a 500 mg ndi 1500 mg mu preeclampsia, chiopsezo chobadwa asanakwane, ndi zotsatira zachiwiri ndi chitetezo.

Kafukufukuyu adayang'ana pa nkhani yofunika kwambiri ya thanzi la anthu ya calcium supplementation mwa amayi apakati pofuna kupewa preeclampsia, ndipo adayesa mayesero akuluakulu osasinthika m'mayiko awiri panthawi imodzi kuti ayankhe funso lofunika kwambiri koma losadziwika bwino la sayansi la mlingo woyenera wa calcium supplementation. Kafukufukuyu anali ndi mapangidwe okhwima, kukula kwakukulu kwachitsanzo, placebo yakhungu iwiri, hypothesis yopanda malire, ndi zotsatira ziwiri zazikulu zachipatala za preeclampsia ndi kubadwa kwa mwana wosabadwayo monga mapeto awiri, zotsatiridwa mpaka masiku 42 pambuyo pobereka. Panthawi imodzimodziyo, khalidwe la kuphedwa linali lapamwamba, chiwerengero cha kutayika kwa zotsatira chinali chochepa kwambiri (99.5% kutsatira zotsatira za mimba, India, 97.7% Tanzania), ndipo kutsatiridwa kunali kwakukulu kwambiri: chiwerengero chapakati cha kutsata chinali 97.7% (India, 93.2-99.2 interquartile interval 3.8% 72). nthawi).

Kashiamu ndi zofunika michere kuti fetal kukula ndi chitukuko, ndi kufunika kashiamu mu amayi apakati kumawonjezeka poyerekeza ndi anthu ambiri, makamaka mochedwa mimba pamene mwana wosabadwayo amakula mofulumira ndi mafupa mineralization nsonga, kashiamu kwambiri ayenera kuwonjezeredwa. Calcium supplementation imachepetsanso kutulutsidwa kwa timadzi ta parathyroid ndi ndende ya kashiamu yam'mimba mwa amayi apakati, komanso kuchepetsa kutsika kwa mitsempha yamagazi ndi minofu yosalala ya chiberekero. Mayesero oyendetsedwa ndi placebo asonyeza kuti mlingo waukulu wa calcium supplementation pa nthawi ya mimba (> 1000 mg) umachepetsa chiopsezo cha preeclampsia ndi 50% ndi chiopsezo cha kubadwa asanakwane ndi 24%, ndipo kuchepetsa kumawoneka ngati kwakukulu kwambiri kwa anthu omwe amamwa calcium yochepa. Choncho, mu "Malangizo Omwe Alangizidwa a Calcium Supplementation panthawi ya mimba kuti ateteze Preeclampsia ndi Zovuta zake" zomwe zinaperekedwa ndi World Health Organization (WHO) mu November 2018, tikulimbikitsidwa kuti anthu omwe ali ndi calcium yochepa ayenera kuwonjezera calcium ndi 1500 mpaka 2000 mg tsiku ndi tsiku, kugawidwa m'maola atatu akumwa chitsulo, ndi kupewa preeclamp oral doses. China's Expert Consensus on Calcium Supplementation for Pregnant Women, yomwe inatulutsidwa mu May 2021, imalimbikitsa kuti amayi apakati omwe ali ndi calcium yochepa amawonjezera calcium 1000 ~ 1500 mg tsiku lililonse mpaka nthawi yobereka.

Pakalipano, mayiko ndi madera ochepa okha ndi omwe agwiritsira ntchito chizolowezi chowonjezera mlingo wa calcium pa nthawi ya mimba, zifukwa zake zikuphatikizapo kuchuluka kwa kashiamu mawonekedwe a mlingo, ovuta kumeza, ndondomeko yoyendetsera zovuta (katatu pa tsiku, ndipo imayenera kupatulidwa ndi chitsulo), ndipo kutsatiridwa kwa mankhwala kumachepetsedwa; M'madera ena, chifukwa cha chuma chochepa komanso kukwera mtengo, kashiamu sikophweka kupeza, kotero kuthekera kwa mlingo waukulu wa calcium supplementation kumakhudzidwa. M'mayesero achipatala omwe amafufuza kashiamu wochepa wa calcium pa nthawi ya mimba (makamaka 500 mg tsiku lililonse), ngakhale poyerekeza ndi placebo, chiopsezo cha preeclampsia chinachepetsedwa mu gulu la calcium supplementation (RR, 0.38; 95% CI, 0.28 ~ 0.52), koma m'pofunika kudziwa za kukhalapo kwa kafukufuku woopsa kwambiri [3]. M'mayesero ang'onoang'ono achipatala omwe amayerekezera mlingo wochepa komanso wowonjezera wa calcium supplementation, chiopsezo cha preeclampsia chikuwoneka kuti chikuchepa m'gulu lamagulu otsika poyerekeza ndi gulu laling'ono (RR, 0.42; 95% CI, 0.18 ~ 0.96); Panalibe kusiyana pakati pa chiopsezo chobadwa msanga (RR, 0.31; 95% CI, 0.09 ~ 1.08)