ABSTRACT :

Introduction: Preeclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality worldwide, particularly in low-resource settings. Characterized by elevated blood pressure and proteinuria after 20 weeks of gestation, preeclampsia can progress to eclampsia if not managed properly. The World Health Organization (WHO) strongly recommends calcium supplementation—1.5 to 2 grams daily starting from the second trimester—as a preventive measure, especially for pregnant women with low dietary calcium intake. However, the effectiveness of this intervention depends heavily on the level of maternal knowledge and adherence to supplementation guidelines. Given that knowledge is a critical determinant of health behavior, it is essential to evaluate the extent to which pregnant women are informed about the role of calcium in preventing preeclampsia.
Materials & Methods: This study used a systematic review approach to synthesize existing evidence on maternal knowledge regarding calcium supplementation for preeclampsia prevention. A total of 22 peer-reviewed articles published between 2013 and 2024 were identified through searches of electronic databases such as PubMed, ScienceDirect, and Google Scholar. Inclusion criteria were studies focusing on pregnant women, knowledge or behavior related to calcium supplementation, and outcomes related to preeclampsia or maternal nutrition. The articles were analyzed thematically to identify key patterns, knowledge gaps, and influencing factors.
Results: Findings across the reviewed studies consistently indicate that knowledge among pregnant women about calcium supplementation is generally inadequate or suboptimal, particularly in low- and middle-income countries. Many women are unaware of the correct dosage, timing, and importance of calcium in reducing the risk of preeclampsia. Knowledge levels are influenced by multiple factors, including educational attainment, exposure to antenatal counseling, access to health services, prior pregnancy experience, and the availability of educational materials. In addition, a positive correlation was found between higher levels of maternal knowledge and increased adherence to calcium supplementation. Conversely, women with limited understanding often demonstrated poor compliance and limited engagement with health promotion activities. Several studies also highlighted the role of healthcare workers in effectively communicating nutrition-related information and the impact of cultural beliefs on supplement use.
Conclusions: The systematic review highlights the urgent need to strengthen maternal education programs as a key strategy in preventing preeclampsia. Improving pregnant women’s knowledge about calcium supplementation should be a central component of antenatal care services. Interventions should include clear, culturally sensitive health communication strategies delivered through both clinical settings and community outreach. Policy makers and health practitioners should prioritize training for health workers, development of accessible information materials, and integration of nutrition education into routine pregnancy care. Such efforts will support more informed maternal decision-making and contribute to reducing the incidence of preeclampsia and its associated health burdens.

KEYWORDS :

Preeclampsia, Calcium Supplementation, Maternal Knowledge, Pregnancy, Systematic Review, Antenatal Care, Nutrition Education.

REFERENCES :

1) S. Ngwenya, “Severe preeclampsia and eclampsia: Incidence, complications, and perinatal outcomes at a low-resource setting, mpilo central hospital, bulawayo, Zimbabwe,” Int J Womens Health, vol. 9, pp. 353–357, May 2017, doi: 10.2147/IJWH.S131934; CTYPE: STRING: JOURNAL.
2) C. W. Ives, R. Sinkey, I. Rajapreyar, A. T. N. Tita, and S. Oparil, “Preeclampsia—Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review,” J Am Coll Cardiol, vol. 76, no. 14, pp. 1690–1702, Oct. 2020, doi: 10.1016/j.jacc.2020.08.014.
3) B. Jim and S. A. Karumanchi, “Preeclampsia: Pathogenesis, Prevention, and Long-Term Complications,” Semin Nephrol, vol. 37, no. 4, pp. 386–397, Jul. 2017, doi: 10.1016/J.SEMNEPHROL.2017.05.011.
4) S. Rana, E. Lemoine, J. Granger, and S. A. Karumanchi, “Preeclampsia: Pathophysiology, Challenges, and Perspectives,” Circ Res, vol. 124, no. 7, pp. 1094–1112, Mar. 2019, doi: 10.1161/CIRCRESAHA.118.313276/ASSET/093CF6BB-9496-4C85-9583-5C41E1DFFFEA/ASSETS/IMAGES/LARGE/1094FIG03.JPG.
5) A. Nankali, S. Malek-Khosravi, M. Zangeneh, M. Rezaei, Z. Hemati, and M. Kohzadi, “Maternal complications associated with severe preeclampsia,” Journal of Obstetrics and Gynecology of India, vol. 63, no. 2, pp. 112–115, Apr. 2013, doi: 10.1007/S13224-012-0283-0/METRICS.
6) K. Pankiewicz, E. Szczerba, T. Maciejewski, and A. Fijałkowska, “Non-obstetric complications in preeclampsia,” Menopause Review/Przegląd Menopauzalny, vol. 18, no. 2, pp. 99–109, 2019, doi: 10.5114/PM.2019.85785.
7) D. Williams, “Long-Term Complications of Preeclampsia,” Semin Nephrol, vol. 31, no. 1, pp. 111–122, Jan. 2011, doi: 10.1016/J.SEMNEPHROL.2010.10.010.
8) M. Jabeen, M. Y. Yakoob, A. Imdad, and Z. A. Bhutta, “Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths,” BMC Public Health, vol. 11, no. SUPPL. 3, pp. 1–11, Apr. 2011, doi: 10.1186/1471-2458-11-S3-S6/FIGURES/6.
9) A. M. Narkhede and D. R. Karnad, “Preeclampsia and Related Problems,” Indian J Crit Care Med, vol. 25, no. Suppl 3, p. S261, Dec. 2021, doi: 10.5005/JP-JOURNALS-10071-24032.
10) N. Kusumawardani, I. Tarigan, Suparmi, and A. Schlotheuber, “Socio-economic, demographic and geographic correlates of cigarette smoking among Indonesian adolescents: results from the 2013 Indonesian Basic Health Research (RISKESDAS) survey,” Glob Health Action, vol. 11, Dec. 2018, doi: 10.1080/16549716.2018.1467605;REQUESTEDJOURNAL:JOURNAL:ZGHA20;CSUBTYPE:STRING:SPECIAL;PAGE:STRING:ARTICLE/CHAPTER.
11) H. Arifin et al., “Analysis of Modifiable, Non-Modifiable, and Physiological Risk Factors of Non-Communicable Diseases in Indonesia: Evidence from the 2018 Indonesian Basic Health Research,” J Multidiscip Healthc, vol. 15, pp. 2203–2221, 2022, doi: 10.2147/JMDH.S382191.
12) N. M. Hustrini, E. Susalit, and J. I. Rotmans, “Prevalence and risk factors for chronic kidney disease in Indonesia: An analysis of the National Basic Health Survey 2018,” J Glob Health, vol. 12, p. 04074, 2022, doi: 10.7189/JOGH.12.04074.
13) D. S. Arsyad et al., “Modifiable risk factors in adults with and without prior cardiovascular disease: findings from the Indonesian National Basic Health Research,” BMC Public Health, vol. 22, no. 1, pp. 1–11, Dec. 2022, doi: 10.1186/S12889-022-13104-0/FIGURES/4.
14) C. S. W. Lestari et al., “The effectiveness of hepatitis B vaccine in toddlers based on the five-year period national basic health research (Riskesdas 2007, 2013 and 2018) in Indonesia,” PeerJ, vol. 11, p. e15199, May 2023, doi: 10.7717/PEERJ.15199/SUPP-5.
15) E. B. Camargo et al., “Survey of calcium supplementation to prevent preeclampsia: The gap between evidence and practice in Brazil,” BMC Pregnancy Childbirth, vol. 13, no. 1, pp. 1–7, Nov. 2013, doi: 10.1186/1471-2393-13-206/TABLES/2.
16) M. O. Omotayo, S. L. Martin, R. J. Stoltzfus, S. E. Ortolano, E. Mwanga, and K. L. Dickin, “With adaptation, the WHO guidelines on calcium supplementation for prevention of pre-eclampsia are adopted by pregnant women,” Matern Child Nutr, vol. 14, no. 2, p. e12521, Apr. 2018, doi: 10.1111/MCN.12521.
17) T. S. Patrelli et al., “Calcium supplementation and prevention of preeclampsia: a meta-analysis,” The Journal of Maternal-Fetal & Neonatal Medicine, vol. 25, no. 12, pp. 2570–2574, Dec. 2012, doi: 10.3109/14767058.2012.715220.
18) G. J. Hofmeyr, L. Duley, and A. Atallah, “Dietary calcium supplementation for prevention of pre-eclampsia and related problems: a systematic review and commentary,” BJOG, vol. 114, no. 8, pp. 933–943, Aug. 2007, doi: 10.1111/J.1471-0528.2007.01389.X.
19) J. Villar et al., “World Health Organization randomized trial of calcium supplementation among low calcium intake pregnant women,” Am J Obstet Gynecol, vol. 194, no. 3, pp. 639–649, Mar. 2006, doi: 10.1016/J.AJOG.2006.01.068.
20) R. Tang, I. C. Tang, A. Henry, and A. Welsh, “Limited evidence for calcium supplementation in preeclampsia prevention: A meta-analysis and systematic review,” Hypertens Pregnancy, vol. 34, no. 2, pp. 181–203, May 2015, doi: 10.3109/10641955.2014.988353;CTYPE:STRING:JOURNAL.
21) R. D. Gebreyohannes, A. Abdella, W. Ayele, and A. C. Eke, “Association of dietary calcium intake, total and ionized serum calcium levels with preeclampsia in Ethiopia,” BMC Pregnancy Childbirth, vol. 21, no. 1, pp. 1–7, Dec. 2021, doi: 10.1186/S12884-021-04005-Y/TABLES/4.
22) M. O. Omotayo, K. L. Dickin, K. O. O’Brien, L. M. Neufeld, L. M. De Regil, and R. J. Stoltzfus, “Calcium Supplementation to Prevent Preeclampsia: Translating Guidelines into Practice in Low-Income Countries,” Advances in Nutrition, vol. 7, no. 2, pp. 275–278, Mar. 2016, doi: 10.3945/AN.115.010736.
23) K. Alnuaimi, J. Abuidhail, and H. Abuzaid, “The effects of an educational programme about preeclampsia on women’s awareness: a randomised control trial,” Int Nurs Rev, vol. 67, no. 4, pp. 501–511, Dec. 2020, doi: 10.1111/INR.12626;PAGE:STRING:ARTICLE/CHAPTER.
24) S. Behjat Sasan, F. Zandvakili, N. Soufizadeh, and E. Baybordi, “The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia,” Obstet Gynecol Int, vol. 2017, no. 1, p. 8249264, Jan. 2017, doi: 10.1155/2017/8249264.
25) S. K. Brooks, D. Weston, and N. Greenberg, “Psychological impact of infectious disease outbreaks on pregnant women: rapid evidence review,” Public Health, vol. 189, pp. 26–36, Dec. 2020, doi: 10.1016/J.PUHE.2020.09.006.
26) E. Kokori et al., “Optimizing pre-eclampsia prevention: Embracing low-dose calcium in sub-Saharan Africa,” International Journal of Gynecology and Obstetrics, vol. 169, no. 3, pp. 1006–1011, Jun. 2025, doi: 10.1002/IJGO.16143;PAGE:STRING:ARTICLE/CHAPTER.
27) C. A. L. De Araújo, L. De Sousa Oliveira, I. M. B. De Gusmão, A. Guimarães, M. Ribeiro, and J. G. B. Alves, “Magnesium supplementation and preeclampsia in low-income pregnant women – A randomized double-blind clinical trial,” BMC Pregnancy Childbirth, vol. 20, no. 1, pp. 1–6, Apr. 2020, doi: 10.1186/S12884-020-02877-0/TABLES/2.
28) H. C. Bucher et al., “Effect of Calcium Supplementation on Pregnancy-Induced Hypertension and Preeclampsia: A Meta-analysis of Randomized Controlled Trials,” JAMA, vol. 275, no. 14, pp. 1113–1117, Apr. 1996, doi: 10.1001/JAMA.1996.03530380055031.
29) A. Imdad, A. Jabeen, and Z. A. Bhutta, “Role of calcium supplementation during pregnancy in reducing risk of developing gestational hypertensive disorders: A meta-analysis of studies from developing countries,” BMC Public Health, vol. 11, no. SUPPL. 3, pp. 1–13, Apr. 2011, doi: 10.1186/1471-2458-11-S3-S18/FIGURES/7.
30) G. J. Hofmeyr, J. M. Belizán, and P. Von Dadelszen, “Low-dose calcium supplementation for preventing pre-eclampsia: A systematic review and commentary,” BJOG, vol. 121, no. 8, pp. 951–957, Jul. 2014, doi: 10.1111/1471-0528.12613;WGROUP:STRING:PUBLICATION.
31) L. V. Moreira et al., “The effectiveness of apple, sugar-free chewing gum, Rolly Brush® and tooth brushing in the reduction of plaque index: Crossover randomized clinical trial,” Rev. estomat. salud, vol. 29, no. 1, pp. 1–9, May 2021, doi: 10.25100/RE.V29I1.11011.
32) A. D. Lieskusumastuti, S. Sab’ngatun, Y. I. F. Hasanah, and C. Setyorini, “PENGETAHUAN IBU HAMIL TENTANG SUPLEMENTASI KALSIUM SEBAGAI PENCEGAHAN PREEKLAMSIA,” Jurnal Kebidanan Indonesia, vol. 15, no. 1, pp. 171–182, Jan. 2024, doi: 10.36419/JKI.V15I1.999.