Calcium supplementation during pregnancy to reduce the risk of pre-

eclampsia
Guidance summary*
WHO recommendations
In populations with low dietary calcium intake, daily calcium supplementation
(1.5 g–2.0 g oral elemental calcium) is recommended for pregnant women to
reduce the risk of pre-eclampsia.

Remarks
 This recommendation is consistent with recommendations in the 2016 WHO
recommendations on antenatal care for a positive pregnancy experience (1) and
2011 WHO recommendations for prevention and treatment of pre-eclampsia
and eclampsia (2), and supersedes the WHO recommendation found in the
2013 Guideline: calcium supplementation in pregnant women (3).
 Dietary counselling of pregnant women should promote adequate calcium
intake through locally available, calcium-rich foods.
 Dividing the dose of calcium may improve acceptability. The suggested
scheme for calcium supplementation is 1.5–2 g daily, with the total dose divided
into three doses, preferably taken at mealtimes.
 Negative interactions between iron and calcium supplements may occur.
Therefore, the two nutrients should preferably be administered several hours
apart rather than concomitantly (3).
 As there is no clear evidence on the timing of initiation of calcium
supplementation, stakeholders may wish to commence supplementation at the
first antenatal care contact, in order to improve compliance to the regimen.
 To reach the most vulnerable populations and ensure a timely and
continuous supply of supplements, stakeholders may wish to consider task
shifting the provision of calcium supplementation in community settings with
poor access to healthcare professionals (4).
 The implementation and impact of this recommendation should be
monitored at the health service, regional and country levels based on clearly
defined criteria and indicators associated with locally agreed targets. Barriers,
enablers and pathways should be evaluated to inform integration of this
recommendation into the antenatal care package.
* This is an extract from the relevant guidelines (1, 2, 5). Additional guidance
information can be found in these documents.

References
1. WHO recommendations on antenatal care for a positive pregnancy
experience. Geneva: World Health Organization; 2016
(https://www.who.int/reproductivehealth/publications/maternal_perinatal_health
/
anc-positive-pregnancy-experience/en/).
2. WHO recommendations for prevention and treatment of pre-eclampsia and
eclampsia. Geneva: World Health Organization; 2011
(https://www.who.int/reproductivehealth/publications/maternal_perinatal_health
/9789241548335/en/).
3. Guideline: Calcium supplementation in pregnant women. Geneva: World
Health Organization; 2013
(https://www.who.int/nutrition/publications/micronutrients/guidelines/calcium_s
upplementation/en/).
4. WHO Recommendations: Optimizing Health Worker Roles to Improve
Access to Key Maternal and Newborn Health Interventions Through Task
Shifting. Geneva: World Health Organization; 2012
(https://www.who.int/reproductivehealth/publications/maternal_perinatal_health
/978924504843/en/).
5. WHO recommendation: calcium supplementation during pregnancy for
prevention of pre-eclampsia and its complications. Geneva: World Health
Organization; 2018
(https://www.who.int/nutrition/publications/guidelines/calcium-
supplementation-recommendation-2018/en/).