Objective To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia.Design Multicentred, randomised, controlled, double-blinded trial.Setting Antenatal care clinics and Hospitals in four countries.Population Pregnant women between 14 and 22 weeks' gestation.Method Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery.Main outcome measures Pre-eclampsia, low birthweight, small for gestational age and perinatal death.Results Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of preeclampsia (RR: 1.0; 95% CI: 0.9-1.3), eclampsia (RR: 1.5; 95% CI: 0.3-8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9-1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8-1.1), small for gestational age (RR: 0.9; 95% CI: 0.8-1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6-1.2) were also unaffected.Conclusion Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.

In 1999, the US Food and Nutrition Board revised the Adequate Intake (AI) for calcium in pregnancy and recommended 1000 mg/day for adult pregnant women and 1300 mg/day for adolescent women (<19 years). Our interest, from the perspective of an international health organization, was to assess if pregnant women globally meet those requirements. This is particularly important because, among the various biological functions of calcium, the potential protective effect of adequate calcium intake in pregnancy on the risk of pre-eclampsia may have major public health implications, pre-eclampsia being one of the most important causes of maternal and perinatal mortality world-wide. Therefore, we conducted a systematic review of studies, published from 1991 to 2004, that assessed calcium dietary intake in pregnant women. In addition, we conducted a multicentre survey of calcium dietary intake during pregnancy among nulliparous women attending antenatal care in developing countries. This survey was conducted before starting a large calcium supplementation multicentre trial: the WHO Calcium Supplementation Trial in Low Calcium Intake Women for the Prevention of Pre-eclampsia. This article presents the results of the systematic review and of the multicentre survey.