Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon

Abstract

IntroductionWomen from low and middle income countries are generally more likely to have sub-optimal calcium intake. The objective of this study was to assess serum calcium disorders and correlates in late pregnancy.MethodsWe conducted from December 2018 to April 2019, a cross-sectional hospital-based study targeting pregnant women in late pregnancy in the Nkongsamba Regional Hospital. Data were collected by measurement of parameters (weight, height, blood pressure and foetal birthweight), administration of a semi-structured questionnaire and analysis of blood samples collected from each participant. Absorption spectrophotometry was used to measure serum calcium and albumin concentrations and corrected serum calcium calculated from the Payne’s equation. With a statistical significant threshold set at p-value = 0.05, the odds ratio was used as a measure of the strength of association between hypocalcaemia and maternofoetal variables.ResultsWe enrolled a total of 354 consenting participants with a mean age of 27.41±5.84 years. The prevalence of hypocalcaemia in late pregnancy was 58.76 [53.42–63.90]%. The rate of calcium supplementation in pregnancy was 57.63[52.28–62.80]% with a mean duration of supplementation of 3.69±1.47 months. When controlled for marital status, age, level of education, and gestational age at delivery, pregnant women with systolic blood pressures below 130 mmHg were significantly less likely to have hypocalcaemia than their counterparts with higher systolic blood pressures (Adjusted Odds Ratio = 0.41[0.18–0.89], p-value = 0.020). No statistically significant associations were found between diastolic blood pressure, body mass index, foetal birth weight and hypocalcaemia.ConclusionHypocalcaemia in late pregnancy is highly prevalent (59%) among women accessing reproductive services at the Nkongsamba Regional Hospital. There is also a wide gap in calcium supplementation compared to World Health Organization recommendations. Hypocalcaemia is significantly associated to higher systolic blood pressure in pregnancy. Systematic calcium supplementation and consumption of high calcium containing locally available meals should be encouraged.

Hypocalcaemia and calcium intake in pregnancy: A research protocol for critical analysis of risk factors, maternofoetal outcomes and evaluation of diagnostic methods in a third-category health facility, Cameroon

“…The foetal outcomes will be evaluated as secondary outcomes) α: The Type I error probability for a two-sided test which was set at 0.05. power: The probability of correctly rejecting the null hypothesis was set at 0.80 p 0 : is the probability of the outcome for a control patient. The prevalence of hypertension in normocalcaemic pregnant women in a recent study was 6.85% (9). p 1 : is the probability of the outcome in an experimental subject.…”

“…p 1 : is the probability of the outcome in an experimental subject. The prevalence of hypertension in hypocalcaemic women in a recent study was 14.40% (9). m is the ratio of control to exposed subjects.…”

“…According to the World Health Organization (WHO), chronic insufficient calcium intake before or during pregnancy is associated with a significantly increased likelihood of hypocalcaemia in pregnancy [ 6 ]. A recent cross-sectional survey evaluating albumin-corrected serum calcium levels in women in late pregnancy reported an alarmingly high prevalence of hypocalcaemia (58%) among women in the Nkongsamba Health District; Cameroon [ 9 ]. Similar findings had been reported among pregnant women in the third trimester in Algeria (70%) [ 10 ] and India (66%) [ 11 ].…”

“…This could significantly affect the perceived burden of this electrolyte imbalance. The recent study in Cameroon (Nkongsamba Regional Hospital) reported an albumin-corrected hypocalcaemia prevalence in pregnancy [ 9 ]. This prevalence is likely to be different when considered from the standpoint of the ionised fraction of serum calcium (the physiologically active fraction).…”

“…In Africa, a recent survey among pregnant women followed up at the Nkongsamba Regional Hospital reported that 43% of pregnant women went through their pregnancy without any form of calcium supplementation. For the 57% who took calcium supplements, the mean calcium supplementation period in pregnancy was only four months [ 9 ]. The mean duration of calcium supplementation in pregnancy in the study by Ajong et al was very short; about four months significantly insufficient to meet maternofoetal calcium demands.…”