Acceptability of routine high-dose calcium supplementation during pregnancy in South India

Abstract

Objective: Hypertensive disorders of pregnancy (HDP) cause 10-15% of maternal deaths globally. Calcium-supplementation can prevent preeclampsia in low- and middle-income countries (LMICs) with low dietary calcium intake, but data on acceptability and adherence to high-dose supplementation (≥1000 mg/d) in public health programs is limited. Setting: We evaluated the acceptability and adherence to routine antenatal calcium-supplementation among pregnant women and healthcare providers in urban Bangalore. Design: An open-label study of 1000mg/d calcium-supplementation was conducted among 275 pregnant women, enrolled ≤20 weeks of gestation attending routine-antenatal-care (ANC), and followed-up until delivery. A mixed-methods approach was used to assess perception, acceptability, and factors influencing calcium-supplementation. Focus group discussions (FGDs) were conducted with pregnant women and healthcare workers. Result: After the first-month of taking calcium, post recruitment, 13.4% reported to have disliked the calcium supplement and this decreased to 7.9% in third trimester. Overall, 157 (57.3%) had ≥75% adherence to the calcium-supplementation regimen. Disliking calcium pills at first ANC follow-up (OR:3.5, 95%; CI:1.58–7.57) or the third trimester visit (OR:7.5, 95%; CI:2.38–23.40) was significantly associated with <75% adherence to calcium-supplementation. FGDs in third trimester identified enablers such as self-perceived benefits, family, and healthcare worker support, while barriers included preference for private clinics (which did not provide free-calcium-supplements), the size and number of calcium tablets/day. Conclusion: Achieving high adherence to calcium-supplementation was challenging during pregnancy. Interventions and strategies supporting pregnant women, while considering the roles of families and healthcare systems, should be assessed to enhance the effective implementation of calcium-supplementation during pregnancy.