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Uxinzelelo lwegazi oluphezulu ngexesha lokukhulelwa lunokukhokelela kwi-eclampsia kunye nokuzala ngaphambi kwexesha kwaye ngunobangela ophambili wokugula kunye nokufa komama kunye nosana olusanda kuzalwa. Njengomlinganiselo obalulekileyo wezempilo yoluntu, i-World Health Organization (WHO) incoma ukuba abafazi abakhulelweyo abanesondlo esinesondlo se-calcium songezelele i-1000 ukuya kwi-1500 mg ye-calcium imihla ngemihla. Nangona kunjalo, ngenxa yesongezo se-calcium esinzima, ukuphunyezwa kwesi sincomo akwanelisi.

Izilingo ezilawulwa ngokungahleliwe eziqhutywe eIndiya naseTanzania nguNjingalwazi uWafie Fawzi weSikole saseHarvard seMpilo yoLuntu e-United States yafumanisa ukuba i-dose ephantsi ye-calcium supplementation ngexesha lokukhulelwa yayingekho mbi ngaphezu kwe-dose ephezulu ye-calcium supplementation ekunciphiseni umngcipheko we-pre-eclampsia. Ngokumalunga nokunciphisa umngcipheko wokuzalwa kwangaphambili, izilingo zaseNdiya naseTanzania zineziphumo ezingahambelaniyo.

Ezi zilingo zimbini zibandakanya abathathi-nxaxheba be-11,000 abaneminyaka eyi-≥18 iminyaka, ubudala bokukhulelwa < ukusuka ngoNovemba 2018 ukuya kuFebruwari 2022 (India) kunye noMatshi 2019 ukuya kuMatshi 2022 (eTanzania). Oomama bokuqala kwiiveki ze-20 ekulindeleke ukuba bahlale kwindawo yovavanyo ukuya kwiiveki ze-6 emva kokubeleka babekwe ngokungahleliwe i-1: i-1 kwi-calcium ephantsi (i-500 mg imihla ngemihla + iipilisi ze-placebo ze-2) okanye i-calcium ephezulu (i-1500 mg imihla ngemihla) de kube ukuhanjiswa. Iziphelo eziphambili zaziyi-preeclampsia kunye nokuzalwa kwangaphambili (i-endpoints ezimbini). Iziphelo zesibini zibandakanya uxinzelelo lwegazi olunxulumene nokukhulelwa, i-preeclampsia enezibonakaliso ezinzima, ukufa okunxulumene nokukhulelwa, ukuzala, ukuzala, ubunzima bokuzalwa obuphantsi, ubuncinci beminyaka yokukhulelwa, kunye nokufa komntwana phakathi kweentsuku ezingama-42. Iziphelo zokhuseleko zibandakanya ukulaliswa esibhedlele kwabasetyhini abakhulelweyo (ngenxa yezizathu ngaphandle kokunikezelwa) kunye ne-anemia enzima kwi-trimester yesithathu. Imida engekho ngaphantsi yayiyingozi ehambelana ne-1.54 (preeclampsia) kunye ne-1.16 (ukuzalwa kwangaphambili), ngokulandelanayo.

Kwi-preeclampsia, i-cumulative incidence ye-500 mg ngokumelene ne-1500 mg iqela kwilingo laseNdiya laliyi-3.0% kunye ne-3.6%, ngokulandelanayo (RR, 0.84; 95% CI, 0.68 ~ 1.03); Kwilingo laseTanzania, isiganeko sasiyi-3.0% kunye ne-2.7%, ngokulandelanayo (RR, 1.10; 95% CI, 0.88 ~ 1.36). Zomibini izilingo zibonise ukuba umngcipheko we-preeclampsia awubi kakhulu kwiqela le-500 mg kuneqela le-1500 mg.

Ukuzalwa kwangaphambi kokuzalwa, kwilingo laseNdiya, iziganeko ze-500 mg ngokuchasene ne-1500 mg yeqela laliyi-11.4% kunye ne-12.8%, ngokulandelanayo (RR, 0.89; 95% CI, 0.80 ~ 0.98), i-non-inferiority yasungulwa ngaphakathi kwexabiso le-1.54; Kwilingo laseTanzania, amazinga okuzalwa kwangaphambi kwexesha ayeyi-10.4% kunye ne-9.7%, ngokulandelanayo (RR, 1.07; 95% CI, 0.95 ~ 1.21), idlule ixabiso le-non-inferiority threshold ye-1.16, kwaye i-non-inferiority ayizange iqinisekiswe.

Kuzo zombini isiphelo sesibini kunye nokhuseleko, kwakungekho bungqina bokuba iqela le-1500 mg lingcono kuneqela le-500 mg. Uhlalutyo lwe-meta lweziphumo zezilingo ezimbini azifumananga nantlukwano phakathi kwe-500 mg kunye ne-1500 mg amaqela kwi-preeclampsia, ingozi yokuzalwa kwangaphambili, kunye neziphumo zesibini kunye nezokhuseleko.

Olu phononongo lugxininise kumbandela obalulekileyo wezempilo yoluntu wokuxhaswa kwe-calcium kubasetyhini abakhulelweyo ukuze kuthintelwe i-preeclampsia, kwaye yenze ulingo olukhulu olulawulwa ngokungacwangciswanga kumazwe amabini ngaxeshanye ukuphendula umbuzo obalulekileyo kodwa ongacacanga wesayensi malunga nedosi esebenzayo ye-calcium supplementation. Uphononongo lwalunoyilo olungqongqo, ubungakanani besampulu enkulu, i-placebo ephindwe kabini, i-hypothesis engekho ngaphantsi, kunye neziphumo ezibini eziphambili zekliniki ze-preeclampsia kunye nokuzalwa kwangaphambi kwexesha njengesiphelo esiphindwe kabini, esilandelwa ukuya kwiintsuku ze-42 emva kokubeleka. Ngelo xesha, umgangatho wokubulawa wawuphezulu, izinga lokulahlekelwa kokulandelwa liphantsi kakhulu (i-99.5% yokulandelwa kwisiphumo sokukhulelwa, i-Indiya, i-97.7% yaseTanzania), kwaye ukuthotyelwa kwakuphezulu kakhulu: ipesenti ephakathi yokuthotyelwa kwe-97.7% (India, 93.2-99.2 interquartile interval3%). isithuba).

I-calcium sisondlo esiyimfuneko ekukhuleni komntwana kunye nophuhliso, kwaye imfuno ye-calcium kubasetyhini abakhulelweyo iyanda xa kuthelekiswa noluntu ngokubanzi, ngakumbi ekukhulelweni kade xa usana lukhula ngokukhawuleza kwaye i-bone mineralization iphezulu, i-calcium eninzi kufuneka ifakwe. I-calcium supplementation inokunciphisa ukukhutshwa kwehomoni ye-parathyroid kunye ne-intracellular calcium concentration kubasetyhini abakhulelweyo, kunye nokunciphisa ukucutha kwemithambo yegazi kunye ne-uterine muscle smooth. Izilingo ezilawulwa yi-placebo zibonise ukuba i-calcium ephezulu ye-calcium ngexesha lokukhulelwa (> 1000 mg) yanciphisa umngcipheko we-preeclampsia ngaphezu kwe-50% kunye nomngcipheko wokuzalwa kwangaphambili ngama-24%, kwaye ukunciphisa kubonakala kukhulu ngakumbi kubantu abane-calcium ephantsi. Ngoko ke, kwi "IiNgcebiso eziNgcotshiweyo zeCalcium Supplementation ngexesha lokukhulelwa ukuVimbela i-Preeclampsia kunye neeNgxaki zayo" ezikhutshwe yi-World Health Organization (WHO) ngoNovemba 2018, kucetyiswa ukuba abantu abane-calcium ephantsi kufuneka bafake i-calcium kunye ne-1500 ukuya kwi-2000 mg imihla ngemihla, ihlulwe kwiiyure ezintathu ze-oral ukuthatha i-iron, kunye neeyure ezininzi zokuthintela i-iron. I-China's Expert Consensus kwi-Calcium Supplementation for Pregnant women, ekhutshwe ngoMeyi ka-2021, icebisa ukuba abafazi abakhulelweyo abane-calcium ephantsi bafake i-calcium 1000 ~ 1500 mg imihla ngemihla de kube nokuziswa.

Okwangoku, amazwe ambalwa kuphela kunye nemimandla eye yaphunyezwa i-routine enkulu-dose ye-calcium supplement ngexesha lokukhulelwa, izizathu zibandakanya umthamo omkhulu wefom ye-calcium dosage, kunzima ukugwinya, isicwangciso solawulo esiyinkimbinkimbi (izihlandlo ezithathu ngosuku, kwaye kufuneka sihlulwe kwisinyithi), kwaye ukuthotyelwa kweyeza kuncitshiswa; Kwezinye iindawo, ngenxa yezibonelelo ezinqongopheleyo kunye neendleko eziphezulu, i-calcium ayilula ukuyifumana, ngoko ke ukwenzeka kwe-dose enkulu ye-calcium supplementation kuchaphazelekayo. Kwizilingo zeklinikhi ezihlola i-calcium ephantsi kwe-dose ngexesha lokukhulelwa (ubukhulu becala i-500 mg imihla ngemihla), nangona kuthelekiswa ne-placebo, umngcipheko we-preeclampsia wancitshiswa kwiqela lokuxhaswa kwe-calcium (RR, 0.38; 95% CI, 0.28 ~ 0.52), kodwa kuyimfuneko ukuba uqaphele ubukho bophando olunobungozi obuphezulu be-bias [3]. Kwilingo elilodwa elincinci leklinikhi elithelekisa i-dose ephantsi kunye ne-high-dose ye-calcium supplementation, umngcipheko we-preeclampsia ubonakala uyancipha kwiqela le-dose ephezulu xa kuthelekiswa neqela eliphantsi (RR, 0.42; 95% CI, 0.18 ~ 0.96); Kwakungekho mmahluko kumngcipheko wokuzalwa kwangaphambili (RR, 0.31; 95% CI, 0.09 ~ 1.08)