To the Editor.
—Bucher et al1 conclude that calcium supplementation reduces blood pressure during pregnancy and also decreases the incidence of preeclampsia. The authors point out that the reduction in blood pressure resulting in the reduced diagnosis of preeclampsia may "have no effect on the harmful pathologic process." Nonetheless, they conclude that "current, limited evidence supports a policy of offering calcium supplementation to all pregnant women in whom there is a concern about the development of preeclampsia." We would like to take issue with their data selection, conclusions, and, most certainly, their recommendations.The studies in the meta-analysis include extremely heterogeneous patients with different risks for developing preeclampsia. Two of the studies2,3 include patients already diagnosed with mild preeclampsia or at high risk for preeclampsia based on angiotensin sensitivity testing. These women are quite different from healthy nulliparous patients who comprise the majority of cases. There are further
Roberts JM, D'Abarno J. Effects of Calcium Supplementation on Pregnancy-Induced Hypertension. JAMA. 1996;276(17):1386-1387. doi:10.1001/jama.1996.03540170030024