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November 6, 1996

Effects of Calcium Supplementation on Pregnancy-Induced Hypertension-Reply

Author Affiliations

McMaster University Hamilton, Ontario
University of Waterloo Kitchener, Ontario

JAMA. 1996;276(17):1388. doi:10.1001/jama.1996.03540170032026

In Reply.  —Drs Roberts and D'Abarno point out the hetero geneity of populations in our meta-analysis of calcium supplementation in pregnancy. We addressed this important issue by conducting sensitivity analyses according to dose and duration of calcium supplementation, methodological quality, parity, and maternal age and race. In selected analyses, we found larger effects for trials involving younger vs older women and high-quality vs low-quality trials. Even for populations in which effects were smaller, trends uniformly favored groups receiving calcium supplementation.Drs Levine and DerSimonian thoughtfully point out some of the limitations of the randomized trials of calcium in pregnancy. They are correct that these limitations weaken the inference that calcium has an important effect on reduction of pregnancy-related adverse events, as do the sparse data on outcomes such as eclampsia and perinatal mortality. On the other hand, the effects on preeclampsia are large, consistent across populations and trials, and even larger in