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October 8, 1997

Contempo 1997: Obstetrics and Gynecology-Reply

JAMA. 1997;278(14):1147-1148. doi:10.1001/jama.1997.03550140039023

In Reply.  —We thank Dr Levine for his interest in our comments regarding calcium supplementation and pregnancy. It should be noted that our discussion was limited to articles published in 1996. Further, our cautious recommendation that calcium supplementation should be considered for pregnant women at high risk for developing preeclampsia was based on a meta-analysis of 14 randomized trials involving 2459 pregnant women.1In July 1997, Levine and colleagues2 published the results of a multicenter, randomized, placebo-controlled trial of calcium supplementation in 4589 nulliparous pregnant women. This large study failed to show the beneficial effects of calcium in reducing the incidence of preeclampsia or pregnancy-associated hypertension. It lends credence to our reservations concerning the application of results from small studies, many of which were performed in countries other than the United States to the general population in the United States.This discussion raises an important question: What accounts for the