Factors affecting the implementation of calcium supplementation strategies during pregnancy to prevent pre-eclampsia: a mixed-methods systematic review
Taryn Young,
Ana Pilar Betran,
Hema Mistry,
Richard Riley,
Shakila Thangaratinam,
Guillermo Carroli,
Edgardo Abalos,
Zahida P Qureshi,
John Allotey,
Anna Thorson,
Meghan A Bohren,
Rana Islamiah Zahroh,
G Justus Hofmeyr,
Juan Pablo Peña-Rosas,
Alfredo Palacios,
Thaís Rocha,
Joshua Peter Vogel,
Luc Smits,
Gabriela Cormick,
Koiwah Koi Larbi,
Kym IE Snell,
Hellen Moraa,
George N Gwako
Affiliations
Taryn Young
1Stellenbosch University, South Africa
Ana Pilar Betran
UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
Hema Mistry
Warwick Clinical Trials Unit, Warwick Medcial School, University of Warwick, Coventry, UK
Richard Riley
Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
Shakila Thangaratinam
University of Birmingham, Birmingham, UK
Guillermo Carroli
Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
Edgardo Abalos
Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
Zahida P Qureshi
Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
John Allotey
Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
Anna Thorson
9 Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
Meghan A Bohren
Gender and Women`s Health Unit, Nossal Institute for Global Health, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
Rana Islamiah Zahroh
Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
G Justus Hofmeyr
Effective Care Research Unit, University of the Witwatersrand Faculty of Health Sciences, East London, Eastern Cape, South Africa
Juan Pablo Peña-Rosas
2 Department of Nutrition and Food Safety, World Health Organization, Geneve, Switzerland
Alfredo Palacios
Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Thaís Rocha
WHO Collaborating Centre for Global Women’s Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
Joshua Peter Vogel
Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
Luc Smits
Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
Gabriela Cormick
Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
Koiwah Koi Larbi
Action on Preeclampsia (APEC), Accra, Ghana
Kym IE Snell
College of Medical and Dental Sciences, University of Birmingham Institute of Applied Health Research, Birmingham, UK
Objectives Daily calcium supplements are recommended for pregnant women from 20 weeks’ gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia.Design Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach.Data sources MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022.Eligibility criteria We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date.Data extraction and synthesis Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators.Results Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium.Conclusion Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions.PROSPERO registration number CRD42021239143.
