Keyukemi Ekpotu*, Uwemedimbuk Ekanem and Motilewa Olugbemi

Department of Community Medicine, University of Uyo Teaching Hospital, Nigeria

*Corresponding Author: Keyukemi Ekpotu, Department of Community Medicine, University of Uyo Teaching Hospital, Nigeria.

Received: December 16, 2022; Published: May 19, 2023

Abstract

Background: Calcium is a necessary for so many physiological processes in the body, especially during pregnancy. Insufficient calcium intake and consequent hypocalcemia poses risks to both fetus and mother including intrauterine growth restriction, low birth weight, poor bone mineralization, preterm birth, maternal hypertension, and preeclampsia. The World Health Organization recommends calcium supplementation for populations with low dietary intake of calcium which necessitates the assessment of serum calcium levels among pregnant women to determine populations that may benefit from calcium supplementation. This study, therefore, aims to compare the serum calcium levels and associated factors of pregnant women utilizing antenatal care in primary health centres (PHC) in urban and rural areas in Uyo senatorial district of Akwa Ibom State.

Methods: This study was a cross-sectional study carried out in 6 primary health care (3 urban and 3 rural) facilities in Uyo senatorial district of Akwa Ibom, selected by simple random sampling. An interviewer administered semi-structured questionnaire was used to obtain information on respondents’ characteristics, 24-hour dietary recall and dietary supplements intake. Serum ionized calcium was measured using an Ion selective electrolyte analyzer LW E60B. Descriptive statistics were presented in tables and figures. Chi square test and Fisher’s exact were performed to examine the relationship between outcome variable and respondents’ characteristics. Statistical significance was set at a p value of 0.05.

Result: A total of 180 pregnant women (90 urban and 90 rural) were enrolled into this study. The average age of respondents was 27.39 ± 4.69 years. Only 10.6% respondents reported receiving calcium supplements during the index pregnancy (rural 16.7% vs urban 4.4%; p = 0.013). However, the average 24-hour dietary protein was 1,331.6 mg (110.9% of Recommended nutrient intake [RNI]), with rural respondents having higher intake (116.0% of RNI) compared to urban respondents (107.1% of RNI). The average serum ionized calcium levels of both urban (1.251 ± 0.129) and rural (1.274 ± 0.06) respondents were within the normal range, and only 7.8% and 13.3% of rural and urban respondents respectively had hypocalcemia. Only gestational age of rural respondents showed significant association with serum ionized calcium level.

Conclusion: Majority of the pregnant women had adequate intakes of dietary calcium with rural respondents having higher intakes compared to urban respondents. And most participants had normal levels of serum ionized calcium, with the mean serum ionized calcium being slightly higher among rural respondents compared to urban respondents. We recommend that high quality controlled trials be carried out in our environment to determine the effect of calcium supplementation on maternal and fetal outcomes in our population considering the already adequate dietary calcium intake and serum calcium levels.

 Keywords: Calcium; Parathyroid Hormone (PTH); Hypertension

References

1. Ward KA., et al. “Bone status during adolescence, pregnancy and lactation”. Current Opinion in Obstetrics and Gynecology 4 (2005): 435-439.
2. World Health Organization. Guideline: calcium supplementation in pregnant women. Geneva: World Health Organization (2013).
3. Almaghamsi A., et al. “Hypocalcemia in Pregnancy: A Clinical Review Update”. Oman Medicine Journal6 (2018): 453-462.
4. Akhter K., et al. “Serum calcium in normal pregnant women”. Mymensingh Medicine Journal1 (2003): 55-57.
5. Farzin L and Sajadi F. “Comparison of serum trace element levels in patients with or without pre-eclampsia”. Journal of Research in Medical Sciences 10 (2012): 938-941.
6. Ephraim RKD., et al. “Serum calcium and magnesium levels in women presenting with pre-eclampsia and pregnancy-induced hypertension: a case-control study in the Cape Coast metropolis, Ghana”. BMC Pregnancy and Childbirth1 (2014): 390.
7. Scholl TO., et al. “Maternal calcium metabolic stress and fetal growth”. The American Journal of Clinical Nutrition4 (2014): 918-925.
8. Chen Y., et al. “Association between maternal vitamin D deficiency and small for gestational age: evidence from a meta-analysis of prospective cohort studies”. BMJ Open8 (2017): e016404.
9. Katung GK and Akande TS. “The prevalence of hypocalcemia in pregnancy and peurperium in northwestern Nigeria”. Tropical Journal of Obstetrics and Gynaecology1 (2016): 27-31.
10. Willemse JPMM., et al. “Calcium intake from diet and supplement use during early pregnancy: the Expect study I”. European Journal of Nutrition1 (2020): 167-174.
11. Merialdi M., et al. “World Health Organization systematic review of the literature and multinational nutritional survey of calcium intake during pregnancy”. Fetal and Maternal Medicine Review2 (2005): 97-121.
12. Benali AI and Demmouche A. “Calcium Deficiency among Pregnant Women and their Newborns in Sidi Bel Abbes Region, Algeria”. Journal of Nutrition and Food Sciences 6 (2014).
13. Cormick G., et al. “Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis”. BJOG4 (2019): 444-456.
14. Agueh VD., et al. “Dietary Calcium Intake and Associated Factors among Pregnant Women in Southern Benin in 2014”. Food and Nutrition Sciences11 (2015): 945.
15. Sachan A., et al. “High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India”. The American Journal of Clinical Nutrition5 (2005): 1060-1064.
16. Akwa Ibom (State, Nigeria) - Population Statistics, Charts, Map and Location. City Population (2020).
17. Scott TA. “Sample Size Planning, Calculation, and Justification”. 12.
18. Okafor IM., et al. “Iron Status of Pregnant Women in Rural and Urban Communities of Cross River State, South-South Nigeria”. Nigerian Journal of Physiology Science2 (2017): 121-125.
19. ESHA Research. Total Diet Assessment. Get the software safely and easily. Software Informer (2022).
20. Meija L and Rezeberga D. “Proper Maternal Nutrition during Pregnancy Planning and Pregnancy” (2017).
21. Opara DC. “Fundamentals of Public Health Nutrition”. 1^st Uyo: Heritage Digi-Link Int’l (2019).
22. Schafer AL and Shoback DM. “Hypocalcemia: Diagnosis and Treatment”. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc. (2000).
23. Gupta A., et al. “Dietary calcium intake, serum calcium level, and their association with preeclampsia in rural North India”. Indian Journal of Community Medicine3 (2016): 223.
24. Bako B., et al. “Prevalence and risk factors of hypocalcemia among pregnant and non-pregnant women in Maiduguri, Nigeria: A cross-sectional study”. Nigerian Journal of Clinical Practice1 (2021): 75.
25. Eli S., et al. “Prevalence of hypocalcaemia and maternal complications among antenatal clinic attendees at the university of Port Harcourt teaching hospital”. Nigerian Journal of Medicine3 (2017): 208.
26. Ajong AB., et al. “Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon”. PLOS ONE11 (2019): e0224855.
27. Natesh N H., et al. “An overview of nutritional and anti nutritional factors in green leafy vegetables”. HIJ 2 (2017).
28. Sholeye OO., et al. “Dietary habits of pregnant women in Ogun-East Senatorial Zone, Ogun State, Nigeria: A comparative study”. IJNAM4 (2014): 42-49.
29. Gao H., et al. “Dietary Intake and Food Habits of Pregnant Women Residing in Urban and Rural Areas of Deyang City, Sichuan Province, China”. Nutrients8 (2013): 2933-2954.
30. Esmaillzadeh A., et al. “Dietary patterns among pregnant women in the west-north of Iran”. Pakistan Journal of Biological Sciences 5 (2008): 793-796.
31. Musa J., et al. “Incidence and risk factors for pre-eclampsia in Jos Nigeria”. African Health Sciences3 (2018): 584-595.
32. Onoh R., et al. “Severe preeclampsia and eclampsia: A 6-year review at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria”. Tropical Journal of Obstetrics and Gynaecology 3 (2019): 418.
33. Ositadinma O., et al. “Evaluation of Serum Calcium Level in Pregnant Normotensive and Pre-eclamptic/Eclamptic Women in Nnewi, Nigeria: A Case Control Study”. Savant Journal of Medicine and Medical Sciences 1 (2015): 60-64.
34. Hofmeyr GJ., et al. “Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems”. Cochrane Database System Review 10 (2018): CD001059.

Citation

Citation: Keyukemi Ekpotu., et al. “Serum Calcium Levels of Pregnant Women Utilizing Antenatal Care in Primary Health Centres (PHC) in Urban and Rural Areas in Uyo Senatorial District of Akwa Ibom State”.Acta Scientific Medical Sciences 7.6 (2023): 80-89.

Copyright

Copyright: © 2023 Keyukemi Ekpotu., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.