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al an r:1#rtn atfis iluasuunfi tfiurulu [email protected] unaoosionrafi on rag
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a ds e.,
Original Rrticle
Thongchai Meelurkan IWD.
Department of Obstetric and Gynecology
Phrae Hospital
Phrae
Sawanpracharak wtedical fournal
VoLo Nor ]anuary-April zooe
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asphysix) firsrir Odd Ratio (OR), 95% Confidence interval (Cl) urar
continuing oral calcium Plus Magnesium supplementation untilDelivery Affect Incidence of pIH and perinatal Outcomes
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(OR = 0.39; 95% Cl 0.22-0.68; P = 0.001) tu:cti'u:ull:.1 (severe
pre-eclampsia) fouar 0.8 uns 2.8 (OR=0 .26; 9}o/o Cl 0.1 Z-0.56;
P<0.001 ; neiruuJiuurfi sufi nrrnaanriounhmun 6a arqn::ririasn,jrgz filnrd' urnn'jrn{ufinur 1oR=1.44;9so/o ct 1.16-1.79; p=0.01)
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L!:n naan, R1?c?1 naonfrtouzrucnaaFt
Abstract
Obiective
Setting
Design
Subiects
Method
To assess the incidence of pregnancy induced hypertension (plH)
and perinatal outcomes of pregnant women who took calcium plus
magnesium supplementation in Phrae Hospital.
Department of Obstetrics and Gynecology, Phrae Hospital
Randomized clinical trial
2,120 pregnant women who fulfil the inclusion criteria during Oetober,
2006 and September, 2008.
The population were randomly divided into two groups. Study group
were pregnant \,vomen who tmk calcium plus rnagnesium supplementatinn
and standard antenatal medication until delivery and control group
received only strandard antenatal medication. Maternal age, body weight
and hight, numbers of previous pregnancies, history of PlH, gestational
age at delivery, fetal birth weight and APGAFI at 1't and 5h minute
score were collected and ana[tzed using SPSS for window programs.
Comparing between study group and control group, the incidence ofResults
fld o ofunr 1 u.a.-rx.u 2ss2
nanrrlfirnnriolua:ulnfiriudursu'rnr:rirunnoadonr:r6nnrr;a:rldilafing.runnr:d,ra::riuardorn:nu:nnaan
C-ontinuing Oral Cabirm plus lrfagnesium Sxpplerxnration Uotil Delivery
imAlOurcom
Conclusion
mild pre - eclampsia (1.6% vs 4.0%) (oR = 0.89; 9s% cr 0.22-0.68;
P = 0.001), severe pre - eclampsia (0.9% vs 2.9%) (OR = 0.26; gS%
Cl 0.12 - 0.56; P<0.001) and preterm labor (16.90lo vs 22.60l") (OR
1-44i 95o/" cl 1.16 - 1.79; p = 0.01) were significanily lower, and
the numbers of fetal birth weight greater than 2,s00 grams were
significantly higher in study group (47o/o vs 4g7yo) (oR 2.23; 9so/o
Cl = 1.64 - 3.05; P = 0.001). There were no significantly difference
in birth asphyxia.
I continuing oral calcium plus magnesium supplementation until delivery
was beneficial in lowering the incidence of plH and preterm delivery,
resulting in higher birth weight infant.
i calcium, magnesium, PlH, fetal body weight, birth asphp<iaKey words
Uild1
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ronmrdr{a.r1. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia.
Obstet Gynecol 2OO2;99: 159-67.,ouolarydorasa
qu-[o noouunflA. n?1ilF]U[Afind.:Tc1411.,1F1{Fl::r'1. LlJ: QIJtA nAaUUFlfla, Ul:6U1finT.t t, . " J . ts d t o c en1:n.ln::Rn?1iltdEhldit. ililvlFr:{ll 1 . d\mn1: tllJttjo{fl1:y1ilil; 2549. fiu1 1 45-94.Au A ' d a e o d d a a 6 e x I f da1?g tnilr.,:Fa\ltafl. 0Fl319t1H?a{3J1TFl1. [U: fllrY{.,:fl tQ:6U?1181, q6UgU [A0Lv{[?oUnQ,
2.
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4. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC lll, Wenstrom KD.
Williams Obstetrics. 22nd ed. New York: Mc Graw-Hill; 2005: p.761-808.A A V d UI A & d O A A V I A A A5. aytEtl 6i51?{Uf,'. n?1iJnuLafinq.:?6usn\:nT;f,i. [lJ : ?Ylg1 ng1?IUE, ?UAT'ITT6U dFlenAn,
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rr5rafru 'irn'ru 2s44. fifi1 293-318.
o. nun Aar. n?1il6iur6anq.:1uan5ftn::ri. lu : nun fro:, n{ati'1.:ri'imuffi,i1:ri rJ:rraigafaoasda-..r.UA-dd
rasrud?, Lnrn nryrnnu, u:T6u1fi'mT. 6nfl1dFrT. Trerv{n:.]ll 2. n?{tYrv{ufi1uFE: 1,,r u
v,lor:urjneirfiurorai zs4z. mrir +zs-sg.A - 4t da ur a & s o d6 v d' u u *7. A:Flno ?.:Fln:v'l:. n?1ilnuLa14Ft6\:?ttuen{n:TR. Lu: tllu iluvouuFt, u16utu ?uYlulFl:,^Cdfi.or4rffz: d?dlJila.:, il.rna ru6ua1fiura, u::€u1Bn1:. 66rrrarr{. firur{n{.:d 1. n?.:Lrlvl
o,daray
Llmliln:: 1,{ LO AThii 2543. Y\1 423-48.
B. ejulo naariumna. fl1?snarruriulafin4.::sa'jr.one.:n::Ji.'[u: rnrfisy fiuot:t, $firu'r qun:#o,
ffirrmBn'n. afinTani. d,,r?61: 6ruu:rurainr:firuv{; 2546. fifl1 73-83.{9. Durland J, Pages N, Bac P, Borra M, Guiet-Bara A. New data on the importance of
gestational Mg deficiency. Magness Res 2OO4; 17(2): 116-25.
10. Levin RJ, Heuth JC, Curet LB, Sibai BM, Catalano PM, Morris CD, et al. Trial of
calcium to prevent preeclampsia. N Engl J Med 1997; 337: 69-76.
11. Bucher HC, Guyatt GH, Cook RJ. Effect of calcium supplementation on
pregnancy-induced hypertension and preeclampsia: a meta-analysis of randomized
controlled trials. JAMA 1996; 275: 1113-7.
12. Belizan JM, Villar J, Gonzalez L, Campodomico L, Bergel E. Calcium supplementation
to prevent hypertension disorders of pregnancy. , =ngl J Med 1991;325: 1399-405.
13. Robert Jm. Prevention or early treatment of preeclampsia. N Engl J Med 1997; 337:
124-25.
14. Villar J, Repke JT. Calcium supplementation during pregnancy may reduce preterm
delivery in high-risk populations. Am J Obstet Gynecol 1990; 163: 1124-31.
H6n1:lriunor*uxuo&uunfi4udunqrim::lirunnoaionr:rfianr:za:udulnf,ngrtrnnr:#.rn::#Iacnall r5nurnnaon
4) e d C-ontinuingoralCalcirmPlusMagmiunsupplercntatimUntilDeliverytrfi o qu.-ufi 1 x.a.-H.g 2552 Affat Ircidme of pIH 8rd ftrinaral outcomes I
15. Sanchez-Ramos L, Brienes DK, Kaunity AM. Prevention of pregnancy-induced
hypertension by calcium supplementation in angiotensin ll sensitive patieints. Obstet
Gynecol 1994; 84:349.
16. Kurzel RB. Serum magnesium levels in pregnancy and preterm labor. Am J Perinatol
1991;8: 119-27.
17. Hofmeyr GJ, Roodt A, Atallah AN, Duley L. Calcium supplementation to prevent
pre-eclampsia: a systemic review. S Afr Med J 2003; 93(3) 224-8.
18. Sukonpan K, Phupong V. Serum calcium and serum magnesium in normal and
preeclamptic pregnancy. Arch Gynecol Obstet 2005; 273: 12-6.
19. Prentice A. Maternal calcium requirements during pregnancy and lactation. Am J Clin
Nutr 1994; 59 supp: s477-82.a a I dAI t o U O .ad20. nnn n:{[n:Lv{t:. l$JniltdErilu5f,1n6l1n6una:1{n1u. Lu : umnrril?1u{1uq?n1y{4ilqfl
taaul;fl. 2oo4 trflrfi.,:rda{ud ze iln:1nil 25511; r{r6.:1fiorn : URl:http://www. uniserv. buu.ac.th/forumZtopic.asp?TOPIC_J D=468
21. Merialdi M, Carroli G, Villar J, Abalos E, Gulmezoglu A, Kulier R, et al. Nutritional
interventions during pregnancy for the prevention or treatment of impaired fetal
growth. J Nutr 2003; 133 suppl 5: s1626-31.
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610(s5.7)
450(44.3)
51.8(e.1)
518(48.e)
542(s1.1)
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26.2(6.6)
553(52.2)
507(47.8)
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64(6.0)
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240(22.6)
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133(12.6)
927(87.4')
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0.86(0.29-2.56)
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