Prevalence and correlates of low serum calcium in late pregnancy: A cross sectional study in the Nkongsamba Regional Hospital; Littoral Region of Cameroon

Autoři: Atem Bethel Ajong aff001;  Bruno Kenfack aff003;  Innocent Mbulli Ali aff002;  Martin Ndinakie Yakum aff004;  Phelix Bruno Telefo aff002
Působiště autorů: Kekem District Hospital, Kekem, West Region, Cameroon aff001;  Department of Biochemistry, University of Dschang, Dschang, West Region, Cameroon aff002;  Department of Obstetrics / Gynaecology and Maternal Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region, Cameroon aff003;  Medecins Sans Frontieres-Spain (MSF-OCBA), Maiduguri, Nigeria aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224855



Women from low and middle income countries are generally more likely to have sub-optimal calcium intake. The objective of this study was to assess serum calcium disorders and correlates in late pregnancy.


We conducted from December 2018 to April 2019, a cross-sectional hospital-based study targeting pregnant women in late pregnancy in the Nkongsamba Regional Hospital. Data were collected by measurement of parameters (weight, height, blood pressure and foetal birthweight), administration of a semi-structured questionnaire and analysis of blood samples collected from each participant. Absorption spectrophotometry was used to measure serum calcium and albumin concentrations and corrected serum calcium calculated from the Payne’s equation. With a statistical significant threshold set at p-value = 0.05, the odds ratio was used as a measure of the strength of association between hypocalcaemia and maternofoetal variables.


We enrolled a total of 354 consenting participants with a mean age of 27.41±5.84 years. The prevalence of hypocalcaemia in late pregnancy was 58.76 [53.42–63.90]%. The rate of calcium supplementation in pregnancy was 57.63[52.28–62.80]% with a mean duration of supplementation of 3.69±1.47 months. When controlled for marital status, age, level of education, and gestational age at delivery, pregnant women with systolic blood pressures below 130 mmHg were significantly less likely to have hypocalcaemia than their counterparts with higher systolic blood pressures (Adjusted Odds Ratio = 0.41[0.18–0.89], p-value = 0.020). No statistically significant associations were found between diastolic blood pressure, body mass index, foetal birth weight and hypocalcaemia.


Hypocalcaemia in late pregnancy is highly prevalent (59%) among women accessing reproductive services at the Nkongsamba Regional Hospital. There is also a wide gap in calcium supplementation compared to World Health Organization recommendations. Hypocalcaemia is significantly associated to higher systolic blood pressure in pregnancy. Systematic calcium supplementation and consumption of high calcium containing locally available meals should be encouraged.

Klíčová slova:

Albumins – Birth weight – Blood plasma – Blood pressure – Hypertensive disorders in pregnancy – Labor and delivery – Preeclampsia – Pregnancy


1. Yakoob MY, Khan YP, Bhutta ZA. Maternal mineral and vitamin supplementation in pregnancy. Expert Rev Obstet Gynecol. 2010;5(2):1–8.

2. Gabbay A, Tzur T, Weintraub AY, Shoham-Vardi I, Sergienko R, Sheiner E. Calcium level during the first trimester of pregnancy as a predictor of preeclampsia. Hypertens Pregnancy. 2014;33(3):311–21. doi: 10.3109/10641955.2013.877925 24475770

3. Kovacs CS. Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin North Am. 2011;40(4):795–826. doi: 10.1016/j.ecl.2011.08.002 22108281

4. Hacker AN, Fung EB, King JC. Role of calcium during pregnancy: Maternal and fetal needs. Nutr Rev. 2012;70(7):397–409. doi: 10.1111/j.1753-4887.2012.00491.x 22747842

5. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. 2010;202(5):429.e1–9.

6. Kovacs CS. Calcium and Bone Metabolism During Pregnancy and Lactation. J ofMammary Gland Biol Neoplasia. 2014;10(2):105–18.

7. Kumar A, Agarwal K, Devi SG, Gupta RK, Batra S. Hypocalcemia in Pregnant Women. Biol Trace Elem Res. 2010 Jul;136(1):26–32. doi: 10.1007/s12011-009-8523-6 19774347

8. Benali AI, Demmouche A. Calcium Deficiency among Pregnant Women and their Newborns in Sidi Bel Abbes Region, Algeria. J Nutr Food Sci. 2014;04(06):4–7.

9. Darnton-Hill I, Mkparu UC. Micronutrients in pregnancy in low- and middle-income countries. Nutrients. 2015;7(3):1744–68. doi: 10.3390/nu7031744 25763532

10. Ritchie LD, King JC. Dietary calcium and pregnancy-induced hypertension: Is there a relation? Am J Clin Nutr. 2000;7(5 suppl):1371S–1374S.

11. Chhabra S, Singh A. Role of Calcium in Hypertensive Disorders of Pregnancy Current Status of Research a Mini Review. J Nutr Disord Ther. 2017;7(2):1–5.

12. Imdad A, Bhutta ZA. Effects of calcium supplementation during pregnancy on maternal, fetal and birth outcomes. Paediatr Perinat Epidemiol. 2012;26(1):138–52.

13. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Gj H, Ta L, et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems (Review). Cochrane database Syst Rev. 2010;4(8):1–132.

14. Hertz-Picciotto I, M. S, M. W-M, K. C, J. A, J. O. Patterns and determinants of blood lead during pregnancy. Am J Epidemiol. 2000;152(9):829–37. doi: 10.1093/aje/152.9.829 11085394

15. Kovacs CS. Commentary: Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab. 2001;86(6):2344–8. doi: 10.1210/jcem.86.6.7575 11397820

16. Scholl TO, Chen X, Stein TP. Maternal calcium metabolic stress and fetal growth. Am J Clin Nutr. 2014;99(4):918–25. doi: 10.3945/ajcn.113.076034 24500145

17. Chen Y, Zhu B, Wu X, Li S, Tao F. Association between maternal Vitamin D deficiency and small for gestational age: Evidence from a meta-analysis of prospective cohort studies. BMJ Open. 2017;7(8):1–10.

18. Prentice A. Maternal calcium metabolism and bone mineral status. Am J Clin Nutr. 2000;71(5):1312S–1316S.

19. Yumusakhuylu Y, Turgut ST, Icagasioglu A, Baklacioglu HS, Atlig RS, Murat S, et al. Bone mineral changes during pregnancy and lactation. Gynecol Endocrinol. 2013;29(8):763–6. doi: 10.3109/09513590.2013.801444 23815509

20. Breast K. Minerals in Pregnancy and Lactation: A Review Article. J Clin diagnostic Res. 2017;11(9):9–13.

21. WHO. Guideline: Calcium supplementation in pregnant women. World Heal Organ [Internet]. 2013;1–26. Available from:;jsessionid=449E64A7606D5D2A2A747A10ADF7CFC3?sequence=1

22. Balk EM, Adam GP, Langberg VN, Earley A, Clark P, Ebeling PR. Global dietary calcium intake among adults: a systematic review. Osteoporos Int. 2017;28(12):3315–24. doi: 10.1007/s00198-017-4230-x 29026938

23. Cormick G, Betran A, IB R, Lombardo C, G€ulmezoglu A, Ciapponi A, et al. Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis. BJOG An Int J Obstet Gynaecol. 2018;3(1):1–13.

24. BIOLABO. CALCIUM CPC method: Reagent for quantitative determination of calcium in human plasma or serum, or urine [Internet]. 2019. p. 1–2. Available from:

25. BIOLABO. ALBUMIN BCG Method: Reagent for quantitative determination of albumin in human serum or plasma [Internet]. BIOLABO; 2011. p. 1–2. Available from:

26. Payne RB, Carver ME, Morgan DB. Interpretation of serum total calcium: effects of adjustment of albumin concentration on frequency of abnormal values and on detection of change in the individual. J Clin Pathol. 1979;32(1):56–60. doi: 10.1136/jcp.32.1.56 429580

27. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of Serum Calcium in Patients with Abnormal Serum Proteins. Br Med J. 1973;4(5893):643–6. doi: 10.1136/bmj.4.5893.643 4758544

28. Schauberger C, Pitkin R. Maternal-Perinatal_Calcium Relationships. Obstet Gynecol. 1979;53(1):74–6. 760023

29. Almaghamsi A, Almalki MH, Buhary BM. Hypocalcemia in pregnancy: A clinical review update. Oman Med J. 2018;33(6):453–62. doi: 10.5001/omj.2018.85 30410686

30. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Heal. 2014;2(6):e323–333.

31. Agueh VD, Tugoué MF, Sossa C, Métonnou C, Azandjemè C, Paraiso NM, et al. Dietary Calcium Intake and Associated Factors among Pregnant Women in Southern Benin in 2014. Food Nutr Sci. 2015;6:945–54.

32. Zhou K, Xu L, Li W, Zhang J. Interventions for leg cramps in pregnancy. Cochrane Database Syst Rev. 2015;11(8):1–12.

33. Hofmeyr GJ, Lawrie TA, Atallah ÁN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2014;(6):1–132.

34. Hofmeyr GJ, Duley L, Atallah A. Dietary calcium supplementation for prevention of pre-eclampsia and related problems: A systematic review and commentary. BJOG An Int J Obstet Gynaecol. 2007;114(8):933–43.

35. Weaver CM. Diet, Gut Microbiome, and Bone Health. Curr Osteoporos Rep. 2015;13(2):125–30. doi: 10.1007/s11914-015-0257-0 25616772

36. Cifuentes M, Morano AB, Chowdhury HA, Shapses SA. Energy restriction reduces fractional calcium absorption in mature obese and lean rats. J Nutr. 2002;132(9):2660–6. doi: 10.1093/jn/132.9.2660 12221226

Článek vyšel v časopise


2019 Číslo 11