nhau

Kukwira kweropa panguva yekuzvitakura kunogona kukonzera eclampsia uye kusununguka nguva isati yakwana uye ndicho chikonzero chikuru chekurwara nekufa kweamai naamai. Sechiyero chakakosha chehutano hweveruzhinji, World Health Organisation (WHO) inokurudzira kuti vakadzi vane nhumbu vane chikafu chisina kukwana che calcium supplement 1000 kusvika 1500 mg yecalcium zuva nezuva. Nekudaro, nekuda kwekuremedza karusiyamu yekuwedzera, kuisirwa kweiyi kurudziro hakuna kugutsa.

Miedzo isina kurongwa yakaitwa muIndia neTanzania naProfessor Wafie Fawzi weHarvard School of Public Health muUnited States yakawana kuti yakaderera-dose calcium supplementation panguva yekuzvitakura yakanga isina kuipa kupfuura high-dose calcium supplementation mukuderedza njodzi yepre-eclampsia. Panyaya yekudzikisa njodzi yekuzvarwa kusati kwasvika, miedzo yeIndia neTanzania yaive nemhedzisiro isingaenderane.

Miedzo miviri iyi yaisanganisira zviuru gumi nerimwe zvevatori vechikamu vane makore ≥18 makore, gestational age < kubva munaNovember 2018 kusvika Kukadzi 2022 (India) uye Kurume 2019 kusvika Kurume 2022 (Tanzania). Vanaamai vekutanga pamasvondo e20 avo vaitarisirwa kurarama munzvimbo yekuedzwa kusvikira mavhiki e6 mushure mekuberekwa vakaiswa zvisina kurongwa 1: 1 kune yakaderera-calcium supplementation (500 mg zuva nezuva + 2 placebo mapiritsi) kana high-calcium supplementation (1500 mg zuva nezuva) kusvikira kusununguka. Mhedzisiro yekutanga yaive preeclampsia uye kuberekwa kusati kwasvika (dual endpoints). Kupera kwechipiri kwaisanganisira mimba-yakabatana hypertension, preeclampsia ine zviratidzo zvakakomba, rufu rune chokuita nemimba, kuberekwa, kuberekwa, uremu hushoma, hudiki hwezera rekuzvitakura, uye kufa kwemwana mukati memazuva makumi mana nemaviri. Migumo yekuchengetedza yaisanganisira kuchipatara kwevakadzi vane pamuviri (nekuda kwezvikonzero kunze kwekusununguka) uye kupererwa kweanemia muchitatu chetatu. Zvisiri-pasi-pasi mapeji aive nengozi dze1.54 (preeclampsia) uye 1.16 (kuberekwa kusati kwasvika), zvichiteerana.

Kune preeclampsia, chiitiko chekuwedzera che 500 mg inopesana ne1500 mg boka muIndia kuedza kwaiva 3.0% uye 3.6%, maererano (RR, 0.84; 95% CI, 0.68 ~ 1.03); Mukutongwa kweTanzania, chiitiko chacho chaiva 3.0% uye 2.7%, maererano (RR, 1.10; 95% CI, 0.88 ~ 1.36). Miedzo miviri yakaratidza kuti njodzi yepreeclampsia yakanga isina kuipa muboka re500 mg kupfuura muboka re1500 mg.

Nokuda kwekuzvarwa kusati kwasvika, mukuedza kweIndia, chiitiko che 500 mg inopesana ne1500 mg boka raiva 11.4% uye 12.8%, maererano (RR, 0.89; 95% CI, 0.80 ~ 0.98), iyo isiri-yakaderera yakasimbiswa mukati mechikamu chekukosha; ye154. Mukutongwa kweTanzania, kuberekwa kusati kwasvika 10.4% uye 9.7%, maererano (RR, 1.07; 95% CI, 0.95 ~ 1.21), yakapfuura iyo isiri-yakaderera chikumbaridzo kukosha kwe1.16, uye kusiri-pasi hakuna kusimbiswa.

Mumativi ose echipiri uye akachengeteka, pakanga pasina uchapupu hwokuti boka re 1500 mg rakanga riri nani kupfuura boka re500 mg. Meta-analysis yemigumisiro yemiedzo miviri haina kuwana misiyano pakati pe500 mg uye 1500 mg mapoka mu preeclampsia, njodzi yekuberekwa isati yasvika, uye yechipiri uye migumisiro yekuchengeteka.

Ichi chidzidzo chakanangana neakakosha ehutano hweveruzhinji nyaya yecalcium supplementation muvakadzi vane nhumbu yekudzivirira preeclampsia, uye yakaita ongororo yakakura yakarongeka munyika mbiri panguva imwe chete kuti vapindure mubvunzo wakakosha asi uchiri kujeka wesainzi weiyo yakanyanya kusimba dose ye calcium supplementation. Chidzidzo chacho chaive nekugadzirwa kwakasimba, saizi yakakura yemuenzaniso, kaviri-mapofu placebo, isiri-inferiority hypothesis, uye maviri akakosha makiriniki emhedzisiro yepreeclampsia uye kuberekwa kusati kwasvika semagumo ekupedzisira, akateverwa kusvika kumazuva makumi mana neshanu mushure mekusununguka. Panguva imwecheteyo, hutano hwekuurayiwa hwakanga hwakakwirira, chiyero chekurasikirwa kwekutevera chakanga chakanyanya kuderera (99.5% kutevera kusvika kune pamuviri, India, 97.7% Tanzania), uye kutevedza kwaive kwakakwirira zvikuru: chikamu chepakati chekuteerera chaiva 97.7% (India, 93.2-99.2 interquartile interval 3%. 7-Tanzania. interval).

Calcium chinhu chinodiwa pakukura nekukura kwe fetal, uye kudiwa kwecalcium muvakadzi vane pamuviri kunowedzera kana zvichienzaniswa nehuwandu hwevanhu, kunyanya panguva yekuzvitakura apo fetus inokura nekukurumidza uye bhonzo mineralization peaks, calcium yakawanda inoda kuwedzerwa. Calcium supplementation inogonawo kuderedza kuburitswa kweparathyroid hormone uye intracellular calcium concentration muvakadzi vane pamuviri, uye kuderedza kusimba kwetsinga dzeropa uye uterine smooth muscle. Miedzo yePlacebo-controlled yakaratidza kuti high-dose calcium supplementation panguva yekuzvitakura (> 1000 mg) yakaderedza ngozi yepreeclampsia inopfuura 50% uye njodzi yekuberekwa kusati kwasvika ne24%, uye kuderedzwa kwakaratidzika kuva kwakanyanya kune vanhu vane calcium shoma. Nokudaro, mu "Mazano Akakurudzirwa eCalcium Supplementation panguva Yepamuviri Kudzivirira Preeclampsia uye Zvinetso Zvayo" yakabudiswa neWorld Health Organization (WHO) munaNovember 2018, zvinokurudzirwa kuti vanhu vane calcium yakaderera kudya vanofanira kuwedzera calcium ne 1500 kusvika 2000 mg zuva rega rega, yakakamurwa kuva katatu oral doses kutora iron kusvika maawa akawanda ekudzivirira. China's Expert Consensus pamusoro peCalcium Supplementation yevakadzi vane pamuviri, yakabudiswa muna Chivabvu 2021, inokurudzira kuti vakadzi vane pamuviri vane calcium yakaderera yekudya vanowedzera calcium 1000 ~ 1500 mg zuva nezuva kusvika pakusununguka.

Parizvino, nyika shomanana chete uye nharaunda dzakashandisa muitiro mukuru-dose calcium supplement panguva yekuzvitakura, zvikonzero zvinosanganisira kuwanda kwehuwandu hwekasium dosage fomu, yakaoma kumedza, chirongwa chekutonga chakaoma (katatu pazuva, uye inoda kuparadzaniswa nesimbi), uye kutevedza kwemishonga kunoderedzwa; Mune dzimwe nzvimbo, nekuda kwezviwanikwa zvishoma uye kudhura kwakanyanya, calcium haisi nyore kuwana, saka kugona kweiyo yakakura dose calcium supplementation inobatwa. Mumakiriniki ekuedzwa achiongorora yakaderera-dose calcium supplementation panguva yekuzvitakura (kunyanya 500 mg zuva nezuva), kunyangwe ichienzaniswa ne placebo, njodzi yepreeclampsia yakaderedzwa muboka re calcium supplementation (RR, 0.38; 95% CI, 0.28 ~ 0.52), asi zvakakosha kuti uzive kuvepo kwekutsvagisa njodzi yakanyanya [3]. Mune imwe chete diki yekiriniki yekuedza ichienzanisa yakaderera-dose uye yakakwirira-dose calcium supplementation, njodzi yepreeclampsia yakaratidza kuderera muboka repamusoro-soro kana ichienzaniswa neboka rakaderera (RR, 0.42; 95% CI, 0.18 ~ 0.96); Pakanga pasina mutsauko munjodzi yekuzvarwa kusati kwasvika (RR, 0.31; 95% CI, 0.09 ~ 1.08)