Evidence map›Paper›PMID 38197817›Full record

Trial reportThe New England journal of medicine2024

Two Randomized Trials of Low-Dose Calcium Supplementation in Pregnancy.

Pratibha Dwarkanath, Alfa Muhihi, Christopher R Sudfeld, Blair J Wylie, Molin Wang, Nandita Perumal, Tinku Thomas, Shabani M Kinyogoli, Mohamed Bakari, Ryan Fernandez and 10 more

2 registry-linked trialsOpen access · bronzeAbstract readEquivalence TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The New England journal of medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 25 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
25citing papers in PubMed, 4 pooled it
26.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03350516 phase3completednot on this map

Demonstrating Non-inferiority of Lower Dose Calcium Supplementation During Pregnancy for Reducing Preeclampsia and Neonatal Outcomes

TypeinterventionalSponsorHarvard School of Public Health (HSPH)Ran2018 to 2022Enrolled22,000ConditionsPregnancy RelatedArmsDaily 500 mg elemental calcium as calcium carbonate, Daily1500 mg elemental calcium as calcium carbonate
NCT07555093 narecruitingnot on this mapstarted 2026, after this paper: background citation

A Randomized Controlled Trial in Lombok: Assessing Factors Influencing Acceptance and Adherence to Multiple Micronutrient Supplementation (MMS) Using Digital Tools

TypeinterventionalSponsorSummit Institute for Development, IndonesiaRan2026 to 2027Enrolled10,012ConditionsPregnancy, AdherenceArmsBottle pack, Blister pack, Standard Care, Digital care
3 · Its place in the literature

Who cites it

25 citing papers in PubMed, 4 syntheses or guidelines pooled it, 46 citations in OpenAlex.

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  15. Dietary supplements and prevention of preeclampsia.Hypertension research : official journal of the Japanese Society of Hypertension · 2025
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  16. Use of calcium during pregnancy: far beyond pre-eclampsia.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

20 authors at 1 institution in 1 country.

Pratibha DwarkanathFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Alfa MuhihiFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Christopher R SudfeldFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Blair J WylieFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Molin WangFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Nandita PerumalFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Tinku ThomasFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Shabani M KinyogoliFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Mohamed BakariFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Ryan FernandezFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
John-Michael RajFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Ndeniria O SwaiFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Nirmala BuggiFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Rani ShobhaFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Mary M SandoFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Christopher P DugganFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Honorati M MasanjaFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Anura V KurpadFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Andrea B PembeFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).
Wafaie W FawziFrom St. John's Research Institute (P.D., R.F.), St. John's Medical College (T.T., J.M.R., A.V.K.), and Bruhat Bengaluru Mahanagara Palike (N.B., R.S.) - all in Bangalore, India; the Africa Academy for Public Health (A.M., S.M.K., M.M.S.), Muhimbili University of Health and Allied Sciences (M.B., A.B.P.), Dar es Salaam Regional Medical Office of Health (N.O.S.), and Ifakara Health Institute (H.M.M.) - all in Dar es Salaam, Tanzania; the Harvard T.H. Chan School of Public Health (C.R.S., M.W., N.P., C.P.D., W.W.F.), Harvard Medical School (M.W., C.P.D.), and Boston Children's Hospital (C.P.D.) - all in Boston; Columbia University Medical Center, New York (B.J.W.); and the University of South Carolina, Columbia (N.P.).ORCID 0000-0002-2908-600X
St. John's National Academy of Health Sciences · IN

Funding

ROLE OF DIETARY CONSTITUENTS ON GENE EXPRESSION IN INTESTINAL EPITHELIUMP30DK040561 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI Elizabeth Austen Lawson, Takara Leah Stanley · 1994 to 2026
$31.6M
Bill and Melinda Gates Foundation OPP1172660CIHR 201910MFE-430812-197459NIDDK NIH HHS P30 DK040561
6 · The paper itself

Abstract

backgroundThe World Health Organization recommends 1500 to 2000 mg of calcium daily as supplementation, divided into three doses, for pregnant persons in populations with low dietary calcium intake in order to reduce the risk of preeclampsia. The complexity of the dosing scheme, however, has led to implementation barriers.

methodsWe conducted two independent randomized trials of calcium supplementation, in India and Tanzania, to assess the noninferiority of a 500-mg daily dose to a 1500-mg daily dose of calcium supplementation. In each trial, the two primary outcomes were preeclampsia and preterm birth, and the noninferiority margins for the relative risks were 1.54 and 1.16, respectively.

resultsA total of 11,000 nulliparous pregnant women were included in each trial. The cumulative incidence of preeclampsia was 3.0% in the 500-mg group and 3.6% in the 1500-mg group in the India trial (relative risk, 0.84; 95% confidence interval [CI], 0.68 to 1.03) and 3.0% and 2.7%, respectively, in the Tanzania trial (relative risk, 1.10; 95% CI, 0.88 to 1.36) - findings consistent with the noninferiority of the lower dose in both trials. The percentage of live births that were preterm was 11.4% in the 500-mg group and 12.8% in the 1500-mg group in the India trial (relative risk, 0.89; 95% CI, 0.80 to 0.98), which was within the noninferiority margin of 1.16; in the Tanzania trial, the respective percentages were 10.4% and 9.7% (relative risk, 1.07; 95% CI, 0.95 to 1.21), which exceeded the noninferiority margin.

conclusionsIn these two trials, low-dose calcium supplementation was noninferior to high-dose calcium supplementation with respect to the risk of preeclampsia. It was noninferior with respect to the risk of preterm live birth in the trial in India but not in the trial in Tanzania. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03350516; Clinical Trials Registry-India number, CTRI/2018/02/012119; and Tanzania Medicines and Medical Devices Authority Trials Registry number, TFDA0018/CTR/0010/5).

Indexed as

CalciumDietary SupplementsPre-EclampsiaPremature BirthFemaleHumansInfant, NewbornPregnancyCalcium

Identifiers

PMID38197817
PMCPMC10921922
OpenAlexW4390690729

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.