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Umfutho wegazi ophakeme ngesikhathi sokukhulelwa ungaholela ku-eclampsia nokuzalwa ngaphambi kwesikhathi futhi uyimbangela enkulu yokugula nokufa komama nezinsana. Njengesilinganiso esibalulekile sezempilo yomphakathi, i-World Health Organization (WHO) incoma ukuthi abesifazane abakhulelwe abanezithako zokudla ze-calcium ezinganele bangezelele ku-1000 kuya ku-1500 mg we-calcium nsuku zonke. Kodwa-ke, ngenxa yesithasiselo se-calcium esinzima kakhulu, ukuqaliswa kwalesi sincomo akwenelisi.

Ukuhlolwa okulawulwa ngokungahleliwe okwenziwa eNdiya naseTanzania nguSolwazi Wafie Fawzi we-Harvard School of Public Health e-United States kwathola ukuthi ukufakwa kwe-calcium ngethamo eliphansi ngesikhathi sokukhulelwa kwakungekubi kakhulu kunokwengezwa kwe-calcium ngomthamo omkhulu ekunciphiseni ingozi ye-pre-eclampsia. Mayelana nokunciphisa ingozi yokuzalwa ngaphambi kwesikhathi, izivivinyo zaseNdiya naseTanzania zibe nemiphumela engaguquki.

Lezi zilingo ezimbili zihlanganisa ababambiqhaza abangu-11,000 abaneminyaka engu-≥18 iminyaka, iminyaka yokukhulelwa < kusukela ngoNovemba 2018 kuya kuFebruwari 2022 (India) kanye noMashi 2019 kuya kuMashi 2022 (eTanzania). Omama bokuqala emavikini angu-20 okwakulindeleke ukuthi bahlale endaweni yesilingo kuze kube amasonto angu-6 ngemva kokubeletha babekelwe ngokungahleliwe i-1: 1 ku-low-calcium supplementation (500 mg nsuku zonke + amaphilisi e-placebo angu-2) noma i-high-calcium supplementation (1500 mg nsuku zonke) kuze kube sekubelethweni. Iziphetho eziyinhloko kwakuyi-preeclampsia kanye nokuzalwa ngaphambi kwesikhathi (ama-endpoints amabili). Iziphetho zesibili zazihlanganisa umfutho wegazi ophakeme ohlobene nokukhulelwa, i-preeclampsia enezimpawu ezinzima, ukufa okuhlobene nokukhulelwa, ukubeletha, ukubeletha, isisindo sokuzalwa esiphansi, isikhathi esincane sokukhulelwa, nokufa kwengane phakathi kwezinsuku ezingu-42. Iziphetho zokuphepha zazihlanganisa ukulaliswa esibhedlela kwabesifazane abakhulelwe (ngezizathu ezingezona ukubeletha) kanye ne-anemia enzima ku-trimester yesithathu. Amamajini angewona aphansi ayeyizingozi ezihlobene ze-1.54 (preeclampsia) kanye ne-1.16 (ukuzalwa ngaphambi kwesikhathi), ngokulandelanayo.

Ku-preeclampsia, izehlakalo eziqoqiwe zeqembu le-500 mg ngokumelene ne-1500 mg ohlolweni lwase-Indian kwaba ngu-3.0% no-3.6%, ngokulandelanayo (RR, 0.84; 95% CI, 0.68~1.03); Esivivinyweni saseTanzania, isigameko sasingu-3.0% no-2.7%, ngokulandelana (RR, 1.10; 95% CI, 0.88 ~ 1.36). Zombili izinhlolo zibonise ukuthi ingozi ye-preeclampsia yayingembi kakhulu eqenjini le-500 mg kuneqembu le-1500 mg.

Ngokuzalwa ngaphambi kwesikhathi, ocwaningweni lwaseNdiya, isigameko seqembu le-500 mg ngokumelene ne-1500 mg sasingu-11.4% no-12.8%, ngokulandelana (RR, 0.89; 95% CI, 0.80 ~ 0.98), okungephansi kwasungulwa ngaphakathi kwevelu ye-threshold; ye-1.54; Esivivinyweni saseTanzania, amazinga okuzalwa ngaphambi kwesikhathi ayengu-10.4% kanye no-9.7%, ngokulandelanayo (RR, 1.07; 95% CI, 0.95 ~ 1.21), adlule inani elingekho ngaphansi kwe-1.16, futhi ukungabi ngaphansi akuzange kuqinisekiswe.

Kuzo zombili iziphetho zesibili nezokuphepha, abukho ubufakazi bokuthi iqembu le-1500 mg lalingcono kuneqembu le-500 mg. Ukuhlaziywa kwemeta kwemiphumela yokuhlolwa okubili akutholanga mehluko phakathi kwamaqembu angu-500 mg kanye ne-1500 mg ku-preeclampsia, ingozi yokuzalwa ngaphambi kwesikhathi, kanye nemiphumela yesibili neyokuphepha.

Lolu cwaningo lugxile odabeni olubalulekile lwezempilo yomphakathi lwe-calcium supplementation kwabesifazane abakhulelwe ukuze kuvinjwe i-preeclampsia, futhi lwenze isilingo esikhulu esilawulwa ngokungahleliwe emazweni amabili ngesikhathi esisodwa ukuphendula umbuzo wesayensi obalulekile kodwa namanje ongacacile womthamo osebenza kahle we-calcium supplementation. Ucwaningo lwalunomklamo oqinile, usayizi omkhulu wesampula, i-placebo eyimpumputhe ephindwe kabili, i-non-inferiority hypothesis, kanye nemiphumela emibili ebalulekile yomtholampilo ye-preeclampsia kanye nokuzalwa ngaphambi kwesikhathi njengeziphetho eziphindwe kabili, ezilandelwa kuze kufike ezinsukwini ezingu-42 ngemuva kokubeletha. Ngesikhathi esifanayo, ikhwalithi yokubulawa yayiphezulu, izinga lokulahlekelwa kokulandelwa laliphansi kakhulu (i-99.5% yokulandelela umphumela wokukhulelwa, i-India, i-97.7% ye-Tanzania), futhi ukuhambisana kwakuphakeme kakhulu: iphesenti eliphakathi lokuthobela laliyi-97.7% (India, 93.2-99.2 interquartile interval3%. isikhawu).

I-calcium isakhi esidingekayo ekukhuleni nasekukhuleni kwengane, futhi isidingo se-calcium kwabesifazane abakhulelwe siyanda uma siqhathaniswa nenani labantu abaningi, ikakhulukazi ngesikhathi sokukhulelwa sekwephuzile lapho umbungu ukhula ngokushesha futhi inani lamaminerali liphezulu, i-calcium eningi idinga ukwengezwa. Ukwengezwa kwe-calcium kunganciphisa nokukhululwa kwe-hormone ye-parathyroid kanye ne-intracellular calcium concentration kwabesifazane abakhulelwe, futhi kunciphise ukufinyela kwemithambo yegazi kanye nemisipha ebushelelezi yesibeletho. Izivivinyo ezilawulwa yi-placebo zibonise ukuthi umthamo ophezulu we-calcium supplementation ngesikhathi sokukhulelwa (> 1000 mg) wehlise ingozi ye-preeclampsia ngaphezu kuka-50% kanye nengozi yokuzalwa ngaphambi kwesikhathi ngama-24%, futhi ukuncipha kubonakale kukhulu nakakhulu kubantu abadla kancane i-calcium. Ngakho-ke, kokuthi "Izincomo Ezinconyiwe Zokwengeza I-Calcium Ngesikhathi Sokukhulelwa Ukuvimbela I-Preeclampsia Nezinkinga Zayo" ekhishwe yi-World Health Organization (WHO) ngoNovemba 2018, kunconywa ukuthi abantu abane-calcium ephansi yokudla kufanele bengeze i-calcium ngo-1500 kuya ku-2000 mg nsuku zonke, ihlukaniswe ngemithamo emithathu yomlomo ethatha i-iron kuya ku-preeclamp amahora amaningana. I-China's Expert Consensus on Calcium Supplementation for Women Pregnant, ekhishwe ngoMeyi 2021, incoma ukuthi abesifazane abakhulelwe abadla i-calcium ephansi bangezele i-calcium engu-1000~1500 mg nsuku zonke kuze kube yilapho bebelethwa.

Njengamanje, amazwe ambalwa kuphela nezifunda eziye zasebenzisa isithako se-calcium esine-dose enkulu ngesikhathi sokukhulelwa, izizathu zihlanganisa umthamo omkhulu wefomu lomthamo we-calcium, okunzima ukugwinya, uhlelo lokuphatha oluyinkimbinkimbi (izikhathi ezintathu ngosuku, futhi ludinga ukuhlukaniswa nensimbi), futhi ukuhambisana nemithi kuyancishiswa; Kwezinye izindawo, ngenxa yezinsiza ezilinganiselwe kanye nezindleko eziphezulu, i-calcium akulula ukuyithola, ngakho-ke ukutholakala komthamo omkhulu we-calcium supplementation kuyathinteka. Ezivivinyweni zomtholampilo ezihlola umthamo ophansi we-calcium supplementation ngesikhathi sokukhulelwa (ikakhulukazi i-500 mg nsuku zonke), nakuba iqhathaniswa ne-placebo, ingozi ye-preeclampsia yancishiswa eqenjini le-calcium supplementation (RR, 0.38; 95% CI, 0.28~0.52), kodwa kuyadingeka ukuqaphela ukuba khona kocwaningo olunengozi enkulu yokuchema [3]. Esivivinyweni esisodwa esincane somtholampilo esiqhathanisa umthamo ophansi kanye ne-high-dose calcium supplementation, ingozi ye-preeclampsia ibonakala yehla eqenjini le-high-dose uma kuqhathaniswa neqembu le-dose ephansi (RR, 0.42; 95% CI, 0.18 ~ 0.96); Kwakungekho mehluko engcupheni yokuzalwa ngaphambi kwesikhathi (RR, 0.31; 95% CI, 0.09~1.08)