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Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of fee and gestational or pregnancy induced hypertension are controversial.
Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July Only randomized controlled trials RCTs in English were selected endnote x7 mahidol free endnohe had any pair of interventions calcium, vitamin D, both, or placebo. Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects.
Twenty-seven RCTs with 28, women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios RRs of 0.
Results of network meta-analysis were similar with the corresponding RRs of 0. Endnote x7 mahidol free of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might endnote x7 mahidol free worked well but further large scale RCTs are warranted to confirm our findings. It is endnote x7 mahidol free of the major contributing causes of maternal-fetal morbidity and endnote x7 mahidol free worldwide [ 1 ].
Globally, 4. The incidence in developed countries was approximately 3. It also related to life-threatening unfavorable outcomes in both mother e. Endnote x7 mahidol free evidence showed an inverse relationship between high blood pressure and calcium intake [ 910 ]. Enenote epidemiological and clinical studies [ 91011 ], and later a series of systematic reviews [ 12131415 ] also demonstrated this association. As a result, the World Health Organization WHO has recommended to supplement calcium fref pregnant women especially to high-risk population with a low calcium diet [ 16 ].
Vitamin D is adobe photoshop cs4 extended rus (+crack) free in regulating bone metabolism, absorption of calcium and phosphate, and maintenance endnote x7 mahidol free muscle function [ 17 ]. Therefore, there might be a benefit of vitamin D supplementation in prevention of preeclampsia. However, systematic reviews [ 1819 ] of randomized controlled trials RCTs did not show any benefit in prevention of preeclampsia, whereas other two systematic reviews [ 20endnote x7 mahidol free ] of observational studies did.
These discrepancy results could be due to confounding bias in the latter or insufficient power in the former. Although these pieces of evidence suggest benefits from both calcium and vitamin D supplements, it is still unclear which supplement or a combination of them is most beneficial for preventing preeclampsia and gestational hypertension GH or pregnancy induced hypertension PIH.
A conventional pairwise meta-analysis can directly compare the efficacy or safety of exactly two treatments in head-to-head clinical trials that can mahdol by use simple method of direct meta-analysis. However, in fre practice, there are often many potential treatments for a single disease.
NMA is an перейти на источник of standard pairwise meta-analysis that provides comprehensive comparative treatment effects by combining both direct and indirect evidence. Because of the possibility to combine evidence from different treatment comparisons, and because they can identify the single best available treatment for decision-making, NMA are becoming increasingly attractive to mahiol.
This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses PRISMAextension of network meta-analyses [ 22 ]. The search terms and strategies were constructed based on Endnote x7 mahidol free i. These strategies were modified to suit each search engine where appropriate.
Study identification was done in two phases. First, all previous systematic reviews of calcium and vitamin D supplementations in pregnant women published since inception of each database to July were identified. Then, only individual RCTs included in these previous reviews were selected. Second, all individual RCTs on the same topic published from inception to July were identified. The reference lists of the retrieved studies were also checked to identify more relevant publications.
Where there were multiple publications from the same author s on the same mahisol, the most complete and recent study was included. Identified studies from Medline, Scopus and Cochrane were imported into EndNote X7 and duplicate studies were removed. The selected studies were independently screened by endnote x7 mahidol free and abstract by two reviewers W.
Full texts were retrieved if decisions could not be reached from information provided in the abstract. Disagreements regarding selection were resolved by consensus or discussion with a third reviewer S.
We contacted authors by email up to three times if data were insufficient. If there was no response after three attempts, then the study was excluded. Studies were excluded from the review if they were crossover trials, included multiple pregnancies, or after three envnote attempts requesting data from authors in the case of insufficient data. Interventions were any of following supplements regardless of dosage endnote x7 mahidol free duration of supplements: Calcium, vitamin D, combined calcium and vitamin D.
The endnote x7 mahidol free group could be placebo, a standard supplementation e. Generally, endnote x7 mahidol free was a new onset hypertension i. An early-onset preeclampsia occurred before 34 weeks of gestation, otherwise it was a late-onset preeclampsia. Eclampsia is a convulsive condition occurring in preeclampsia patients.
Красота, pixologic zbrush 4r8 a comprehensive guide 4th edition pdf free мысль reviewers W. Co-variables such as kahidol age, gestational age at enrolment and endnote x7 mahidol free, gravida, parity, body mass index BMI нажмите чтобы увидеть больше, smoking, diabetes mellitus, and duration of supplementation were also extracted.
If duration of supplementation was endnote x7 mahidol free reported, it was calculated by subtracting gestational age at delivery with gestational age at initiating. If gestational age at delivery of that study was not reported, mean gestational age at delivery, i. Data entry, cleaning and checking were performed separately for each reviewer. The two datasets were compared and validated, and any disagreement resolved by consensus. Study quality was independently assessed by two reviewers W.
The following seven domains were evaluated: selection bias sequence generation and concealmentperformance bias blinding of participants and assessorsdetection bias blinding of outcome assessmentattrition bias incomplete outcome dataselective outcome reporting, and other endnote x7 mahidol free. Each item was classified as low, high, or an unclear risk of bias if there was insufficient information.
The RRs were then directly pooled across studies using fixed-effect model i. Network meta-analysis was applied to indirectly compare effects of supplementation. Нажмите чтобы узнать больше two-stage multivariate meta-analysis was applied as follows: Coefficients i.
These parameters were then pooled across studies using a multivariate meta-analysis with maximum likelihood function [ 25 ]. Between-study variance and covariance of comparisons were considered using unstructured method.
Effects between active versus active supplementation were then compared using a frde combination of the multivariate meta-analysis model. The inconsistency assumption i.
Violation of consistency was assumed if the IF was significantly different free 0. All pairwise comparisons between direct and indirect effects, were estimated and displayed. In addition, small study effect for the whole network was assessed by constructing a comparison-adjusted funnel plot taking into endnote x7 mahidol free different comparisons [ 26 ].
Supplementations were coded from older to newer as 1, 2, 3, 4 for placebo, calcium, vitamin D, and calcium plus vitamin D, respectively. In the absence of small-study effects, we expected the studies to form an inverted funnel centered at zero, i.
Finally, a predictive probability of best intervention was estimated using surface under a cumulative ranking curve SUCRA. Efficacy of supplementation was then ranked by predicting probability.
The schema for selection of studies is displayed in Figure 1. Searching for previous systematic reviews identified review studies. Among these, review studies were excluded for reasons describe in Figure 1leaving 29 review studies with individual 71 RCTs that were eligible for further assessment.
In searching for individual studies, studies were identified for screening titles and abstracts. Among these, studies were excluded leaving enndnote individual RCTs that met inclusion criteria for further assessment. After removing duplicates with searching from systematic reviews, 78 RCTs were eligible for assessing full-text.
Of these, only 27 RCTs studies met our inclusion criteria and were considered for quantitative synthesis. The characteristics of the 27 RCTs are described in Table 1.
Individual endnote x7 mahidol free sizes ranged from 30 to with a median of The types of pregnant women varied, The mean age ranged from 16 to Among 27 Думаю, adobe acrobat xi pro livecycle designer free что, three studies [ 293738 ] were conference abstracts, thus the risk of bias could not be assessed because eendnote did not publish full articles.
In the remaining 24 studies, sequence generation was clearly described in 17 trials Allocation concealment was adequately performed in 13 trials Direct comparisons with calcium vs. These corresponding pooled effects were 0. Sources of heterogeneity for the pooled calcium vs. Subgroup analysis was therefore performed accordingly. The protective effect of calcium продолжение здесь endnote x7 mahidol free greater in high risk pregnancies than low risk pregnancies with a pooled RR of 0.
The sndnote supplement effect was also higher in pregnant women whose supplement durations were 18 weeks or shorter but ennote for longer than 18 weeks with the pooled RRs of 0. In addition, subgroup analysis by country of setting developing and developed countries showed significant preventive effects of calcium in developing countries but not for developed countries with the pooled RR of 0. Fourteen RCTs compared effects of calcium vs. Sources of heterogeneity were next explored, as нажмите для продолжения were identified as a source of heterogeneity.
Only studies on preeclampsia were included in indirect comparison, because there was a lack of RCT studies which reported on effect of vitamin D alone or combination with calcium for GH or PIH causing insufficient data for pooling. All interventions were mapped in a network plot Figure S3. Endnote x7 mahidol free size of each /5103.txt was proportional to the number of included studies, whereas the edge of each comparison was weighted by the number of pregnant women for that comparison.
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