(P27-012-25) Impact of Scaling Up Prenatal Calcium Supplementation on Long-Term Maternal Noncommunicable Disease Risks: A Modeling Study Across 132 Low- and Middle-Income Countries

Objectives: Prenatal calcium supplementation reduces the risk of pre-eclampsia (PE), which is an established risk factor for long-term maternal non-communicable disease (NCD). We quantified the impact of scaling up calcium supplementation coverage to 90% on reducing later-life NCD risk factors and cause-specific mortality among mothers in 132 LMICs.

Methods: We developed a population-based simulation model using the generalized population impact fraction estimator to assess long-term impacts. The effect of calcium supplementation on PE was derived from meta-analyses of randomized trials and the association between PE and subsequent risk of diabetes (DM) and hypertension (HTN) and the impact of DM/HTN on disease outcomes were obtained from meta-analyses of cohort studies. We used the latest demographic data from the UN population division and cause-specific disease data (by age, sex, and country) from the Global Burden of Disease study. Modeled NCDs included cardiovascular disease, hypertensive heart disease, peripheral vascular disease, chronic kidney disease, and ovarian cancer. Outcomes were averted DM and HTN cases, delayed NCD deaths, and years of life gained. These estimates were discounted at 3% annually.

Results: Scaling up calcium supplementation coverage to 90% in all 132 LMICs could prevent 664,200 PE cases annually and subsequently delay 0.06% of annual female NCD deaths (5,790 NCD deaths annually) and yield 91,900 years of life gained. It could reduce DM prevalence by 0.15% (averting 285,700 cases per cohort) and HTN by 0.14% (averting 809,600 cases). Notable variations were observed across regions and countries. Sub-Saharan Africa (SSA) had the largest number of prevented PE cases, while Southeast Asia saw the largest reduction in the number of DM, HTN and NCD deaths. When adjusted for population size, SSA and Latin America showed the greatest health benefits. Vascular and renal diseases accounted for 97% of delayed deaths, with ovarian cancer for 3%.

Conclusions: Scaling up calcium supplementation could substantially reduce PE incidence and modestly reduce long-term maternal NCDs. Given the coexistence of rising NCDs, persistent malnutrition, and maternal mortality in LMICs, expanding prenatal nutritional interventions that can simultaneously address these intertwined issues warrant urgent attention.

Funding Sources: Nutrition International