The dissemination and implementation of this recommendation is to be considered by all actors involved in the provision of care for pregnant women at the international, national and local levels. There is a vital need to increase access and strengthen the capacity of health centres to provide high quality services to all women giving birth. It is therefore crucial that this recommendation is translated into antenatal care packages and programmes at country and health-facility levels (where appropriate).
Recommendation dissemination and evaluation
A shorter document containing the recommendation, remarks, implementation considerations and research priorities will be formulated for public dissemination. This document will have annexes (also made publicly available) containing all the information in this document, including methods, evidence-to-decision frameworks and GRADE tables.
WHO recommendation on calcium supplementation during pregnancy for prevention of pre-eclampsia and its complications.
The recommendation will be disseminated through WHO regional and country offices, ministries of health, professional organizations, WHO collaborating centres, other United Nations agencies and nongovernmental organizations, among others. This recommendation will also be available on the WHO website, the WHO Reproductive Health Library (www.who.int/rhl) and WHO e-Library of Evidence for Nutrition Actions (eLENA) (www.who.int/elena). Updated recommendations are also routinely disseminated during meetings or scientific conferences attended by WHO maternal and perinatal health staff.
The recommendation document will be translated into the six UN languages and disseminated through the WHO regional offices. Technical assistance will be provided to any WHO regional office willing to translate the full recommendation into any of these languages.
Implementation considerations
The successful introduction of this recommendation into national programmes and healthcare services depends on well-planned and participatory consensus-driven processes of adaptation and implementation. The adaptation and implementation processes may include the development or revision of existing national guidelines or protocols based on this recommendation;
The recommendation should be adapted into a locally appropriate document that can meet the specific needs of each country and health service. Any changes should be made in an explicit and transparent manner;
A set of interventions should be established to ensure that an enabling environment is created for the use of the recommendations (including, for example, the availability of oral calcium supplements in antenatal care settings), and that the behaviour of the healthcare provider changes towards the use of this evidence-based practice;
In this process, the role of local professional societies is important and an all-inclusive and participatory process should be encouraged;
Policymakers and other stakeholders should consider the level of dietary calcium intake amongst pregnant women;
The WHO antenatal care guidelines outline the 2016 WHO antenatal care model, which includes timing, content and frequency of antenatal care contacts (
2). In that model, the need for and compliance with calcium supplementation should be considered at all antenatal care contacts.
Healthcare providers should be trained in how to correctly advise women on calcium intake during pregnancy, and how to encourage compliance;
Healthcare services implementing this recommendation should put in place measures to ensure adequate stocks of calcium supplements are consistently available wherever antenatal care is provided;
The target group for this recommendation comprises populations with observed low dietary calcium intake, or those living in geographical areas where calcium-rich foods are not commonly available or consumed. Calcium intake at population level can be estimated through various means including dietary surveys using 24-hour recalls, food frequency questionnaires or food weighing, as well as through secondary data estimates derived from the Food and Agriculture Organization (FAO) food balance sheets or household consumption and expenditure surveys (
22);
When determining dosage for individual women, healthcare providers should take into consideration a woman’s calcium intake from other sources, such as medications (e.g. antacids).
