e-Library of Evidence for Nutrition Actions (eLENA)

Calcium supplementation during pregnancy for the prevention of pre-eclampsia

Guidance summary*

WHO recommendations

In populations with low dietary calcium intake, daily calcium supplementation (1.5 g - 2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia.


  • This recommendation is consistent with recommendations in the 2011 WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia (1) (strong recommendation, moderate-quality evidence) and supersedes the WHO recommendation found in the 2013 Guideline: calcium supplementation in pregnant women (2).

  • Dietary counselling of pregnant women should promote adequate calcium intake through locally available, calcium-rich foods.

  • Dividing the dose of calcium may improve acceptability. The suggested scheme for calcium supplementation is 1.5–2 g daily, with the total dose divided into three doses, preferably taken at mealtimes.

  • Negative interactions between iron and calcium supplements may occur. Therefore, the two nutrients should preferably be administered several hours apart rather than concomitantly (2).

  • As there is no clear evidence on the timing of initiation of calcium supplementation, stakeholders may wish to commence supplementation at the first ANC visit, given the possibility of compliance issues.

  • To reach the most vulnerable populations and ensure a timely and continuous supply of supplements, stakeholders may wish to consider task shifting the provision of calcium supplementation in community settings with poor access to health-care professionals (see Recommendation E.6.1, in section E: Health systems interventions to improve the utilization and quality of antenatal care, found in the guideline, WHO recommendations on antenatal care for a positive pregnancy experience).

  • The implementation and impact of this recommendation should be monitored at the health service, regional and country levels, based on clearly defined criteria and indicators associated with locally agreed targets. Successes and failures should be evaluated to inform integration of this recommendation into the antenatal care package.

  • Further WHO guidance on prevention and treatment of pre-eclampsia and eclampsia is available in the 2011 WHO recommendations (1), available at: http://apps.who.int/iris/bitstream/10665/44703/1/9789241548335_eng.pdf.

* This is an extract from the relevant guidelines (1, 3). Additional guidance information can be found in these documents.


1. WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia. Geneva: World Health Organization; 2011 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9789241548335/en/).

2. Guideline: Calcium supplementation in pregnant women. Geneva: World Health Organization; 2013 (http://www.who.int/nutrition/publications/micronutrients/guidelines/calcium_supplementation/en/).

3. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/