Objective:

To reduce the risk of developing gestational hypertensive disorders and associated health problems
thereby improving maternal and newborn health and nutrition outcomes through provision of daily
calcium supplementation to pregnant women.

General Guidelines:

I. Calcium Supplementation in pregnant women

Calcium supplementation has the potential to reduce adverse gestational outcomes, in

particular by decreasing the risk of developing hypertensive disorders during
pregnancy, which are associated with a significant number of maternal deaths and
considerable risk of preterm birth, the leading cause of early neonatal and infant
mortality.

The following is the recommended scheme for calcium supplementation in pregnant

women:

Dosage Calcium Carbonate 500mg elemental calcium tablet

Frequency Daily to be taken three times a day preferably during
mealtime (approximately 420 calcium carbonate tablets per
pregnant women)
Duration From 20 week’s gestation (5th month) until the end of
pregnancy
Target Group All pregnant women, particularly those at higher risk of
gestational hypertension
Distribution Calcium supplement distribution will be done at the health
facilities starting on the second pre-natal visit or on the 20th
week (2nd trimester)
Areas of Coverage Initially in selected provinces of the Regions III, IV-B, V,
VII, IX and XII.
As supplies become available, it will be implemented in all
regions.
Local Government Units are encouraged to implement
calcium supplementation immediately providing for the
calcium carbonate tablets to their pregnant women.

II. Additional Instruction for Administration

A. Excessive consumption of calcium from diet, supplements and antacids may increase
the risk of urinary stones and urinary tract infection, and, reduce the absorption of other
essential micronutrients. Increased water intake is recommended to minimize the
aforesaid risk.

B. Interaction between iron supplements and calcium supplements may occur, so the
two supplements should be administered several hours apart i.e. iron may be taken
before bedtime rather than during mealtime together with the calcium supplement.
 C. Calcium supplements are available as tablets or capsules. Calcium carbonate is
recommended because it has the highest content elemental calcium compared with other
calcium salt formulation.

III. Recording and Reporting

The delivery of calcium supplements shall be monitored to assess coverage. In the

Target Client List or on the Mother and Child Book include the provision of calcium
carbonate tablets starting on the 5th month of pregnancy in the Treatment and other
services section, as shown below:

Treatment and Other Services

Check (/) if done

Micronutrient Supplements 1st 2nd 3rd 4th 5th 6th 7th 8th 9th
 Iron with Folic Acid / / / / / / / /
 Calcium Carbonate / / / / /

Check for STI/HIV/AIDS

Dental check Up
Hepatitis B Screening
Breast Examination
Sputum Exam (if signs /symptoms)

IV. Information Dissemination

Orientation for health workers on Calcium Supplementation for pregnant women,

especially those working on maternal and child health and nutrition, shall be conducted.
It could be done during regular meetings, gatherings and consultation to ensure that
every health worker is informed on the importance and beneficial effect of calcium
supplementation.

Advocacy to Local government Chief Executives to immediately implement calcium

supplementation among pregnant women providing for the required supplements while
the Department of Health is still in the process of upscaling its procurement for calcium
supplementation.