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Maternal and pediatric nutrition

Associations between maternal calcium intake from diet and supplements during pregnancy and the risk of preterm birth in a Chinese population



Preterm birth is a global public health priority related to maternal nutrition. The effect of maternal calcium intake during pregnancy on preterm birth is inconclusive and data is lacking in China. We aimed to estimate the role of calcium intake from diet and supplements on preterm birth in the Chinese population.


We used data of 7195 women from a large-scale cross-sectional study in Northwest China. Dietary intake was evaluated via a validated food frequency questionnaire, and other information was collected by a structured questionnaire. Generalized estimating equation models were used to estimate the relationship between calcium intake and preterm birth.


Inadequate dietary calcium intake was universal in our population (85.9%), and no association was found between daily dietary calcium intake and preterm birth. Maternal calcium supplementation was significantly associated with reduced risk of preterm birth (OR 0.72, 95% CI 0.60, 0.87, P = 0.001), particularly among women who commenced calcium supplementation in the second and third trimester of pregnancy with longer duration (OR 0.62, 95% CI 0.42, 0.91, P = 0.015). Higher daily calcium intake from supplements was linked with lower preterm birth risk (every 100 mg increase: OR 0.87, 95% CI 0.79, 0.96, P = 0.004). There is a negative association between daily total calcium intake and preterm birth among calcium supplement users (every 100 mg increase: OR 0.91, 95% CI 0.84, 0.97, P = 0.007).


In conclusion, appropriate calcium supplementation during pregnancy could be beneficial in the prevention of preterm birth, and it might be suitable for implementing in low calcium intake areas of China.

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The authors are grateful to all women who took part in this research, all health staff who coordinated fieldwork and all investigators who contributed to data collection.


This research was funded by the National Natural Science Foundation of China (grant number 81230016 and 81202218), the Shaanxi Health and Family Planning Commission (grant number Sxwsjswzfcght2016–013), and the National Key Research and Development Program of China (grant numbers 2017YF0907200 and 2017YF0907201).

Author information




DL, YZ, YC, and HY conceived and designed the study; DL, SL, FL, BM, PQ, BZ, AL, ML, and GS collected and cleared the data; DL, LZ, SD, BM, and PQ analyzed and interpreted the data; DL, SL, FL, SD, YZ, YC, LZ, and HY drafted and revised the paper. All authors read and approved the final version of the paper.

Corresponding author

Correspondence to Hong Yan.

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The authors declare that they have no conflict of interest.

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This study was approved by the Ethic Review Committee and Academic Committee of Xi’an Jiaotong University Health Science Center (Approval No. 2012008).

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Written informed consent was obtained from all participants.

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Liu, D., Li, S., Lei, F. et al. Associations between maternal calcium intake from diet and supplements during pregnancy and the risk of preterm birth in a Chinese population. Eur J Clin Nutr 75, 141–150 (2021).

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