Signs of hypocalcemia in pregnant women

Hypocalcaemia is a low level of calcium in the blood. Calcium in the blood helps our nerves work, makes our muscles squeeze together so we can move, helps in clotting in case of bleeding, and helps the heart work properly. Hypocalcaemia can hinder the human body’s ability to perform these important functions. In the developing world where daily calcium intakes are suboptimal, hypocalcaemia in pregnancy remains a major health issue.It is associated with foetal growth restriction (which alone causes about 40% of stillbirths), neonatal low bone mass, increased risk of small for gestational age, and increased maternal serum lead levels all with a significant potential of increasing maternofoetal and neonatal morbi-mortality
During pregnancy, hemodilution causes the serum albumin and hemoglobin to decrease while the albumin remains low until birth. This fall in albumin causes the total serum calcium to drop to levels associated with symptomatic hypocalcemia. Women in LMICs are significantly more likely to have suboptimal calcium intake and therefore, low serum calcium concentrations. According to the World Health Organization (WHO), chronic insufficient calcium intake before or during pregnancy is associated with a significantly increased likelihood of hypocalcemia in pregnancy. Factors that may increase the risk of hypocalcemia are hypoparathyroidism, pseudohypoparathyroidism, calcium disorders, actual Vitamin D deficiency and dependency, functional Vitamin D deficiency and dependency, medication effects, and severe hypomagnesemia which inhibits PTH response to hypocalcemia.


Some of the symptoms of hypocalcemia include twitching in the hands, face, and feet, numbness, tingling, depression, memory loss, scaly skin, changes in the nails, rough hair texture, cramps, seizures, and abnormal heartbeats.
Definitive diagnosis of hypocalcemia requires a blood test for calcium. Treatment may vary based on factors such as the underlying cause and the severity of the problem. A sudden drop in a person’s calcium level will likely need calcium infusion through an intravenous (IV) line. In milder cases, oral calcium supplements can do the job although they need a longer time. People suffering from low calcium should increase their exposure to sunlight to absorb more Vitamin D. One might also need to take magnesium for calcium metabolism.

Preventing calcium deficiency in the body is better than treating it. This can be done by including calcium-rich food like cheese, yogurt, and almonds in the diet, and adding supplements of Vitamin D and magnesium. For pregnant women, frequent monitoring of calcium levels every 3–4 weeks throughout pregnancy as well as within one week postpartum is important to ensure normal calcium levels in both mother and fetus. Monitoring should continue during lactation every 4–6 weeks, as well as during the weaning period to ensure the stability of maternal calcium levels.
(Author: Dr. Dibyendu Banerjee, Gynecologist, Obstetrician and Infertility Specialist)