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Calcium lactate in pregnancy: What you need to know.

Calcium based antacids like calcium lactate are invaluable medications in pregnancy to the extent that almost no pregnant mother ever completes the pregnancy period without having a complaint that will eventually be curbed by these medications. However, not everyone knows about them and their enormous uses. If you are one of them, you’ve just clicked the right article. Let’s get started.

Calcium makes up 1 to 2% of total body mass, with 98% of it in the skeletal system. Calcium intake is of paramount importance when it comes to bone development and maintenance throughout life. It is vital during both pregnancy and lactation as there are a recognized transient reduced bone mineral density and increased rate of bone resorption during these periods. A foetus accumulates 25 to 30g of calcium over the course of the pregnancy. By 20 weeks gestation, a foetus amasses calcium at a rate of 50mg per day and 330mg per day by 35 weeks gestation. During lactation, 210mg per day is in breast milk. The Institute of Medicine recommends 1000mg per day of calcium for pregnant and lactating women aged 19 – 50 years, and 1300mg per day for those aged below 19 years. Heartburn and cramps are not uncommon symptoms during pregnancy with the later occurring early whilst the former late during pregnancy, both of which may need treatment at one point in time if lifestyle changes don’t cure them.

We recommend, however, that the minimum, only crucial medications be used during pregnancy and only used if benefits outweigh the risks. As the pregnancy grows, the ‘potential space’ initially occupied by the stomach is encroached on by the enlarging uterus but the cells producing hydrochloric acid as the ‘usual’ amounts don’t. It means that depending on what food you’ve eaten; a pregnant mother is likely to have acid refluxing into the oesophagus culminating in heartburn. To further illustrate this, in a study conducted on 607 pregnant women, 72% of them had experienced heartburn: its occurrence increased with gestational age.

The IUPAC name of calcium lactate is calcium 2-hydroxypropanoate. The calcium lactate acts as an antacid. It is an antidote for soluble fluoride ingestion and hydrofluoric acid and treatment of hypocalcaemia. How it becomes an invaluable drug in pregnancy is further emphasized in the next statements.

Antacids react with gastric acid to produce a salt, water and carbon dioxide as postulated in a simplified chemical reaction below.

CaCO3 + 2HCl ——> CaCl2 + H2O + CO2

The doses commonly used result in a PH of about 9. When dissolved in 30 to 40mls of water, 2g of calcium lactate will readily bring 100ml of hydrochloric acid to a pH above 6. The increase in gastric pH diminishes the activity of pepsin in the gastric secretion. The calcium lactate is well absorbed when taken with food. It contains the highest amount of elemental calcium, containing twice as much essential calcium as calcium citrate (another antacid used in the treatment of heartburn), hence fewer tablets when compared to calcium citrate for either heartburn relief or hypocalcaemia. Antacids are the preferred first-line treatment for heartburn in pregnancy in which solace comes through acid reduction. Calcium based antacids like calcium lactate improve oesophageal sphincter pressure for more than 30 minutes as well as improving on the peristalsis and acid clearance.

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When pregnant women take calcium lactate for either muscle cramps or heartburn, it serves two benefits. To treat her symptoms as well as add more calcium to her ever-demanding body such that enough calcium is available for the growing foetus. It, however, doesn’t replace good feeding. Dairy products and leafy greens are credible sources of dietary calcium. All pregnant mothers should have it on their menu.

In accord with FDA, calcium lactate is a category C drug, used with caution when benefits outweigh the risks. The milk-alkali syndrome has usually occurred in patients taking large doses. It entails high calcium levels in the blood, alkalosis with impaired kidney function. Patients with renal impairment or dehydration and electrolyte imbalance are predisposed. High doses or prolonged use may lead to gastric hypersecretion and acid rebound.

If you are not expecting, it’s worth remembering that you cannot take calcium lactate if you have any of the conditions below.

  • Concomitant digoxin therapy
  • Renal calculi and nephrolithiasis
  • Zollinger- Ellison syndrome
  • Hypercalcemia and hyperparathyroidism

In a nutshell, Calcium lactate remains an invaluable source of relief in pregnancy-associated acid reflux and as a calcium supplement during pregnancy.

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MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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