Which of the following provide is useful to decrease risk of PIH?

NORCET 3 - 2022 (Shift-1)

Obstetrics & Gynaecology

Medium

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Calcium supplementation is a proven strategy to reduce the risk of pregnancy-induced hypertension (PIH) and preeclampsia.
The benefit is most significant in women who have low dietary calcium intake, a common scenario in many populations.
The proposed mechanism involves calcium's role in regulating vascular smooth muscle tone, leading to vasodilation and lower blood pressure.
Although calcium is a mineral, not a vitamin, it is the only option listed that is recommended for the prevention of PIH.

Option A: Large randomized clinical trials, including the Combined Antioxidant and Preeclampsia Prediction Studies (CAPPS), have shown that supplementation with the antioxidant Vitamin C (Ascorbic acid) does not reduce the rates of preeclampsia.
Option B: Similar to Vitamin C, studies have failed to demonstrate a benefit of Vitamin E supplementation in preventing PIH or preeclampsia. It is not recommended for this purpose.
Option D: The primary and well-established role of folic acid supplementation in the periconceptional period is the prevention of neural tube defects (like spina bifida) in the fetus. Clinical trials have shown it does not prevent PIH.

Visual 1: Infographic: A comparison table showing the roles of Calcium, Vitamin C, Vitamin E, and Folic Acid in pregnancy, highlighting their effectiveness (or lack thereof) for PIH prevention.
Visual 2: Flowchart: Illustrating the proposed mechanism of how low calcium levels contribute to increased blood pressure and how supplementation counteracts this.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Micronutrient supplementation for the prevention of Pregnancy-Induced Hypertension (PIH) as background academic context rather than a clinical decision trigger.
Nurses play a key role in educating antenatal patients about the importance of calcium, especially in regions with low dietary intake, as a low-cost, effective public health intervention to reduce preeclampsia risk.
It is crucial for nurses to advise patients to take calcium supplements at least 2 hours apart from iron supplements, as calcium can significantly impair the absorption of iron, potentially leading to or worsening anemia.
Patient education should include dietary sources of calcium (dairy products, ragi, leafy greens) alongside supplementation instructions.

How to Approach the Question

First, identify the core of the question: which listed substance helps prevent Pregnancy-Induced Hypertension (PIH).
Recognize that the question uses the word 'vitamin,' but one option, 'Calcium,' is a mineral. This is a common type of imperfection in test questions; evaluate all options based on the clinical goal (PIH prevention), not just the strict definition of 'vitamin'.
Recall the established roles of each supplement in pregnancy.
Eliminate Folic acid, as its primary role is preventing neural tube defects.
Eliminate Ascorbic acid (Vitamin C) and Vitamin E, as large trials have shown these antioxidants are ineffective for preventing PIH.
This leaves Calcium. Recall that calcium supplementation is a key WHO recommendation to reduce PIH/preeclampsia risk, especially in women with deficient diets. Therefore, it is the best available answer.

Concept Tested & Keywords

Concept Tested: Micronutrient supplementation for the prevention of Pregnancy-Induced Hypertension (PIH)
Stem keywords: vitamin, decrease risk, PIH, pregnancy-induced hypertension
Lead-in keywords: Which
Negative lead-in flag: false

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