Calcium Deficiency and Bone Health During Pregnancy

Calcium is the most abundant mineral in the human body and is essential for building and maintaining strong bones and teeth. During pregnancy, your baby requires a substantial amount of calcium to develop its skeleton, particularly during the third trimester when bone mineralisation accelerates rapidly. If your dietary calcium intake is insufficient, your body will draw calcium from your own bones to meet the baby's needs.

Calcium deficiency, or hypocalcemia, occurs when blood calcium levels fall below the normal range. In many parts of India, including Visakhapatnam, studies suggest that a significant proportion of pregnant women do not meet the recommended daily calcium intake of 1,000 to 1,200 milligrams. This shortfall is often due to low dairy consumption, limited awareness of non-dairy calcium sources, and dietary habits that do not prioritise calcium-rich foods.

The consequences of calcium deficiency extend beyond bone health. Calcium is also involved in muscle contraction, nerve transmission, blood clotting, and the regulation of blood pressure. Addressing calcium status during pregnancy is therefore important for multiple aspects of maternal and fetal health.

Inadequate dietary intake is the leading cause of calcium deficiency during pregnancy. Women who consume limited amounts of dairy products, either due to lactose intolerance, dietary preferences, or economic constraints, are at heightened risk. In many Indian households, women may prioritise feeding other family members and consume smaller portions themselves, further reducing their intake.

Vitamin D deficiency, which is widespread in India, directly impairs calcium absorption in the intestine. Even women who consume adequate calcium may develop deficiency if their vitamin D levels are too low to facilitate proper absorption. High intake of phytates (found in whole grains and legumes) and oxalates (found in spinach and certain vegetables) can also bind calcium and reduce its bioavailability.

Women under 25 years of age are still building their own peak bone mass, making them more vulnerable to calcium depletion during pregnancy. Those with closely spaced pregnancies, a history of fractures, or conditions affecting calcium metabolism are also at elevated risk and should pay particular attention to their calcium status.

Mild calcium deficiency may not cause obvious symptoms, making it a silent concern during pregnancy. As levels drop, you may experience numbness or tingling in the fingers and toes, muscle cramps (particularly in the calves and feet, often at night), and generalised muscle stiffness. These symptoms are frequently dismissed as routine pregnancy aches.

More significant deficiency can lead to dental problems, including weakening of tooth enamel, brittle nails, and dry skin. In severe cases, hypocalcemia can cause confusion, memory difficulties, and an irregular heartbeat. If you notice persistent cramps, spasms, or unusual sensations in your extremities, discuss these with your healthcare provider promptly.

For the mother, chronic calcium deficiency during pregnancy and lactation can lead to reduced bone mineral density, increasing the risk of osteoporosis later in life. Research has also established a link between low calcium intake and the development of pregnancy-induced hypertension and preeclampsia. The WHO recommends calcium supplementation for pregnant women in populations with low dietary intake to help reduce the risk of these hypertensive disorders.

For the developing baby, calcium is indispensable for skeletal formation, dental development, and the proper functioning of the heart, muscles, and nervous system. Severe maternal calcium deficiency can result in poor fetal bone mineralisation, low birth weight, and in rare cases, neonatal hypocalcemia presenting with jitteriness or seizures in the newborn.

Meeting calcium requirements during pregnancy is an investment in the long-term health of both mother and child. Even modest improvements in calcium intake can have meaningful benefits for blood pressure regulation and bone health.

Dairy products remain the most bioavailable sources of calcium. Milk, curd (yoghurt), paneer, and buttermilk are staples in many Indian diets and can significantly contribute to daily calcium needs. A glass of milk provides approximately 300 mg of calcium, and a serving of curd or paneer offers similar amounts. For those who are lactose intolerant, curd and buttermilk are often better tolerated due to partial lactose digestion by bacterial cultures.

Non-dairy sources of calcium are equally important, especially for women who avoid dairy. Ragi (finger millet) is one of the richest plant-based calcium sources available in India and can be prepared as porridge, dosa, or roti. Sesame seeds (til), dried figs (anjeer), almonds, and green leafy vegetables like amaranth and drumstick leaves are also excellent choices. Small dried fish with edible bones, common in Visakhapatnam's coastal cuisine, provide highly absorbable calcium.

Calcium supplements may be necessary if dietary intake is consistently low. Your doctor may prescribe calcium carbonate or calcium citrate, often combined with vitamin D to enhance absorption. Take calcium supplements with meals for better absorption, and space them apart from iron supplements, as calcium can interfere with iron uptake when taken simultaneously.

Discuss your calcium intake with your obstetrician during prenatal visits. If you have risk factors such as low dairy consumption, vitamin D deficiency, a history of preeclampsia, or a family history of osteoporosis, your doctor may recommend a serum calcium test and targeted supplementation. Hospitals in Visakhapatnam routinely assess calcium levels as part of comprehensive prenatal care.

Seek prompt medical attention if you experience severe muscle cramps, numbness or tingling that does not resolve, irregular heartbeat, or signs of preeclampsia such as sudden swelling, severe headaches, or visual disturbances. Your healthcare provider can tailor a calcium supplementation plan that accounts for your dietary habits, vitamin D status, and overall pregnancy health. Do not exceed the recommended dosage without medical advice, as excessive calcium can lead to kidney stones and impaired absorption of other essential minerals.