Objectives: To evaluate calcium-regulating hormones and parathyroid hormone-related peptide (PTHrP) in normal human pregnancy and postpartum in women not deficient in vitamin D. Design: A prospective longitudinal study was conducted in pregnant Saudi women during the course of pregnancy (n ¼ 40), at term and 6 weeks postpartum (n ¼ 18). Maternal concentrations of serum calcidiol and calcitriol were determined, together with those of serum intact-parathyroid hormone (PTH), PTHrP, calcitonin, osteocalcin, human placental lactogen (hPL), prolactin, vitamin D binding protein, alkaline phosphatase, calcium, phosphate and magnesium. A group of non-pregnant women (n ¼ 280) were included for comparative purposes. Results: The calcidiol concentrations decreased (meanϮS.D.) significantly from 54Ϯ10 nmol/l in the first trimester to 33Ϯ8 nmol/l in the third trimester (P < 0:001) and remained decreased at term and postpartum (both P < 0:001). The calcitriol concentration increased through pregnancy, from 69Ϯ17 pmol/l in the first trimester to 333Ϯ83 pmol/l at term (P < 0:001). Intact-PTH concentrations increased from 1.31Ϯ0.25 pmol/l in the first trimester to 2.26Ϯ0.39 pmol/l in the second trimester, but then declined to values of the first trimester and increased significantly postpartum (4.02Ϯ0.36 pmol/l) (P < 0:001). PTHrP concentration increased through pregnancy from 0.81Ϯ0.12 pmol/l in the first trimester to 2.01Ϯ0.22 pmol/l at term and continued its increase postpartum (2.63Ϯ0.15 pmol/l) (P < 0:001). Significant positive correlations were evident between PTHrP and alkaline phosphatase up to term (r ¼ 0:051, P < 0:001) and between PTHrP and calcitriol (r ¼ 0:46, P < 0:001), osteocalcin (r ¼ 0:23, P < 0:05) and prolactin (r ¼ 0:41, P < 0:05) during pregnancy. Osteocalcin started to increase from 0.13Ϯ0.01 nmol/l in the second trimester, through pregnancy and postpartum (P < 0:001). Calcitonin was increased more than twofold by the second trimester compared with the first trimester (P < 0:001) and subsequently decreased (P < 0:001). Prolactin concentrations were significantly greater in the second (6724Ϯ1459 pmol/l) and third (8394Ϯ2086 pmol/l) trimesters compared with values before pregnancy (P < 0:001). hPL increased throughout the course of pregnancy, reaching a maximum at term (7.61Ϯ2.57 mIU/ml). There was no direct correlation between serum calcitriol concentrations during pregnancy and serum prolactin (r ¼ ¹0:12, P < 0:19) or serum hPL (r ¼ 0:17, P < 0:21). Significant changes were observed in the serum concentrations of calcium and phosphate, but not in that of magnesium, during the course of pregnancy; calcium concentrations showed a maximal decrease at term. Conclusions: Changes in serum PTHrP during the course of pregnancy, at term and postpartum have been demonstrated, suggesting that the placenta (during pregnancy) and mammary glands (postpartum) are the main sources of PTHrP. No support for the concept of 'physiological hyperparathyroidism' of pregnancy could be demonstrated in the present work. The ...

The reference values of bone mineral density (BMD) were determined in healthy Saudis of both sexes and compared with US / northern European and other reference data. BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femur including subregions: trochanter, Ward's triangle, and neck, in 1,980 randomly selected Saudis (age range 20-79 years; 915 males and 1,065 females) living in the Jeddah area. Age-related changes in BMD were similar to those described in US / northern European and Lebanese reference data. Decreases in BMD of males were evident (% per year): 0.3-0.8 (lumbar spine), 0.2-0.4 (femoral trochanter), 0.2-1.4 (Ward's triangle), and 0.2-0.7 (femoral neck). Also, decreases in BMD of females were observed (% per year): 0.8-0.9 (lumbar spine), 0.7-0.9 (Ward's triangle), and 0.3-0.7 (femoral neck). Using stepwise multiple regressions that included both body weight and height, the former had 2-4 times greater effect on BMD than the latter. Using the mean BMD of the <35-year-old group the T-score values were calculated for Saudis. The prevalence of osteoporosis in Saudis (50-79 years) at the lumbar spine using the manufacturer's vs Saudi reference data was 38.3-47.7% vs 30.5-49.6 (P<0.000), respectively. Similarly, based on BMD of total femur, the prevalence of osteoporosis using the manufacturer's vs Saudi reference data was 6.3-7.8% vs 1.2-4.7% (P<0.000), respectively. Saudis (> or =50 years) in the lowest quartile of body weight exhibited higher prevalence of osteoporosis (25.6% in females and 15.5% in males) as compared to that of the highest quartiles (0.0% in females and 0.8% in males). The present study underscores the importance of using population-specific reference values for BMD measurements to avoid overdiagnosis and/or underdiagnosis of osteoporosis.

The relationship between glycated haemoglobin (an index of long-term diabetic control), fructosamine (an index of intermediate-term diabetic control), and serum IgA, IgG, and IgM was studied in 110 diabetic patients (41 Type 1 and 69 Type 2) and compared with 111 healthy non-diabetic subjects. Significant increases in serum IgA (by 82.7%, p < 0.001) and IgG (by 35.2%, p < 0.001) concentrations were observed whereas the concentration of IgM was significantly decreased (by 46.7%, p < 0.001) in diabetic patients compared with non-diabetic subjects. Using Spearman's rank correlations, IgA correlated with fructosamine (r = 0.77, p < 0.001), HbA1 (r = 0.76, p < 0.001), and albumin (r = -0.58, p < 0.001) for the entire population sample but only fructosamine (r = 0.19, p < 0.05) and HbA1 (r = 0.28, p < 0.001) correlated with IgA in diabetic patients, respectively. It is concluded that abnormal levels of IgA, IgG, and IgM are very common in diabetic patients in whom serum IgA concentrations are influenced by the degree of glycaemic control. Whether changes in IgA and other immunoglobulins are implicated in the pathogenesis of diabetic complications (such as susceptibility to infection) deserve further study.

Objectives:Tocompare maternal and neonatal complications in twin and triplet gestations at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.Methods:Retrospective medical records of 165 women with 144 twin and 21 triplet pregnancies from 2004 to 2011 were analyzed. Comparisons were carried out for maternal complications, gestational age at birth, neonatal birth weight, and neonatal intensive care admission.Results:Most common complications were preterm birth (49%), gestational diabetes mellitus (13.3%), and premature rupture of membrane (4.8%). All triplet pregnancies and 42% twin pregnancies terminated in preterm birth. Gestational length was longer (p<0.001) in twin births (36.0 ± 3.05 weeks) than for triplet births (32 ± 3.81 weeks). Rates for in vitro fertilization, ovulation induction, and cesareans were higher in women with triplets than in those with twins. Neonatal intensive care unit (NICU) admission was higher (p<0.001) for triplets (76.2%) than for twins (23.6%). The mean weight of twins was 2333.83 ± 558.69 grams and triplets was 1553.41 ± 569.73 grams. Hyaline membrane disease, neonatal jaundice, and neonatal sepsis were most common neonatal complications.Conclusion:Neonates from triplet pregnancies were preterm, had low birth weight and needed more often NICU admission in comparison to those from twin pregnancies.