Ten women were followed serially to determine the effect of stages of reproduction on calcium and bone metabolism. The study periods were nonpregnant nonlactating, the end of each trimester of gestation, 3 mo lactation, and postweaning. Comparisons were with nonpregnant nonlactating status for each individual. Fractional calcium absorption (P < 0.0001) and concentrations of 1,25-dihydroxyvitamin D (P < 0.01) were higher in the second and third trimesters. Total urinary calcium was higher during pregnancy and lower postweaning. Parathyroid hormone (PTH) concentrations were higher only postweaning (P < 0.01). Markers of bone turnover increased at the third trimester and during lactation: serum tartrate resistant acid phosphatase and bone specific alkaline phosphatase, and urinary deoxypyridinoline (P < 0.01). Serum procollagen I carboxypeptides increased only in the third trimester (P < 0.01). Bone mineral density by single-photon absorptiometry did not differ by period. We conclude that absorption and urinary excretion of calcium increase during pregnancy whereas bone turnover increases during late pregnancy and lactation; only renal changes consistent with an increase in PTH were seen postweaning.
This pilot study reports parathyroid hormone-related protein (PTHrP) in milk from 14 women (placebo = 6, calcium = 8) over the duration of lactation. Milk samples collected 0 to 250 days postpartum were assayed for PTHrP by a two-site immunoradiometric assay. PTHrP concentrations were significantly lower in colostrum 0-4 days postpartum (5,080 +/- 1575 pmol/L) than at 7-60 days postpartum (11,863 +/- 1528-14,213 +/- 1574 pmol/L); concentrations did not differ between calcium and placebo groups. A suggestive diurnal variation was seen in two women who collected milk samples over 48 continuous hours. Confounding factors related to milk synthesis and milk sampling contribute to variability in PTHrP concentrations.
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