A Detailed Assessment of Alterations in Bone Turnover, Calcium Homeostasis, and Bone Density in Normal Pregnancy

Black, Alison; Topping, Joanne; Durham, B; Farquharson, Roy G.; Fraser, William D.

doi:10.1359/jbmr.2000.15.3.557

Cited by 261 publications

(130 citation statements)

References 31 publications

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“…Serum inorganic phosphate level found to the almost similar during pregnancy in different trimester. The lower level of serum calcium at third trimester is in agreement with others [17][18][19][20][21] . It is argued that increased need to the growing fetus and at the same time dilution of the molecule owing to increased extracellular fluid may explain the lower level of calcium level in third trimester.…”

Section: Resultssupporting

confidence: 92%

Serum calcium and phosphate level in normal pregnant women

Sultana

Begum²,

Akhter

et al. 2012

Bangladesh J Med Sci

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Abstract:Background and Objectives: Pregnancy is the physiological process in which progressive anatomical, physiological and biochemical changes occur. Secretion of different hormones during pregnancy is responsible for maternal adaptation to the increasing demand of the growing fetus. The present study was aimed to evaluate serum calcium and phosphate status in normal pregnant women in different trimesters. Materials and Methods: A total number of 140 subjects, age range 20-40 (yrs) were recruited in the study which includes 100 normal pregnant women termed as study group (Group B) and 40 healthy women without pregnant (Group A), served as Control. Group B subjects were subdivided into Group B1 (n=12), Group B2 (n=30) and Group B3 (n=58) on the basis of duration of pregnancy-1st, 2nd and 3rd trimesters respectively. Calcium was measured by CPC (photometric method for Ca) and serum phosphate by colorimetric method. Statistical analysis was done using SPSS for Windows, Version 10. Unpaired Student's -'t' test performed to calculate statistical differences between groups. Results: Age (yrs) (mean±SD) and BMI of the pregnant women in different groups did not show statistical difference. Serum calcium (mean±SD) levels in the 1st (p=0.0001) and 2nd (p=0.02) trimester was significantly higher compared to the Controls. In 3rd the value was significantly lower (p=0.015) compared to the Controls and of 1st and 2nd trimesters (p=0.001). Serum phosphate (mean±SD) levels in three trimesters did not show statistical significant difference compared to the Controls and among the pregnancy groups. Conclusion: The data concluded that serum calcium level was lower during third trimester of the study subjects which may be explained by the fact of increased demand of the growing fetus and exposing the mother at risk of complications related to low serum calcium.

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Section: Resultssupporting

confidence: 92%

Serum calcium and phosphate level in normal pregnant women

Sultana

Begum²,

Akhter

et al. 2012

Bangladesh J Med Sci

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“…Owing to the difficulties in the performance of the assays used to measure PTHrp in pregnancy, there has been debate on whether the circulating levels of PTHrp increase (20,21) or remain unchanged (22). The complications with the accurate measurement of PTHrp start by the expression of three different isoforms by the human gene (23).…”

Section: Pth and Pthrpmentioning

confidence: 99%

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.

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“…Of the calciotropic hormones, PTH is reported to be either unchanged during pregnancy (67,109,144) or significantly decreased (13,39) . There is evidence to suggest that, following a nadir in early gestation, plasma PTH concentration increases during pregnancy relative to the first trimester (3,43,60) .…”

Section: Regulation Of Calcium Metabolism In Pregnancy and Lactationmentioning

confidence: 99%

Calcium economy in human pregnancy and lactation

et al. 2012

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Pregnancy and lactation are times of additional demand for Ca. Ca is transferred across the placenta for fetal skeletal mineralisation, and supplied to the mammary gland for secretion into breast milk. In theory, these additional maternal requirements could be met through mobilisation of Ca from the skeleton, increased intestinal Ca absorption efficiency, enhanced renal Ca retention or greater dietary Ca intake. The extent to which any or all of these apply, the underpinning biological mechanisms and the possible consequences for maternal and infant bone health in the short and long term are the focus of the present review. The complexities in the methodological aspects of interpreting the literature in this area are highlighted and the inter-individual variation in the response to pregnancy and lactation is reviewed. In summary, human pregnancy and lactation are associated with changes in Ca and bone metabolism that support the transfer of Ca between mother and child. The changes generally appear to be independent of maternal Ca supply in populations where Ca intakes are close to current recommendations. Evidence suggests that the processes are physiological in humans and that they provide sufficient Ca for fetal growth and breast-milk production, without relying on an increase in dietary Ca intake or compromising long-term maternal bone health. Further research is needed to determine the limitations of the maternal response to the Ca demands of pregnancy and lactation, especially among mothers with marginal and low dietary Ca intake, and to define vitamin D adequacy for reproductive women.

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A Detailed Assessment of Alterations in Bone Turnover, Calcium Homeostasis, and Bone Density in Normal Pregnancy

Cited by 261 publications

References 31 publications

Serum calcium and phosphate level in normal pregnant women

Serum calcium and phosphate level in normal pregnant women

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Calcium economy in human pregnancy and lactation

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