women at young ages, as one would expect; there was also a somewhat higher proportion aged over 70 compared with 30-69 years. There has been a tendency for the proportion of women having very large families to decrease, and this was again reflected by an increased proportion of women in the high parous group at older ages. The data were originally examined for those having three, four, or five or more children; it was particularly in those having five or more children that the proportion at the older age groups was higher.One crucial point about this study is whether it was appropriate to assume that the relative risk of breast cancer is constant within parity subgroups over a wide age range; unfortunately this issue has not been adequately quantified. The nearest set of data most relevant to this was a study by Miller et al,6 who examined the parity for women in three provinces in Canada registered with all forms of malignant disease in 1969-71. By special inquiry parity for these women was obtained and compared with the census data. The relative risk of breast cancer in women having four or more children compared with nulliparae was similar in the age ranges 20-44, 45-54, and 55 years and over.Applying England and Wales incidence rates to the age distribution of women by parity enabled the average age at diagnosis to be estimated; the results approximate to the findings of Woods et al.1 It was suggested that their result was a reflection of variation in the age distribution of women by parity, rather than any particular influence of parity on accelerating or slowing the date of presentation of breast cancer. The increased concentrations of 1,25-(OH)2D enable the increased physiological need for calcium to be met by enhancing intestinal absorption of this element. The simultaneous rise in calcitonin opposes the bone-resorbing activities of 1,25-(OH)2D, thereby protecting the integrity of the maternal skeleton. Maternal calcium homoeostasis is thus maintained yet the requirements of the fetus are fulfilled.
IntroductionThe increased physiological requirement for calcium during pregnancy presents a major challenge to maternal calcium homoeostasis. The needs of the growing fetus have to be supplied but at the same time maternal bone and plasma calcium concentrations have to be maintained. If both these conditions are to be fulfilled changes in the secretion of calciumregulating hormones must occur.To determine the gestational changes in the secretion of calcium-regulating hormones we measured the plasma concentrations of calcitonin, parathyroid hormone, and the vitamin D metabolites 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH),D) on four occasions during entirely normal pregnancies in a cross-sectional study. Previous studies either have been conducted only at the end of pregnancy or have been incomplete as important hormones have not been measured and details of the obstetric outcome have invariably been lacking. Thus the full interrelations of the calciumregulating hormones in normal pregn...