The Chemical Composition of the Human Fetus

Givens, Maurice H.; Macy, Icie G.

doi:10.1016/s0021-9258(18)50207-6

Cited by 139 publications

(14 citation statements)

References 7 publications

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“…The endochondral skeleton of the embryo gradually mineralizes with approximately 80% of the mineral accruing in the third trimester (42,43). The placenta is essential for the delivery of essential minerals namely calcium, phosphate and magnesium to the fetus from the maternal circulation.…”

Section: What Is the Impact Of Maternal Hypoparathyroidism On The Dev...mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management

Khan

Clarke

Rejnmark

et al. 2019

European Journal of Endocrinology

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Purpose Review calcium homeostasis in pregnancy and provide evidence-based best practice recommendations for the management of hypoparathyroidism in pregnancy. Methods We searched MEDLINE, EMBASE and Cochrane databases from January 2000 to April 1, 2018. A total of 65 articles were included in the final review. Conclusions During pregnancy, calcitriol levels increase by two- to—three-fold resulting in enhanced intestinal calcium absorption. The renal filtered calcium load increases leading to hypercalciuria. PTHrP production by the placenta and breasts increases by three-fold, and this may lower the doses of calcium and calcitriol required during pregnancy in mothers with hypoparathyroidism. The literature however describes a wide variation in the required doses of calcium and calcitriol during pregnancy in hypoparathyroid mothers, with some women requiring higher doses of calcitriol, whereas others require lower doses. Close monitoring is necessary as hypercalcemia in the mother may suppress the fetal parathyroid gland development. Also hypocalcemia in the mother is harmful as it may result in secondary hyperparathyroidism in the fetus. This may be associated with demineralization of the fetal skeleton and the development of intrauterine fractures. Inadequate treatment of hypoparathyroidism may also result in uterine contractions and an increased risk of miscarriage. Treatment targets during pregnancy are to maintain a low normal serum calcium. Calcium, calcitriol and vitamin D supplements are safe during pregnancy. Close monitoring of the mother with a multidisciplinary team is advised for optimal care. If calcium homeostasis is well controlled during pregnancy, most women with hypoparathyroidism have an uncomplicated pregnancy and give birth to healthy babies.

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Section: What Is the Impact Of Maternal Hypoparathyroidism On The Dev...mentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management

Khan

Clarke

Rejnmark

et al. 2019

European Journal of Endocrinology

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“…The MAVIDOS trial also offered the opportunity to study the impact of gestational vitamin D supplementation on the maternal skeleton, as maternal calcium homeostasis adapts to meet the calcium demands of the developing foetus, 66–68 though its response to vitamin D supplementation is not well defined. Biochemical markers of bone turnover offer a noninvasive method of monitoring changes in bone resorption or formation during pregnancy; 69 in the MAVIDOS trial maternal urinary C-terminal telopeptide of type I collagen (CTX) was measured at 14 weeks and 34 weeks gestation.…”

Section: Key Findings Of the Mavidos Trialmentioning

confidence: 99%

The importance of maternal pregnancy vitamin D for offspring bone health: learnings from the MAVIDOS trial

Moon

Curtis

Woolford

et al. 2021

Therapeutic Advances in Musculoskeletal

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Optimisation of skeletal mineralisation in childhood is important to reduce childhood fracture and the long-term risk of osteoporosis and fracture in later life. One approach to achieving this is antenatal vitamin D supplementation. The Maternal Vitamin D Osteoporosis Study is a randomised placebo-controlled trial, the aim of which was to assess the effect of antenatal vitamin D supplementation (1000 IU/day cholecalciferol) on offspring bone mass at birth. The study has since extended the follow up into childhood and diversified to assess demographic, lifestyle and genetic factors that determine the biochemical response to antenatal vitamin D supplementation, and to understand the mechanisms underpinning the effects of vitamin D supplementation on offspring bone development, including epigenetics. The demonstration of positive effects of maternal pregnancy vitamin D supplementation on offspring bone development and the delineation of underlying biological mechanisms inform clinical care and future public-health policies.

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“…(55,56,(59)(60)(61)(62) Inadequate calcium intake in the first trimester may impact skeletal development in the last trimester, the period of greatest bone accrual in the developing fetal skeleton (80%). (67,68) Further, maternal hypercalcemia can result in fetal parathyroid gland suppression and hypocalcemia in the neonate. (69) The risk of maternal hypercalcemia is highest shortly before and after giving birth, probably due to increased synthesis of PTHrP during this period.…”

Section: Hypopt In Pregnancymentioning

confidence: 99%

Management of Hypoparathyroidism

Khan

Guyatt

Ali

et al. 2020

Journal of Bone and Mineral Research

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Hypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta‐analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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The Chemical Composition of the Human Fetus

Cited by 139 publications

References 7 publications

MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management

MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management

The importance of maternal pregnancy vitamin D for offspring bone health: learnings from the MAVIDOS trial

Management of Hypoparathyroidism

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