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Calcium metabolism in pregnancy

Published online by Cambridge University Press:  10 October 2008

Barry NJ Walters*
Affiliation:
Physician in Obstetric Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia
*
Dr BNJ Walters, Consultant Physician, Suite 6, 400 Barker Road, Subiaco 6008, Western Australia, Australia.

Extract

During pregnancy and lactation there are many changes in maternal calcium physiology which maintain homeostasis in the face of greatly altered calcium balance. In the course of fetal growth and development, 30g of calcium is incorporated into the fetus by term, an amount derived wholly from the maternal system. Most of this accumulates in the latter half of pregnancy, representing a net transfer of 200mg calcium/day (5mmoles). The fact that this is not achieved at the expense of the maternal skeleton is testimony to the conservative and protective adjustments that are seen in calcium metabolism in pregnancy. Furthermore, the changes must persist both in the puerperium and later when lactation presents a source of continuing maternal calcium loss to the suckling infant. The calcium content of human breast milk s i 6–9mmols calcium/l, two to three times the maternal serum level. In the course of one week a normal breast-fed at term infant takes two to three litres of milk, containing 10–30mmols of calcium. The maternal daily calcium intake recommended by the World Health Organization s i 1.25g (30mmol) of which only 25% is absorbed. Thus calcium loss from mother to baby is significant and may not be replaced by diet in many parts of the world.

Type
Articles
Copyright
Copyright © Cambridge University Press 1989

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References

1 Cundy, T, Kanis, JA. Calcium homeostasis during pregnancy Br Med J 1981; 283: 562–63.CrossRefGoogle ScholarPubMed
2 Feeley, RM, Eitenmiller, RR, Jones, JB, Barnhart, H. Calcium, phosphorus, and magnesium contents of human milk during early lactation. Journal ofPediatric Gastroenterology and Nutrition 1983; 2: 262–67.Google ScholarPubMed
3 Pitkin, RM, Reynolds, WA, Williams, GA, Haryis, GK. Calcium metabolism in normal pregnancy: A longitudinal study. Am J Obstet Gynecol 1979; 133: 781–91.CrossRefGoogle ScholarPubMed
4 Fogh-Anderson, N, Schultz-Larsen, P. Free calcium ion concentration in pregnancy. Acta Obstet Gynecol Scand 1981; 60: 309–12.CrossRefGoogle Scholar
5 Martinez, ME, Sanchez, C, Salinas, M et al. Ionic calcium levels during pregnancy, at delivery and in the first hours of life. Scand J Clin Lab Invest 1986; 46: 2730.CrossRefGoogle ScholarPubMed
6 Gertner, JM, Coustan, DR, Kliger, AS et al. Pregnancy as state of physiologic absorptive hypercalciuria. Am J Med 1986; 81: 451–56.CrossRefGoogle ScholarPubMed
7 Newman, RL. Serum electrolytes in pregnancy, parturition and puerperium. Obstet Gynecol 1957; 10: 51–5.Google ScholarPubMed
8 Shenolikar, IS. Absorption of dietary calcium in pregnancy. Am J Clin Nutr 1970; 23: 6367.CrossRefGoogle ScholarPubMed
9 Heaney, RP, Skillman, TG. Calcium metabolism in normal human pregnancy. J Clin Endocr 1971; 33: 661–70.CrossRefGoogle ScholarPubMed
10 Duggin, GG, Lyneham, RC, Dale, NE, Evans, RA, Tiller, DJ. Calcium balance in pregnancy. Lancet 1974; 2: 926.CrossRefGoogle ScholarPubMed
11 Purdie, DW, Aaron, JE, Selby, PL. Bone histology and mineral homeostasis in human pregnancy. BrJ Obstet Gynaecol 1988; 95: 849–54.CrossRefGoogle ScholarPubMed
12 Kumar, R, Cohen, WR, Silva, P, Epstein, FH. Elevated 1,25 Dihydroxyvitamin D plasma levels in normal human pregnancy and lactation. J Clin Invest 1979; 63: 342–44.CrossRefGoogle Scholar
13 Whitehead, M, Lane, G, Young, O, et al. Interrelations of calcium regulating hormones during normal pregnancy. BrMedJ 1981; 283: 1012.Google ScholarPubMed
14 Lund, B, Seines, A. Plasma 1,25 dihydroxyvitamin D levels in pregnancy and lactation. Acta Endocr 1979; 92: 330–35.Google Scholar
15 Weisman, Y, Harell, A, Edelstein, S et al. 1,25-dihydroxyvitamin D3 and 24, 25 dihydroxyvitamin D3 in vitro synthesis. Nature 1979; 281: 317–19.CrossRefGoogle Scholar
16 Whitsett, JA, Tsang, RC. Calcium uptake and binding by membrane fractions of human placenta: ATP-dependent calcium accumulation. PediatRes 1980: 14: 769–75.Google ScholarPubMed
17 Spanos, E, Pike, JW, Haussler, MR et al. Circulating 1-alpha, 25 dihydroxyvitamin D in the chicken: enhancement by injection of prolactin and during egg laying. Life Sciences 1976; 19: 1751–56.CrossRefGoogle Scholar
18 Spanos, E, Barrett, D, Maclntyre, I et al. Effect of growth hormone on vitamin D metabolism. Nature 1978; 273: 2420–23.CrossRefGoogle ScholarPubMed
19 Bouillon, R, Van Assche, FA, Van Baelen, H et al. Influence of the vitamin D binding protein on the serum concentration of 1,25 dihydroxyvitamin D3. J Clin Invest 1981; 67: 589–96.CrossRefGoogle Scholar
20 Dent, CE, Gupta, MM. Plasma 25-hydroxyvitamin D levels during pregnancy in Caucasians and in vegetarian and non-vegetar ian Asians. Lancet 1975; ii: 1057–60.CrossRefGoogle Scholar
21 MacLennan, WJ, Hamilton, JC, Darmady, JM. The effects of season and stage of pregnancy on plasma 25-hydroxyvitamin D concentrations in pregnant women. Postgrad Med J 1980; 56: 7579.CrossRefGoogle Scholar
22 Kokkonen, J, Koivisto, M, Kirkinen, P. Seasonal variation in serum-25-OH-D3 in mothers and newborn infants in Northern Finland. Acta PaediatScand 1983; 72: 9396.CrossRefGoogle ScholarPubMed
23 Hillman, LS, Haddad, JG. Perinatal vitamin D metabolism. Ill: factors influencing late gestation human serum 25-hydroxyvitamin D. Am J Obstet Gynecol 1976; 125: 196200.CrossRefGoogle Scholar
24 Serenius, F, Elidrissy, ATH, Dandona, P. Vitamin D nutrition in pregnant women at term and in newly born babies in Saudi Arabia. J Clin Path 1984; 37: 444–47.CrossRefGoogle ScholarPubMed
25 Cushard, WG, Creditor, S, Canterbury, JM, Reiss, E. Physiologic hyperthyroidism in pregnancy. J Clin Endocr Metab 1972; 34: 767–71.CrossRefGoogle Scholar
26 Reitz, RE, Daane, TA, Woods, JR, Weinstein, RL. Calcium, magnesium, phosphorus and parathyroid hormone interrelationships in pregnancy and newborn infants. Obstet Gynecol 1977; 50: 701.Google ScholarPubMed
27 Allgrove, J, Adami, S, Manning, RM, O'Riordan, JLH. Cytochemical bioassay of parathyroid hormone in maternal and cord blood. Arch Dis Childh 1985; 60: 110–15.CrossRefGoogle ScholarPubMed
28 Okonofua, F, Menon, RK, Houlder, S et al. Calcium, vitamin D and parathyroid hormone relationships in pregnant Caucasian and Asian women and their neonates. Ann Clin Biochem 1987; 24: 2228.CrossRefGoogle ScholarPubMed
29 Markestad, T, Ulstein, M, Bassoe, HH, Aksnes, L, Aarskog, D. Vitamin D metabolism in normal and hypoparathyroidism pregnancy and lactation. Case report. BrJ Obstet Gynaecol 1983; 90: 971–76.CrossRefGoogle ScholarPubMed
30 Reddy, GS, Norman, AW, Willis, DM et al. Regulation of vitamin D metabolism in normal human pregnancy. J Clin Endocr Metab 1983; 56: 363–70.CrossRefGoogle ScholarPubMed
31 Sgambato, S, Passariello, N, Buoninconti, R et al. Plasma calcitonin variations in normal women and in women with family history of diabetes during pregnancy. Diabetes and Metabolism 1986; 12: 297301.Google ScholarPubMed
32 Bogert, LJ, Plass, ED. Placental transmission. 1. The calcium and magnesium content of fetal and maternal blood serum. J Biol Chem 1923; 56: 297307.CrossRefGoogle Scholar
33 Moniz, CF, Nicolaides, KH, Bamforth, FJ, Rodeck, CH. Normal reference ranges for biochemical substances relating to renal, hepatic, and bone function in fetal and maternal plasma throughout pregnancy. J Clin Path 1985; 38: 468–72.CrossRefGoogle ScholarPubMed
34 Northrop, G, Misenheimer, HR, Becker, FO. Failure of parathyroid hormone to cross the nonhuman primate placenta. Am J Obstet Gynecol 1977; 129: 449–53.CrossRefGoogle ScholarPubMed
35 Moniz, CF, Nicolaides, KH, Tzannatos, C, Rodeck, CH. Calcium homeostasis in second trimester fetuses. J Clin Path 1986; 39: 838–41.CrossRefGoogle ScholarPubMed
36 Care, AD, Caple, IW, Abbas, SK, Pickard, DW. The effect of fetal thyroparathyroidectomy on the transport of calcium across the ovine placenta to the fetus. Placenta 1986; 7: 417–24.CrossRefGoogle ScholarPubMed
37 Delvin, EE, Salle, BL, Glorieux, FH et al. Vitamin D supplementation during pregnancy: effect on neonatal calcium homeostasis. J Pediat 1986; 109: 328–34.CrossRefGoogle ScholarPubMed
38 Steichen, JJ, Tsang, RC, Gratton, TL et al. Vitamin D homeostasis in the perinatal period. New Engl J Med 1980; 302: 315–19.CrossRefGoogle ScholarPubMed
39 Better, O, Levi, J, Greif, E et al. Prolonged neonatal parathyroid suppression: a sequel to asymptomatic maternal hyperparathyroidism. Arch Surg 1973; 106: 722–24.CrossRefGoogle ScholarPubMed
40 Gould, CS, O'Malley, BP, MacVicar, J. Endocrine hyperemesis-the need for a high index of clinical suspicion. J Obstet Gynecol 1984; 4: 191–92.Google Scholar
41 Thomason, JL, Sampson, MB, Farb, HF, Spellacy, WN. Pregnancy complicated by concurrent primary hyperparathyroidism and pancreatitis. Obstet Gynaecol 1981; 57: 34S36S.Google ScholarPubMed
42 Clark, D, Seeds, JW, Cefalo, RC. Hyperparathyroid crisis and pregnancy. Amer J Obstet Gynecol 1981; 140: 840–42.CrossRefGoogle ScholarPubMed
43 Wilson, DT, Martin, T, Christensen, R et al. Hyperparathyroidism in pregnancy: case report and review of the literature. Canad Med Ass J 1983; 129: 986–89.Google ScholarPubMed
44 Shangold, MM, Dor, N, Welt, SI et al. Hyperparathyroidism and pregnancy; a re view. Obstet Gynecol Surv 1982; 37: 217–28.CrossRefGoogle Scholar
45 Lowe, DK, Orwoll, ES, McClung, MR et al. Hyperparathyroidism in pregnancy. Amer J Surg 1983; 145: 611–14.CrossRefGoogle Scholar
46 Kristoffersson, A, Dahlgren, S, Lithner, F, Jarhult, J. Primary hyperparathyroidism in pregnancy. Surgery 1985; 97: 326–30.Google ScholarPubMed
47 Montoro, MN, Collea, JV, Mestman, JH. Management of hyperparathyroidism in pregnancy with oral phosphate. Obstet Gynecol 1980; 65: 431–34.Google Scholar
48 Levy, HA, Peiruui, L, Stroup, P. Oral phosphate treatment of hypercalcemia in pregnancy. J Med Soc NJ 1981; 78: 113.Google ScholarPubMed
49 Eastell, R, Edmonds, CJ, de Chayal, RCS, McFadyen, IR. Prolonged hypopara thyroidism presenting eventually as second trimester abortion. Br Med J 1985; 291: 955–56.CrossRefGoogle Scholar
50 Landing, BH, Kamoshita, S. Congenital hyperparathyroidism secondary to maternal hypoparathyroidism. J Ped 1970; 77: 842–47.CrossRefGoogle ScholarPubMed
51 Sann, L, David, L, Thomas, A et al. Congenital hyperparathyroidism and vitamin D deficiency secondary to maternal hypoparathyroidism. Acta Paediat Scand 1976; 65: 381–85.CrossRefGoogle ScholarPubMed
52 Goldberg, E, Winter, ST, Better, OS, Berger, A. Transient neonatal hyperparathyroidism associated with maternal hypoparathyroidism. Israel J Med Sci 1976; 12: 199201.Google ScholarPubMed
53 Gradus, D, Le Roith, D, Karplus, M et al. Congenital hyperparathyroidism and rickets secondary to maternal hypoparathyroidism and vitamin D deficiency. Israel J Med Sci 1981; 17: 705709.Google ScholarPubMed
54 Sadeghi-Nejad, A, Wolfsdorf, JI, Senior, B. Hypoparathyroidism and pregnancy: treatment with calcitriol. J Am Med Ass 1980; 243: 254–55.CrossRefGoogle ScholarPubMed
55 Salle, BL, Berthezene, F, Glorieux, FH et al. Hypoparathyroidism during pregnancy: treatment with calcitriol. J Clin Endocr 1981; 52: 810–12.CrossRefGoogle ScholarPubMed
56 Graham, WP, Gordon, GS, Loken, HF et al. Effect of pregnancy and of the menstrual cycle on hypoparathyroidism. J Clin Endocr 1964; 24: 512–16.CrossRefGoogle ScholarPubMed
57 Jensen, LP, Ras, G, Boes, EG. Hypercalcaemia in pregnancy. A case report. S Afr Med J 1980; 57: 712–13.Google ScholarPubMed
58 Glass, EJ, Barr, DG. Transient neonatal hyperparathyroidism secondary to maternal pseudohypoparathyroidism. Arch Dis Childh 1981; 56: 566–68.CrossRefGoogle ScholarPubMed
59 O'Donnell, D, Costa, J, Meyers, AM. Management of pseudohypoparathyroidism in pregnancy. Case report. Br J Obstet Gynaecol 1985; 92: 639–41.CrossRefGoogle ScholarPubMed