I. Introduction II. Maternal Physiology and Pathophysiology During Pregnancy A. Maternal adaptive goals during pregnancy B. Mineral ions and calcitropic hormones C. Intestinal absorption of calcium D. Renal handling of calcium E. Skeletal calcium metabolism F. Primary hyperparathyroidism G. Hypoparathyroidism and pseudohypopara- thyroidism H. Summary III. Fetal-Placental Physiology and Pathophysiology A. Fetal adaptive goals B. Mineral ions and calcitropic hormones C. Fetal-placental calcium transport D. Renal handling of calcium and the amniotic fluid E. Skeletal calcium metabolism F. Fetal response to maternal hyper- or hypoparathy-roidism G. Integrated fetal calcium homeostasis H. Summary IV. Maternal Physiology and Pathophysiology During Lactation A. Maternal adaptive goals during lactation B. Mineral ions and calcitropic hormones C. Intestinal absorption of calcium D. Renal handling of calcium E. Skeletal calcium metabolism F. Hypoparathyroidism and pseudohypoparathy- roidism G. Summary V. Neonatal P...

/pdf/maternal-fetal-calcium-and-bone-metabolism-during-pregnancy-1u8014xtio.pdf

Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation.

During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ∼30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

/pdf/maternal-mineral-and-bone-metabolism-during-pregnancy-1kuk79kgya.pdf

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Mineral and bone metabolism are regulated differently in utero compared with the adult. The fetal kidneys, intestines, and skeleton are not dominant sources of mineral supply for the fetus. Instead...

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

1 – Growth and Composition of the Fetus and Newborn

The effects of pregnancy and lactation on endosteal bone formation and resorption were evaluated in vitamin D-depleted (-D) and vitamin D-repleted (+D) rats. Pregnancy induced a marked stimulation of osteoclastic bone resorption and of static and dynamic parameters of bone formation and mineralization. Bone resorption increased independently of vitamin D status and did not correlate with plasma 1,25-dihydroxyvitamin D3 [1,25(OH)2D] levels, but it was associated with increased plasma immunoreactive parathyroid hormone (iPTH) concentrations. Stimulation of the endosteal bone formation rate was mainly impaired in D-depleted rats, resulting in trabecular bone loss, which, in -D mother rats, was associated with decreased bone ash and total bone calcium. Lactation further stimulated bone resorption and reduced the trabecular bone volume; ash weight and bone calcium content were also decreased independently of the vitamin D status and changes in plasma iPTH levels. In presence of vitamin D, the bone formation rate increased fourfold during lactation but was unchanged in -D lactating rats. During lactation, vitamin D-depleted rats lost twofold more calcified bone than +D rats because of impaired mineralization. Thus, the present study shows that both the endosteal bone resorption and formation are stimulated by pregnancy and lactation and that vitamin D is required for normal bone mineralization during the reproductive period.

Bone changes due to pregnancy and lactation: influence of vitamin D status

The comparative metabolism of calcium and strontium during fetal development was investigated in rats and rabbits using double tracer techniques In general, the placental transfer from dam to fetu

Placental transfer of calcium and strontium in the rat and rabbit.

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Placental transfer of calcium and strontium in the rat and rabbit.