American Journal of Clinical Nutrition, Vol 67, 693-701, Copyright © 1998 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses

LD Ritchie, EB Fung, BP Halloran, JR Turnlund, MD Van Loan, CE Cann and JC King
Department of Nutritional Sciences, University of California, Berkeley, USA.

To clarify the role of the intestine, kidney, and bone in maintaining calcium homeostasis during pregnancy and lactation and after the resumption of menses, a longitudinal comparison was undertaken of 14 well-nourished women consuming approximately 1200 mg Ca/d. Measurements were made before conception (prepregnancy), once during each trimester of pregnancy (T1, T2, and T3), early in lactation at 2 mo postpartum (EL), and 5 mo after resumption of menses. Intestinal calcium absorption was determined from the enrichment of the first 24-h urine sample collected after administration of stable calcium isotopes. Bone mineral of the total body and lumbar spine was measured by dual-energy X-ray absorptiometry and quantitative computerized tomography, respectively. Twenty-four-hour urine and fasting serum samples were analyzed for calcium, calcitropic hormones, and biochemical markers of bone turnover. Despite an increase in calcium intake during pregnancy, true percentage absorption of calcium increased from 32.9+/-9.1% at prepregnancy to 49.9+/-10.2% at T2 and 53.8+/-11.3% at T3 (P < 0.001). Urinary calcium increased from 4.32+/-2.20 mmol/d at prepregnancy to 6.21+/-3.72 mmol/d at T3 (P < 0.001), but only minor changes in maternal bone mineral were detected. At EL, dietary calcium and calcium absorption were not significantly different from that at prepregnancy, but urinary calcium decreased to 1.87+/-1.22 mmol/d (P < 0.001) and trabecular bone mineral density of the spine decreased to 147.7+/-21.2 mg/cm3 from 162.9+/-25.0 mg/cm3 at prepregnancy (P < 0.001). Calcium absorption postmenses increased nonsignificantly to 36.0+/-8.1% whereas urinary calcium decreased to 2.72+/-1.52 mmol/d (P < 0.001). We concluded that fetal calcium demand was met by increased maternal intestinal absorption; early breast-milk calcium was provided by maternal renal calcium conservation and loss of spinal trabecular bone, a loss that was recovered postmenses.

This article has been cited by other articles:

				M. Arora, A. S. Ettinger, K. E. Peterson, J. Schwartz, H. Hu, M. Hernandez-Avila, M. M. Tellez-Rojo, and R. O. Wright Maternal Dietary Intake of Polyunsaturated Fatty Acids Modifies the Relationship between Lead Levels in Bone and Breast Milk J. Nutr., January 1, 2008; 138(1): 73 - 79. [Abstract] [Full Text] [PDF]

				P. T. Alpert and U. Shaikh The Effects of Vitamin D Deficiency and Insufficiency on the Endocrine and Paracrine Systems Biol Res Nurs, October 1, 2007; 9(2): 117 - 129. [Abstract] [PDF]

				S. Khosla Estrogen and the Death of Osteoclasts: A Fascinating Story IBMS BoneKEy, October 1, 2007; 4(10): 267 - 272. [Full Text] [PDF]

				N. Charoenphandhu, K. Tudpor, K. Thongchote, W. Saengamnart, S. Puntheeranurak, and N. Krishnamra High-calcium diet modulates effects of long-term prolactin exposure on the cortical bone calcium content in ovariectomized rats Am J Physiol Endocrinol Metab, February 1, 2007; 292(2): E443 - E452. [Abstract] [Full Text] [PDF]

				L. M. Jarjou, A. Prentice, Y. Sawo, M A. Laskey, J. Bennett, G. R Goldberg, and T. J Cole Randomized, placebo-controlled, calcium supplementation study in pregnant Gambian women: effects on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion in the first year of life Am. J. Clinical Nutrition, March 1, 2006; 83(3): 657 - 666. [Abstract] [Full Text] [PDF]

				K. O O'Brien, C. M Donangelo, C. L V. Zapata, S. A Abrams, E M. Spencer, and J. C King Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations Am. J. Clinical Nutrition, February 1, 2006; 83(2): 317 - 323. [Abstract] [Full Text] [PDF]

				K. Shankar, M. Hidestrand, R. Haley, R. A. Skinner, W. Hogue, C.-H. Jo, P. Simpson, C. K. Lumpkin Jr., J. Aronson, T. M. Badger, et al. Different Molecular Mechanisms Underlie Ethanol-Induced Bone Loss in Cycling and Pregnant Rats Endocrinology, January 1, 2006; 147(1): 166 - 178. [Abstract] [Full Text] [PDF]

				S. Khosla, B. L. Riggs, R. A. Robb, J. J. Camp, S. J. Achenbach, A. L. Oberg, P. A. Rouleau, and L. J. Melton III Relationship of Volumetric Bone Density and Structural Parameters at Different Skeletal Sites to Sex Steroid Levels in Women J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5096 - 5103. [Abstract] [Full Text] [PDF]

				S. A. Abrams, I. J. Griffin, K. M. Hawthorne, and L. Liang Height and Height Z-Score Are Related to Calcium Absorption in Five- to Fifteen-Year-Old Girls J. Clin. Endocrinol. Metab., September 1, 2005; 90(9): 5077 - 5081. [Abstract] [Full Text] [PDF]

				M. Shaarawy, S. Zaki, A.-M. Ramzi, M. E. Salem, and A. M. El-Minawi Feto-maternal Bone Remodeling in Normal Pregnancy and Preeclampsia Reproductive Sciences, July 1, 2005; 12(5): 343 - 348. [Abstract] [PDF]

				S. C. Miller, B. L. Anderson, and B. M. Bowman Weaning Initiates a Rapid and Powerful Anabolic Phase in the Rat Maternal Skeleton Biol Reprod, July 1, 2005; 73(1): 156 - 162. [Abstract] [Full Text] [PDF]

				B. Specker Vitamin D requirements during pregnancy Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1740S - 1747S. [Abstract] [Full Text] [PDF]

				F. F Bezerra, L. M. Mendonca, E. C Lobato, K. O O'Brien, and C. M Donangelo Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes Am. J. Clinical Nutrition, November 1, 2004; 80(5): 1322 - 1326. [Abstract] [Full Text] [PDF]

				C. L Vargas Zapata, C. M Donangelo, L. R Woodhouse, S. A Abrams, E M. Spencer, and J. C King Calcium homeostasis during pregnancy and lactation in Brazilian women with low calcium intakes: a longitudinal study Am. J. Clinical Nutrition, August 1, 2004; 80(2): 417 - 422. [Abstract] [Full Text] [PDF]

				C. J. Chantry, P. Auinger, and R. S. Byrd Lactation Among Adolescent Mothers and Subsequent Bone Mineral Density Arch Pediatr Adolesc Med, July 1, 2004; 158(7): 650 - 656. [Abstract] [Full Text]

				H. Matsushita, T. Kurabayashi, M. Tomita, and K. Tanaka Effects of vitamin D and estrogen receptor gene polymorphisms on the changes in lumbar bone mineral density with multiple pregnancies in Japanese women Hum. Reprod., January 1, 2004; 19(1): 59 - 64. [Abstract] [Full Text] [PDF]

				K. O O'Brien, M. S. Nathanson, J. Mancini, and F. R Witter Calcium absorption is significantly higher in adolescents during pregnancy than in the early postpartum period Am. J. Clinical Nutrition, December 1, 2003; 78(6): 1188 - 1193. [Abstract] [Full Text] [PDF]

				A. Prentice Micronutrients and the Bone Mineral Content of the Mother, Fetus and Newborn J. Nutr., May 1, 2003; 133(5): 1693S - 1699. [Abstract] [Full Text] [PDF]

				A. B Beck, S. Bugel, S. Sturup, M. Jensen, C. Molgaard, M. Hansen, O. W. Krogsgaard, and B. Sandstrom A novel dual radio- and stable-isotope method for measuring calcium absorption in humans: comparison with the whole-body radioisotope retention method Am. J. Clinical Nutrition, February 1, 2003; 77(2): 399 - 405. [Abstract] [Full Text] [PDF]

				S. DeSantiago, L. Alonso, A. Halhali, F. Larrea, F. Isoard, and H. Bourges Negative calcium balance during lactation in rural Mexican women Am. J. Clinical Nutrition, October 1, 2002; 76(4): 845 - 851. [Abstract] [Full Text] [PDF]

				F. F. Bezerra, F. P. Laboissiere, J. C. King, and C. M. Donangelo Pregnancy and Lactation Affect Markers of Calcium and Bone Metabolism Differently in Adolescent and Adult Women with Low Calcium Intakes J. Nutr., August 1, 2002; 132(8): 2183 - 2187. [Abstract] [Full Text] [PDF]

				S. A. Atkinson and W. E. Ward Clinical nutrition: 2. The role of nutrition in the prevention and treatment of adult osteoporosis Can. Med. Assoc. J., November 1, 2001; 165(11): 1511 - 1514. [Full Text] [PDF]

				E. G. Vajda, B. M. Bowman, and S. C. Miller Cancellous and Cortical Bone Mechanical Properties and Tissue Dynamics During Pregnancy, Lactation, and Postlactation in the Rat Biol Reprod, September 1, 2001; 65(3): 689 - 695. [Abstract] [Full Text] [PDF]

				P. B. Moser-Veillon, A. R. Mangels, N. E. Vieira, A. L. Yergey, K. Y. Patterson, A. D. Hill, and C. Veillon Calcium Fractional Absorption and Metabolism Assessed Using Stable Isotopes Differ between Postpartum and Never Pregnant Women J. Nutr., September 1, 2001; 131(9): 2295 - 2299. [Abstract] [Full Text] [PDF]

				C. S. Kovacs Calcium and Bone Metabolism in Pregnancy and Lactation J. Clin. Endocrinol. Metab., June 1, 2001; 86(6): 2344 - 2348. [Full Text] [PDF]

				K. Y. Patterson and C. Veillon Stable Isotopes of Minerals as Metabolic Tracers in Human Nutrition Research Experimental Biology and Medicine, April 1, 2001; 226(4): 271 - 282. [Abstract] [Full Text]

				J. C. King Effect of Reproduction on the Bioavailability of Calcium, Zinc and Selenium J. Nutr., April 1, 2001; 131(4): 1355S - 1358. [Abstract] [Full Text]

				O. Ogueh, G. Khastgir, A. Abbas, J. Jones, K.H. Nicolaides, J.W. Studd, J. Alaghband-Zadeh, and M.R. Johnson The feto-placental unit stimulates the pregnancy-associated increase in maternal bone metabolism Hum. Reprod., August 1, 2000; 15(8): 1834 - 1837. [Abstract] [Full Text] [PDF]

				J. Z. Ilich and J. E. Kerstetter Nutrition in Bone Health Revisited: A Story Beyond Calcium J. Am. Coll. Nutr., June 1, 2000; 19(6): 715 - 737. [Abstract] [Full Text] [PDF]

				J. C King Physiology of pregnancy and nutrient metabolism Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1218S - 1225. [Abstract] [Full Text] [PDF]

				A. Prentice Maternal calcium metabolism and bone mineral status Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1312S - 1316. [Abstract] [Full Text] [PDF]

				B. L Salle, E. E Delvin, A. Lapillonne, N. J Bishop, and F. H Glorieux Perinatal metabolism of vitamin D Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1317S - 1324. [Abstract] [Full Text] [PDF]

				J. C King Determinants of maternal zinc status during pregnancy Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1334S - 1343. [Abstract] [Full Text] [PDF]

				L. D Ritchie and J. C King Dietary calcium and pregnancy-induced hypertension: is there a relation? Am. J. Clinical Nutrition, May 1, 2000; 71(5): 1371S - 1374. [Abstract] [Full Text] [PDF]

				J. M. Hopkinson, N. F. Butte, K. Ellis, and E. O’B. Smith Lactation Delays Postpartum Bone Mineral Accretion and Temporarily Alters Its Regional Distribution in Women J. Nutr., April 1, 2000; 130(4): 777 - 783. [Abstract] [Full Text]

				E.G. Vajda, M. Kneissel, B. Muggenburg, and S.C. Miller Increased Intracortical Bone Remodeling During Lactation in Beagle Dogs Biol Reprod, December 1, 1999; 61(6): 1439 - 1444. [Abstract] [Full Text]