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Rached V, Diogenes MEL, Donangelo CM, Bezerra FF. Calcium plus vitamin D supplementation during pregnancy reduces postpartum fat mass in adolescents: A randomized trial. Am J Hum Biol 2023; 35:e23911. [PMID: 37166151 DOI: 10.1002/ajhb.23911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Pregnancy during adolescence may increase the risk of overweight/obesity. There is evidence that increasing calcium intake, alone or vitamin D-combined, may favor loss of weight and/or fat mass. OBJECTIVES We hypothesized that calcium supplementation during pregnancy reduces excessive fat accumulation during postpartum period. We aimed to investigate the effect of calcium plus vitamin D supplementation during pregnancy on body composition measurements throughout 1 year postpartum in Brazilian adolescents with habitually low calcium intake (~600 mg/day). METHODS Adolescents (14-19 years) were randomly assigned to receive a daily supplement (600 mg of calcium plus 200 UI of cholecalciferol, n = 30) or a placebo (n = 26) from 26 weeks of gestation until parturition. Body composition was determined at 5, 20, and 56 weeks postpartum by dual-energy x-ray absorptiometry. The effects of intervention group, time point, as well as their interaction were assessed using repeated measures mixed-effects models. RESULTS In the adjusted analysis, those supplemented showed lower total body mass [mean difference = -3.32 kg; confidence interval (CI) 95% -6.12 to -0.52 kg], trunk (-1.25 kg; CI 95% -2.34 to -0.15 kg), android (-0.29 kg; CI 95% -0.53 to -0.04 kg) and subcutaneous (-0.23 kg; CI 95% -0.43 to -0.03 kg) fat masses. In the supplemented group, BMI and postpartum weight retention significantly decreased from 5 to 20 weeks (-0.90 kg/m2 and -1.76 kg, respectively; p < .05). At 56 weeks, BMI was still lower (-1.22 kg/m2 ; p < .05) than 5 weeks. CONCLUSIONS Our findings suggest that increasing calcium intake through supplementation in combination with vitamin D contributes to a more pronounced reduction in total body mass overtime, mostly as a consequence of fat mass reductions in central body regions. This trial was registered at clinicaltrials.gov as NCT01732328.
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Affiliation(s)
- Verônica Rached
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Eduarda Leão Diogenes
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Brazilian National Cancer Institute José Alencar Gomes da Silva, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Diogenes MEL, Bezerra FF, Donangelo CM. Reduction in Bone Loss from 5 to 20 Weeks Postpartum in Adolescents Supplemented with Calcium Plus Vitamin D during Pregnancy Is Not Sustained at 1 Year Postpartum: Follow-up Study of a Randomized Controlled Trial. J Nutr 2021; 151:548-555. [PMID: 33561253 DOI: 10.1093/jn/nxaa418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/06/2020] [Accepted: 12/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Calcium plus vitamin D supplementation of pregnant Brazilian adolescents with habitually low calcium intake (∼600 mg/d) reduced bone loss during the first 20 wk postpartum. OBJECTIVE We investigated maternal bone mass changes during the first year postpartum as a follow-up of the clinical trial. METHODS Pregnant adolescents (14-19 y) received calcium (600 mg/d) plus cholecalciferol (200 IU/d) supplementation (n = 30) or placebo (n = 26) from 26 wk of gestation until parturition. Bone area and bone mineral content and bone mineral density (BMD) at total body, lumbar spine, and hip (total and femoral neck) were assessed by DXA at 3 time points postpartum (5 wk, 20 wk, and 56 wk). Intervention group, time postpartum, and group × time interaction effects were tested by repeated-measures mixed-effects models adjusting for calcium intake, return of menses, breastfeeding practices, and body weight. RESULTS Time (P < 0.05) but not group affected several absolute bone measurements. There was a group × time interaction for femoral neck BMD (P = 0.045). Mean ± SE values (g/cm2) at 5 wk, 20 wk, and 56 wk were, respectively, 1.025 ± 0.026, 0.980 ± 0.026, and 1.022 ± 0.027 for the placebo group and 1.057 ± 0.025, 1.030 ± 0.024, and 1.055 ± 0.025 for the supplemented group. An interaction also was observed for percentage change in femoral neck BMD relative to 5 wk (P = 0.049), with a more pronounced decrease in the placebo group (-4.58 ± 0.42%) than in the supplemented group (-3.15% ± 0.42%) at 20 wk (P = 0.019), and no difference between groups at 56 wk (-0.44% ± 0.71% in the placebo and -0.76% ± 0.62% in the supplemented group; P = 0.65). CONCLUSIONS Calcium plus vitamin D supplementation of the adolescent mothers reduces the magnitude of bone loss at the femoral neck from 5 to 20 wk postpartum without an effect on bone changes after 1 y postpartum, indicating that there is no sustained effect of the supplement tested.
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Affiliation(s)
- Maria Eduarda L Diogenes
- Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Brazilian National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - Flávia F Bezerra
- Nutrition Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Dietary Choices of New Zealand Women during Pregnancy and Lactation. Nutrients 2020; 12:nu12092692. [PMID: 32899261 PMCID: PMC7551142 DOI: 10.3390/nu12092692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/17/2022] Open
Abstract
Dietary recommendations during pregnancy and lactation have become increasingly complex, and sources of information more numerous but not always reliable, potentially causing confusion and unsafe choices. Women were recruited during pregnancy or within six months postpartum and completed questionnaires on dietary choices, food safety, and sources of nutrition information. Women (n = 458) from around New Zealand participated in the study. They consumed a wide range of foods and beverages and reported various dietary changes. In pregnancy, women commonly avoided alcohol (92%), raw milk products (86%), and raw, smoked, or pre-cooked seafood and fish (84%), and made changes due to food safety concerns. Influential advice was acquired from a range of sources including midwives (37%) and the New Zealand pregnancy and breastfeeding guidelines (25%) during pregnancy. Food avoidance was less common in lactation. However, fewer women consumed milk products during lactation (64%) than pregnancy (93%). Potentially unreliable sources were used more frequently in lactation including alternative health practitioners (26%) and family or friends (12%), and dietary changes were often made in response to infant symptoms without supporting evidence. This study highlighted a need for good communication of evidence-based recommendations to women, especially during lactation.
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King JC. Maintaining Balance. Annu Rev Nutr 2019; 39:1-19. [PMID: 30986116 DOI: 10.1146/annurev-nutr-082018-124634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Writing this biography forced me to look back over my career as a scientist, teacher, wife, and mother. To my surprise, a lifelong theme emerged that I was unaware of, that is, the role of maintaining balance between work and family, science and teaching, mentorship and administration, and personal values and challenges. My primary mentor, Dr. Doris Calloway, demonstrated the importance of maintaining balance. My interest in nutrition started as a preschooler living on a farm where I learned firsthand the importance of balancing the expense of providing good nutrition to the livestock with potential income. In our small high school, I became acquainted with the fascinating field of chemistry, but found it critical to balance that interest with a politically correct field of study for a woman in the early 1960s. I chose dietetics for its strong roots in chemistry. As a US Army dietitian, I learned firsthand how to conduct metabolic studies and knew, immediately, that I had to balance that interest with future opportunities feasible for a dietitian. I chose the University of California, Berkeley, for my PhD because it needed to train dietitians in research to balance an emerging need to offer undergraduates a practicum in dietetics. My subsequent faculty appointment there enabled me to develop novel isotopic approaches for studying zinc and prenatal nutrition, and balance my research with teaching and administrative responsibilities. During the next 40 years, my work as a Berkeley professor led to appointments at the Western Human Nutrition Research Center and Children's Hospital Oakland Research Institute, while balancing my responsibilities as a wife and a mother to my two sons. Balance is defined as a condition in which different elements are equal or in the correct proportions. It is extremely satisfying to look back and see evidence of successfully balancing the disparate elements of my career.
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Affiliation(s)
- Janet C King
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, California 94720-3104, USA.,Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital, Oakland, California 94609, USA;
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Calcium plus vitamin D supplementation during pregnancy interacts with polymorphisms in the promoter region of the VDR gene to affect postpartum bone mass of Brazilian adolescent mothers: A randomized controlled trial. Nutrition 2016; 32:1068-74. [PMID: 27211082 DOI: 10.1016/j.nut.2016.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/17/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated whether calcium plus vitamin D supplementation interacts with polymorphisms in the VDR gene promoter region to affect changes on maternal bone mass from 5 to 20 wk postpartum in Brazilian adolescent mothers. METHODS Pregnant adolescents (14-19 y) randomly received calcium plus cholecalciferol (600 mg/d + 200 IU/d, n = 30) or placebo (n = 26) from 26 wk of pregnancy until parturition. Bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at total body, lumbar spine, total hip, and femoral neck were evaluated at 5 and 20 wk postpartum. Serum 25-hydroxyvitamin D (25[OH]D) and parathyroid hormone concentrations were measured. Real-time polymerase chain reaction was used for genotyping rs7139166 (1521 pb G > C) and rs4516035 (1012 pb A > G). Interactions between supplementation and polymorphisms were adjusted for significant covariates. RESULTS Changes in serum 25(OH)D from pregnancy to postpartum differed between supplemented and placebo groups for mothers carrying 1521 GG/1012 AA genotypes (P = 0.004). Only in the placebo group, mothers carrying 1521 GG/1012 AA had greater reduction in total BMD z score, femoral neck BMC, and BMD from 5 to 20 wk postpartum compared with those with 1521 GC/1012 AG (P < 0.05). In the placebo group, total hip BA decreased from 5 to 20 wk postpartum in adolescents with 1521 GG/1012 AA, but increased in those with 1521 GC/1012 AG (P < 0.05), in contrast to the supplemented group. CONCLUSION Calcium plus vitamin D supplementation during pregnancy interacted with polymorphisms in the VDR gene promoter region affecting postpartum bone loss. The increased supply of calcium and vitamin D appeared to minimize postpartum bone loss particularly in adolescents with 1521 GG/1012 AA.
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Shagina NB, Fell TP, Tolstykh EI, Harrison JD, Degteva MO. Strontium biokinetic model for the pregnant woman and fetus: application to Techa River studies. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2015; 35:659-676. [PMID: 26295413 DOI: 10.1088/0952-4746/35/3/659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A biokinetic model for strontium (Sr) for the pregnant woman and fetus (Sr-PWF model) has been developed for use in the quantification of doses from internal radiation exposures following maternal ingestion of Sr radioisotopes before or during pregnancy. The model relates in particular to the population of the Techa River villages exposed to significant amounts of ingested Sr radioisotopes as a result of releases of liquid radioactive wastes from the Mayak plutonium production facility (Russia) in the early 1950s. The biokinetic model for Sr metabolism in the pregnant woman was based on a biokinetic model for the adult female modified to account for changes in mineral metabolism during pregnancy. The model for non-pregnant females of all ages was developed earlier with the use of extensive data on (90)Sr-body measurements in the Techa Riverside residents. To determine changes in model parameter values to take account of changing mineral metabolism during pregnancy, data from longitudinal studies of calcium homeostasis during human pregnancy were analysed and applied. Exchanges between maternal and fetal circulations and retention in fetal skeleton and soft tissues were modelled as adaptations of previously published models, taking account of data on Sr and calcium (Ca) metabolism obtained in Russia (Southern Urals and Moscow) relating to dietary calcium intakes, calcium contents in maternal and fetal skeletons and strontium transfer to the fetus. The model was validated using independent data on (90)Sr in the fetal skeleton from global fallout as well as unique data on (90)Sr-body burden in mothers and their still-born children for Techa River residents. While the Sr-PWF model has been developed specifically for ingestion of Sr isotopes by Techa River residents, it is also more widely applicable to maternal ingestion of Sr radioisotopes at different times before and during pregnancy and different ages of pregnant women in a general population.
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Affiliation(s)
- N B Shagina
- Urals Research Centre for Radiation Medicine, Chelyabinsk, 454076 Russia
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Diogenes MEL, Bezerra FF, Rezende EP, Donangelo CM. Calcium Plus Vitamin D Supplementation During the Third Trimester of Pregnancy in Adolescents Accustomed to Low Calcium Diets Does Not Affect Infant Bone Mass at Early Lactation in a Randomized Controlled Trial. J Nutr 2015; 145:1515-23. [PMID: 26019245 DOI: 10.3945/jn.114.208140] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/04/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnancy and lactation in adolescents with low calcium intake may impair fetal growth and infant bone mass. OBJECTIVE We investigated the effects of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers consuming low calcium diets (∼600 mg/d) on fetal biometry and infant bone mass, and the relation between infant and maternal bone mass during early lactation. METHODS Infants of mothers who received calcium (600 mg/d) plus cholecalciferol (200 IU/d) supplementation (n = 30) or placebo (n = 26) from 26 wk of gestation until parturition were studied. Fetal biometric measurements at 23 and 36 wk of gestation were obtained from medical records. Infant anthropometric and total body bone measurements [bone mineral content (BMC), bone area (BA), and bone mineral density (BMD)] at 5 wk postpartum were assessed by dual-energy X-ray absorptiometry. Maternal BMD z scores for total body, lumbar spine, total hip, and femoral neck at 5 wk postpartum were obtained. Group comparisons were adjusted for significant covariates. RESULTS Maternal mean serum 25-hydroxyvitamin D was 59 nmol/L at baseline in both groups. No differences in fetal measurements at 36 wk of gestation were observed between the groups, except for body weight and its increment from 23 to 36 wk, which were higher in the supplemented group (6.8%, P = 0.014 and 10.5%, P = 0.07, respectively). Infant BMC (61.1 ± 21.7 g), BA (167 ± 79 cm(2)), and BMD (0.385 ± 0.069 g/cm(2)) did not significantly differ between the groups. In the placebo group, infant BMC and BA were negatively correlated with maternal BMD z scores for total body (r = -0.40 and r = -0.47; P < 0.05) and hip (r = -0.41 and r = -0.46; P < 0.05). In contrast, no correlations were observed in the supplemented group. CONCLUSIONS Calcium and vitamin D supplementation of the adolescents studied resulted in higher fetal body weight at 36 wk of gestation and had no effect on infant bone mass at 5 wk postpartum. Because correlations between maternal and infant bone mass were evident only in the placebo group, infant bone mass appeared to be more dependent on maternal skeletal mass when calcium intake was low. This trial was registered at clinicaltrials.gov as NCT01732328.
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Affiliation(s)
- Maria Eduarda L Diogenes
- Food and Nutritional Biochemistry Laboratory, Chemistry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Brazilian National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - Flávia F Bezerra
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil; and
| | - Elaine P Rezende
- Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil; and
| | - Carmen M Donangelo
- Food and Nutritional Biochemistry Laboratory, Chemistry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; School of Nutrition, University of the Republic, Montevideo, Uruguay
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El Lithy A, Abdella RM, El-Faissal YM, Sayed AM, Samie RMA. The relationship between low maternal serum vitamin D levels and glycemic control in gestational diabetes assessed by HbA1c levels: an observational cross-sectional study. BMC Pregnancy Childbirth 2014; 14:362. [PMID: 25308347 PMCID: PMC4287592 DOI: 10.1186/1471-2393-14-362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/06/2014] [Indexed: 12/01/2022] Open
Abstract
Background A great association between vitamin D deficiency and type 2 diabetes mellitus has been suggested in literature. During pregnancy, this deficiency is even more critical. It appears that vitamin D insufficiency during pregnancy may be associated with maternal hazards. The aim of this study was to assess the relation between the levels of 25-hydroxy-cholecalciferol (vitamin D), and the glycemic control in pregnant women. Methods An observational cross-section study including 160 pregnant women between 20-40 years in age, in their third trimester, divided into two equal groups. First group consisted of 80 women with established diagnosis of gestational diabetes and the second group with proved normal blood glucose levels. We assessed vitamin D in serum, fasting blood glucose, serum insulin and glycosylated hemoglobin (HbA1c) levels and we depicted the insulin sensitivity using the Quantitative insulin sensitivity check index (Quicki). The results were collected and statistically correlated. Results The mean vitamin D levels were 46.61 ± 6.087 and 47.25 ± 10.181in controls and women with gestational diabetes mellitus (GDM) respectively. The fasting insulin levels were significantly higher in the group with GDM with a mean of 18.51 ± 6.44 compared to 8.95 ± 2.52 in the control group. The correlation coefficient (r) between HbA1c levels and Vitamin D level was -0.492 with a P value <0.05. Similar associations were also found with the fasting blood sugar levels (r = - 0.386) and with Quicki values (r = -0.250). Vitamin D levels correlated significantly with the fasting blood glucose, the fasting serum insulin and the HbA1c levels, the P value in all these correlations were <0.05. The P value with Quicki results was 0.064. Conclusions There is a statistically significant negative correlation between the glycemic control and vitamin D levels in serum in the whole study population. The effect of adequate vitamin D replacement on glycemic control was not studied in our work correlation. We suggest larger scale studies addressing this issue.
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Dynamic changes in serum 25-hydroxyvitamin D during pregnancy and lack of effect on thyroid parameters. PLoS One 2014; 9:e90161. [PMID: 24608866 PMCID: PMC3946450 DOI: 10.1371/journal.pone.0090161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 01/28/2014] [Indexed: 12/29/2022] Open
Abstract
Background & Aims To explore vitamin D status and its dynamic changes during pregnancy in women living in Northeast China. The association between 25-hydroxyvitamin D and serum calcium, phosphate and parathyroid hormone was studied. Because vitamin D deficiency or thyroid dysfunction/autoimmunity during pregnancy may lead to similar adverse events, the relationship between 25-hydroxyvitamin D and thyroid parameters was investigated. Methods Serum samples of 50 women (aged 22 to 36 years) were selected retrospectively. The samples were collected at gestational 8 weeks ±3 days, 20 weeks ±3 days and 32 weeks ±3 days for measurement of 25-hydroxyvitamin D, calcium, phosphate, parathyroid hormone, and thyroid parameters. Results The median 25-hydroxyvitamin D levels were 28.29, 39.23 and 40.03 nmol/L, respectively, from the first to the third trimester. The 25-hydroxyvitamin D concentration during the first trimester was significantly lower than the next two trimesters (p<0.01) and was unchanged between the second and the third trimester. Of these women, 96%, 78% and 76% showed 25-hydroxyvitamin D ≤50 nmol/L during each trimester. Season was associated with 25-hydroxyvitamin D during each trimester (p<0.05), and a significant association was found between calcium and 25-hydroxyvitamin D during the first and the second trimesters. Only triiodothyronine was associated with 25-hydroxyvitamin D in the first trimester (p = 0.024), but statistical significance was only a trend (p = 0.063) after excluding abnormal values. No association was observed between 25-hydroxyvitamin D and phosphate, parathyroid hormone, and other thyroid parameters. Conclusions Vitamin D deficiency during pregnancy was prevalent in women from Northeast China who did not use supplementation. No significant relationships were observed between 25-hydroxyvitamin D and thyroid parameters during pregnancy.
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Diogenes MEL, Bezerra FF, Rezende EP, Taveira MF, Pinhal I, Donangelo CM. Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers: a randomized, placebo-controlled trial. Am J Clin Nutr 2013; 98:82-91. [PMID: 23719547 DOI: 10.3945/ajcn.112.056275] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass. OBJECTIVE We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets (∼600 mg/d). DESIGN Pregnant adolescents (14-19 y) randomly received daily calcium (600 mg) plus vitamin D3 (200 IU) (n = 30) or a placebo (n = 26) from 26 wk of pregnancy (baseline) until parturition. The bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the total body, lumbar spine, and hip (total and femoral neck) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum. Serum hormones and 25-hydroxyvitamin D [25(OH)D] were measured. Group comparisons were adjusted for significant covariates. RESULTS The mean serum 25(OH)D concentration was 59 nmol/L at baseline. In comparison with the placebo, 25(OH)D tended to be 14-15 nmol/L higher postpartum in the supplemented group (P = 0.08). Total body and hip BMC and BMD decreased over time (P ≤ 0.005) in both groups with a group × time interaction at the femoral neck (P < 0.04). Supplemented mothers had higher lumbar spine BA (6.7%; P = 0.002) and lumbar spine BMC (7.9%, P = 0.08) than did mothers who consumed the placebo at 5 wk postpartum. At 20 wk postpartum, differences between groups were more evident, with higher lumbar spine BMC (13.9%), lumbar spine BA (6.2%), and lumbar spine BMD (10.6%) in the supplemented group (P ≤ 0.008). CONCLUSIONS Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation. Additional studies are required to determine whether bone effects are temporary or long-lasting. This trial was registered at clinicaltrials.gov as NCT01732328.
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Affiliation(s)
- Maria Eduarda L Diogenes
- Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química and the Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Ito N, Ito K, Koshimichi H, Hisaka A, Honma M, Igarashi T, Suzuki H. Contribution of Protein Binding, Lipid Partitioning, and Asymmetrical Transport to Drug Transfer into Milk in Mouse Versus Human. Pharm Res 2013; 30:2410-22. [DOI: 10.1007/s11095-013-1085-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 05/19/2013] [Indexed: 01/12/2023]
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Abstract
OBJECTIVE To provide a better understanding of dietary intakes of pregnant women in low- and middle-income countries. DESIGN Systematic review was performed to identify relevant studies which reported nutrient intakes or food consumption of pregnant women in developing countries. Macronutrient and micronutrient intakes were compared by region and the FAO/WHO Estimated Average Requirements. Food consumption was summarized by region. SETTING Developing countries in Africa, Asia, and the Caribbean and Central/South America. SUBJECTS Pregnant women in the second or third trimester of their pregnancies. RESULTS From a total of 1499 retrieved articles, sixty-two relevant studies were analysed. The ranges of mean/median intakes of energy, fat, protein and carbohydrate were relatively higher in women residing in the Caribbean and Central/South America than in Africa and Asia. Percentages of energy from carbohydrate and fat varied inversely across studies in all regions, whereas percentage of energy from protein was relatively stable. Among selected micronutrients, folate and Fe intakes were most frequently below the Estimated Average Requirements, followed by Ca and Zn. Usual dietary patterns were heavily cereal based across regions. CONCLUSIONS Imbalanced macronutrients, inadequate micronutrient intakes and predominantly plant-based diets were common features of the diet of pregnant women in developing countries. Cohesive public health efforts involving improving access to nutrient-rich local foods, micronutrient supplementation and fortification are needed to improve the nutrition of pregnant women in developing countries.
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O'Brien KO, Donangelo CM, Ritchie LD, Gildengorin G, Abrams S, King JC. Serum 1,25-dihydroxyvitamin D and calcium intake affect rates of bone calcium deposition during pregnancy and the early postpartum period. Am J Clin Nutr 2012; 96:64-72. [PMID: 22648718 PMCID: PMC3374733 DOI: 10.3945/ajcn.111.029231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 05/01/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Factors affecting bone calcium deposition across pregnancy and lactation are not well characterized. OBJECTIVE The impact of maternal age, calcium intake, race-ethnicity, and vitamin D status on the rate of bone calcium deposition (VO+) was assessed across pregnancy and lactation. DESIGN Stable calcium isotopes were given to 46 women at pre- or early pregnancy (trimester 1), late pregnancy (trimester 3), and 3-10 wk postpartum. Three cohorts were included: 23 adolescents from Baltimore (MD), aged 16.5 ± 1.4 y (mean ± SD; Baltimore cohort); 13 adults from California, aged 29.5 ± 2.6 y (California cohort); and 10 adults from Brazil, aged 30.4 ± 4.0 y (Brazil cohort). The total exchangeable calcium pool, VO+, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D [1,25(OH)₂D], parathyroid hormone, and calcium intake were evaluated. RESULTS At trimester 3, inverse associations between 1,25(OH)₂D and VO+ were evident in the Baltimore (P = 0.059) and Brazil (P = 0.008) cohorts and in the whole group (P = 0.029); calcium intake was not a significant determinant of VO+ in any group during pregnancy. At postpartum, a significant positive association was evident between VO+ and calcium intake (P ≤ 0.002) and between VO+ and African ethnicity (P ≤ 0.004) in the whole group and within the Baltimore and Brazil cohorts. CONCLUSIONS Elevated 1,25(OH)₂D was associated with decreased rates of bone calcium deposition during late pregnancy, a finding that was particularly evident in pregnant adolescents and adult women with low calcium intakes. Higher dietary calcium intakes and African ethnicity were associated with elevated rates of bone calcium deposition in the postpartum period.
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Calcium and magnesium status is not impaired in pregnant women. Nutr Res 2012; 32:542-6. [PMID: 22901563 DOI: 10.1016/j.nutres.2012.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 05/16/2012] [Accepted: 05/21/2012] [Indexed: 11/24/2022]
Abstract
Deficiencies in calcium (Ca) and magnesium (Mg) are associated with various complications during pregnancy. To test the hypothesis that the status of these minerals is inadequate in pregnancy, a cross-sectional study was conducted of the dietary intake and status of Ca and Mg in pregnant women (n = 50) attending a general public university hospital in Brazil. Dietary intake was assessed from 4-day food records; levels of plasma Mg, erythrocyte Mg, and urinary Ca and Mg excretion were determined by flame atomic absorption spectroscopy; and type I collagen C-telopeptides were evaluated by enzyme-linked immunosorbent assay. Probabilities of inadequate Ca and Mg intake were exhibited by 58 and 98% of the study population, respectively. The mean levels of urinary Ca and Mg excretion were 8.55 and 3.77 mmol/L, respectively. Plasma C-telopeptides, plasma Mg, and erythrocyte Mg were within normal levels. Multiple linear regression analysis revealed positive relationships among urinary Ca excretion, Ca intake (P = .002) and urinary Mg excretion (P < .001) and between erythrocyte Mg and Mg intake (P = .023). It is concluded that the Ca and Mg status of participants was adequate even though the intake of Ca and Mg was lower than the recommended level.
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Young BE, McNanley TJ, Cooper EM, McIntyre AW, Witter F, Harris ZL, O'Brien KO. Vitamin D insufficiency is prevalent and vitamin D is inversely associated with parathyroid hormone and calcitriol in pregnant adolescents. J Bone Miner Res 2012; 27:177-86. [PMID: 21956833 PMCID: PMC3291801 DOI: 10.1002/jbmr.526] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/28/2011] [Accepted: 09/22/2011] [Indexed: 11/11/2022]
Abstract
Few large studies have assessed changes in calcitropic hormones and maternal 25-hydroxyvitamin D (25(OH)D) status across pregnancy, and how this may impact maternal bone turnover and neonatal hormone status. We aimed to identify determinants of 25(OH)D, parathyroid hormone (PTH), and calcitriol across pregnancy in a longitudinal study of 168 pregnant adolescents (≤18 years of age). Maternal 25(OH)D, PTH, and calcitriol were assessed at mid-gestation (∼26 weeks), delivery, and in cord blood. Data were related to measures of maternal anthropometrics, dietary intake, physical activity, and bone turnover markers. Approximately 50% of teens and their infants had serum 25(OH)D ≤ 20 ng/mL; 25(OH)D was lower in African Americans versus whites (p < 0.001). PTH increased across gestation (p < 0.001). Elevated PTH (≥60 pg/mL) was detected in 25% of adolescents at delivery, and was associated with increased concentrations of serum N-telopeptide (NTX) (p = 0.028). PTH and calcitriol did not significantly differ across the range of Ca intake consumed (257-3220 mg/d). In the group as a whole, PTH was inversely associated with 25(OH)D in maternal circulation at mid-gestation (p = 0.023) and at delivery (p = 0.019). However, when the cohort was partitioned by 25(OH)D status, this relationship was only present in those with 25(OH)D ≤ 20 ng/mL, suggestive of a threshold below which 25(OH)D impacts PTH during pregnancy. Mid-gestation 25(OH)D was inversely associated with calcitriol at delivery (p = 0.023), irrespective of Ca intake. Neonatal PTH and calcitriol were significantly lower than (p < 0.001), but unrelated to maternal concentrations. These findings indicate that maternal 25(OH)D status plays a role in calcitropic hormone regulation in pregnant adolescents.
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Affiliation(s)
- Bridget E Young
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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Changes in bone mineral density of adolescent mothers during the 12-month postpartum period. Public Health Nutr 2009; 13:1522-7. [DOI: 10.1017/s1368980009992199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveBone mineral density (BMD) loss has been described in adult women in the 12-month postpartum period. However, little is known about the precise BMD pattern in adolescent mothers. The present study aimed to evaluate BMD in Argentinean adolescent mothers followed up during the 12-month postpartum period.DesignAnalytical, prospective clinical trial. BMD and body composition were determined by dual-energy X-ray absorptiometry; bone mineral content (BMC) and BMD were measured in the lumbar spine (L2–L4), femoral neck (FN), femur trochanter (TR), total hip (TH) and total body. Changes in BMD and BMC were analysed using ANOVA for pairwise comparisons. Other comparisons were performed with the paired-sample t test and Wilcoxon test; Pearson’s correlation coefficient was used to analyse the relationship among continuous variables.SettingLa Plata, Argentina.SubjectsAdolescent mothers (n 35; 17 years old or less) were recruited within 15 d after delivery. Studies and follow-up were performed at 15 d and 3, 6 and 12 months postpartum.ResultsBMD and BMC losses at 3 and 6 months and recovery at 12 months fitted a quadratic curve (ANOVA) at the three sites studied (FN, TH, TR), in total-body BMD (P = 0·000) and BMC (P = 0·038). At hip sites, BMD loss occurred at 3 months (FN, P = 0·000; TR, P = 0·000; TH, P = 0·000) and 6 months (FN, P = 0·000; TR, P = 0·000; TH, P = 0·000) compared with basal values. Percentage BMD loss immediately after delivery up to 6 months was about 5 %.ConclusionsAdolescents showed significant BMD and BMC losses at 6 months postpartum, with an almost total recovery at 12 months in all sites studied.
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Maghbooli Z, Hossein-Nezhad A, Nikoo MK, Shafei AR, Rahmani M, Larijani B. Bone marker status in mothers and their newborns in Iran. J Matern Fetal Neonatal Med 2009; 20:639-43. [PMID: 17701663 DOI: 10.1080/14767050701483470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The contribution of maternal skeletal calcium metabolism in pregnancy is evidenced in changes in the markers of bone formation and bone resorption. Changes in maternal bone markers could affect fetal bone mineralization. The aim of this study was to determine the association between maternal and cord blood bone markers. METHODS Five hundred and fifty-two pregnant women were recruited from Tehran University educating hospitals in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum was assayed for osteocalcin and crosslaps, calcium, and parathyroid hormone. RESULTS There was significant correlation between maternal and cord blood serum osteocalcin and crosslaps levels, and the mean cord blood levels of osteocalcin and crosslaps were significantly higher at about 1.59- and 1.62-fold maternal levels, respectively. Serum calcium levels strongly correlated with osteocalcin and crosslaps in mothers (r = 0.21, p = 0.001 and r = 0.25, p = 0.001, respectively). CONCLUSIONS Skeletal calcium release may play a major role in calcium homeostasis during pregnancy. Because of this, calcium supplements could have an important role in pregnant women in decreasing the risk of subsequent complications such as osteoporosis.
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Affiliation(s)
- Zhila Maghbooli
- Endocrinology and Metabolism Research Center, Medical Sciences, University of Tehran, Tehran, Iran
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Sanders KM, Nowson CA, Kotowicz MA, Briffa K, Devine A, Reid IR. Calcium and bone health: position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia. Med J Aust 2009; 190:316-20. [PMID: 19296813 DOI: 10.5694/j.1326-5377.2009.tb02421.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 11/18/2008] [Indexed: 12/31/2022]
Abstract
This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia. Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women. Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling. In adults with a baseline calcium intake of 500-900 mg/day, increasing or supplementing this intake by a further 500-1000 mg/day has a beneficial effect on bone mineral density. Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.
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Affiliation(s)
- Kerrie M Sanders
- Department of Clinical and Biomedical Sciences, Barwon Health, University of Melbourne, Geelong, VIC, Australia.
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Bezerra FF, Cabello GMK, Mendonça LMC, Donangelo CM. Bone mass and breast milk calcium concentration are associated with vitamin D receptor gene polymorphisms in adolescent mothers. J Nutr 2008; 138:277-81. [PMID: 18203891 DOI: 10.1093/jn/138.2.277] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Lactation-associated bone loss has been reported in adolescent mothers. Polymorphisms in the vitamin D receptor (VDR) gene may contribute to differences in the physiologic skeletal response to lactation in these mothers. We evaluated the influence of VDR gene polymorphisms ApaI, BsmI, and TaqI on bone mass, bone and calcium-related hormones, and breast milk calcium of lactating adolescents with habitually low calcium intake. Total body bone mineral content (TBMC), total body bone mineral density (TBMD), lumbar spine BMD (LSBMD), serum hormones [intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, insulin-like growth factor-I (IGF1), prolactin, and estradiol), and breast milk calcium were measured in 40 lactating Brazilian adolescents (15-18 y), and compared by VDR genotype subgroups after adjustment for calcium intake and postmenarcheal and lactational periods. TBMD and LSBMD Z scores were -0.55 +/- 1.01 and -1.15 +/- 1.48, respectively. LSBMD was higher (21%; P < 0.05) in adolescents with the aa genotype (n = 5) compared with those with the AA genotype (n = 7). TBMC and IGF1 were higher (23 and 50%, respectively; P < 0.05) in adolescents with tt (n = 4) than those with TT (n = 29) and Tt (n = 7) genotypes. Breast milk calcium and serum iPTH were higher (24 and 80%, respectively; P < 0.05) in adolescents with bb (n = 8) compared with those with BB (n = 21) genotype. These results indicate that bone mass and breast milk calcium are significantly associated with VDR genotypes in lactating Brazilian adolescents. Those with aa and tt genotypes had a better bone status and those with bb genotype had greater breast milk calcium.
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Affiliation(s)
- Flávia F Bezerra
- Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 21941-909
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Maghbooli Z, Hossein-Nezhad A, Karimi F, Shafaei AR, Larijani B. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24:27-32. [PMID: 17607661 DOI: 10.1002/dmrr.737] [Citation(s) in RCA: 180] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The serum level of 25-hydroxyvitamin D deficiency has long been suspected as a risk factor for glucose intolerance and perhaps 1,25-dihydroxyvitamin D has a role in the regulation of insulin secretion. This study investigates the relation between 25-hydroxyvitamin D concentrations and insulin resistance in pregnant women. METHODS A cross-sectional study was conducted on 741 pregnant women referred to five educating hospital clinics. Universal screening was performed with a GCT-50 g, and those with plasma glucose levels > pr = 7.2 mmol/L were diagnosed as GDM if they had an impaired GTT-100 g based on Carpenter and Coustan criteria. The levels of insulin and C-peptide were measured during OGTT-100 g test. The homeostasis model assessment index (HOMA) equation was used as the insulin resistance index. The concentrations of 25-hydroxyvitamin D, and PTH were also measured. RESULTS Total prevalence of vitamin D deficiency (<25 nmol/L) was found in 70.6% of pregnant women. Prevalence of severe vitamin D deficiency (<12.5) in GDM patients was higher than in normoglycaemic pregnancies. The regression model revealed a strong correlation between the HOMA index and serum levels of vitamin D. CONCLUSIONS These results show that a positive correlation of 25(OH) vitamin D concentrations with insulin sensitivity and vitamin D deficiency could be a confirmative sign of insulin resistance.
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Affiliation(s)
- Zhila Maghbooli
- Endocrinology & Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Moran VH. Nutritional status in pregnant adolescents: a systematic review of biochemical markers. MATERNAL & CHILD NUTRITION 2007; 3:74-93. [PMID: 17355441 PMCID: PMC6860744 DOI: 10.1111/j.1740-8709.2007.00081.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Adolescent pregnancy is a major public health challenge for many industrialized countries and is associated with significant medical, nutritional, social and economic risk for mothers and their infants. Despite this, relatively little is known about the nutritional status of this population. The aim of this paper was to conduct a systematic review of the current evidence relating to the biochemical markers of nutritional status of pregnant adolescents living in industrialized countries. Six papers were identified that fulfilled the inclusion criteria, the majority of which were conducted in the United States. The studies were of variable quality and most failed to control for potential confounders which may have strongly influenced the findings. Due to limited research, conclusions cannot be drawn about the zinc and calcium status of pregnant adolescents, and data on folate and vitamin B(12) status appeared conflicting. There was some consensus among studies, however, to suggest that indicators of anaemia and iron status were compromised in pregnant adolescents, particularly during the third trimester of pregnancy. Chronological age did not appear to influence nutritional status, although there was some evidence to suggest that increasing gynaecologic age may positively influence plasma ferritin levels. Current research is limited by sampling and measurement bias, and research is urgently required to address these limitations. Further consideration should also be made of the influence of the role of socio-economic support on pregnant adolescents' nutritional status. The achievement of improved nutrition in pregnancy among adolescents requires multidisciplinary collaborations of adolescent healthcare providers, academics, professional organizations, policymakers, industry and service users. Only once this is achieved can adolescent nutrition, and adolescent nutrition in pregnancy, be significantly and sustainably optimized.
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Affiliation(s)
- Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, Faculty of Health, University of Central Lancashire, Preston, UK.
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Maghbooli Z, Hossein-Nezhad A, Shafaei AR, Karimi F, Madani FS, Larijani B. Vitamin D status in mothers and their newborns in Iran. BMC Pregnancy Childbirth 2007; 7:1. [PMID: 17295904 PMCID: PMC1808477 DOI: 10.1186/1471-2393-7-1] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 02/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adequate vitamin D concentrations during pregnancy are necessary to neonatal calcium homeostasis, bone maturation and mineralization. The aim of study is to evaluate serum vitamin D concentrations in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcomes. METHODS 552 pregnant women were recruited from Tehran University educating hospitals in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum was assayed for 25-hydroxyvitamin D3, calcium, phosphorus and parathyroid hormone. RESULTS The prevalence of vitamin D deficiency in maternal and cord blood samples were 66.8% and 93.3%, respectively (<35 nmol/l). There was significant correlation between maternal and cord blood serum concentrations of vitamin D. In mothers with vitamin D deficiency, cord blood vitamin D concentrations was lower than those from normal mothers (P = .001). Also, a significant direct correlation was seen between maternal vitamin D intake and weight gain during pregnancy. CONCLUSION Consideration to adequate calcium and vitamin D intake during pregnancy is essential. Furthermore, we think it is necessary to reconsider the recommendation for vitamin D supplementation for women during pregnancy.
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Affiliation(s)
- Zhila Maghbooli
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
| | - Arash Hossein-Nezhad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
| | - Ali Reza Shafaei
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
| | - Farzaneh Karimi
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
| | - Farzaneh Sadat Madani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, 5Floor, Shariati Hospital, North Kargar Avenue, Tehran 14114, Iran
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Silva HGV, Tórtora RP, Farias MLF. Increased bone turnover during the third trimester of pregnancy and decreased bone mineral density after parturition in adolescents as compared to age-matched control patients. Gynecol Endocrinol 2005; 21:174-9. [PMID: 16335911 DOI: 10.1080/09513590500279675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
To evaluate the impact of pregnancy on bone, we studied bone turnover at the first (T1) and third (T3) trimester of gestation in 58 adolescents and 28 healthy adolescents who had never been pregnant. Total body (TB) and lumbar spine (LS) bone mineral density (BMD) and body composition were evaluated by dual-energy X-ray absorptiometry in all control patients (C) and after parturition in 28 pregnant patients (G). Paired and unpaired t tests, Mann-Whitney and Pearson correlation tests were used. Bone turnover markers were above the reference range for adult women in more than 80% of the adolescents, with no difference between C and G patients at T1. Increase in urinary N-telopeptide crosslinks of type I collagen and serum bone-specific alkaline phosphatase, markers of bone turnover, was seen during pregnancy ( p < 0.0001). Body composition did not differ between groups, but LS BMD, percentage of expected LS BMD, LS Z-score, percentage of expected TB BMD and TB Z-score were lower in G than C patients ( p < 0.05). TB BMD was positively correlated with LS BMD (r2 = 0.52). The inverse correlations between bone markers and LS BMD suggest that the increased bone turnover during pregnancy probably explains the low bone density after parturition. The impact on future peak bone mass must be studied.
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Affiliation(s)
- Henyse G V Silva
- Division of Endocrinology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janiero, Brazil
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Abstract
Adequate vitamin D concentrations during pregnancy are necessary to ensure appropriate maternal responses to the calcium demands of the fetus and neonatal handling of calcium. The purpose of this report is to review studies that investigated maternal and neonatal outcomes of vitamin D deficiency or supplementation during pregnancy. Most studies reported included women at high risk of vitamin D deficiency, because of low vitamin D and calcium intake or decreased ability to synthesize endogenous vitamin D (attributable to lack of sun exposure or to heavily pigmented skin). Overall, vitamin D supplementation in these populations leads to improved neonatal handling of calcium. Results concerning benefits for fetal growth and bone development are inconclusive. There is no evidence of a benefit of supplementation during pregnancy above amounts routinely required to prevent vitamin D deficiency.
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Affiliation(s)
- Bonny Specker
- Ethel Austin Martin Program in Human Nutrition, South Dakota State University, Brookings, SD 57007,
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Bezerra FF, Mendonça LM, Lobato EC, O'Brien KO, Donangelo CM. Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes. Am J Clin Nutr 2004; 80:1322-6. [PMID: 15531682 DOI: 10.1093/ajcn/80.5.1322] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescent mothers may be at increased risk of irreversible bone loss during pregnancy and lactation, particularly when calcium intake is low. OBJECTIVE Longitudinal changes in bone mass from lactation to postweaning were evaluated in 10 adolescent mothers aged 15-18 y who habitually consumed <500 mg Ca/d. DESIGN Total-body bone mineral content (TBBMC), total-body bone mineral density (TBBMD), and lumbar spine bone mineral density (LSBMD) were measured at lactation (6-24 wk postpartum) and after weaning (12-30 mo postpartum). Serum hormones (intact parathyroid hormone, estradiol, and prolactin), serum calcium, and markers of bone turnover [urinary N-telopeptide cross-linking region of type I collagen (NTx) and plasma activity of bone alkaline phosphatase] were measured at lactation. RESULTS TBBMC, total calcium content, TBBMD, and LSBMD increased from lactation to postweaning (P < 0.01). TBBMD and LSBMD were, respectively, 3.6% and 9.7% lower than predicted at lactation and 0.3% and 4.8% lower than predicted in the postweaning period. The increase in age-matched TBBMD adequacy was correlated with the time after resumption of menses (r = 0.86, P < 0.01). Calcium accretion from lactation to postweaning correlated negatively with estradiol (r = -0.86) and prolactin (r = -0.69) and positively with intact parathyroid hormone (r = 0.72) and NTx (r = 0.84) measured at lactation (P < 0.05). CONCLUSIONS It appears that adolescent mothers with habitually low calcium intakes recover from lactation-associated bone loss after weaning. The rate of bone accretion, however, may not be sufficient to attain peak bone mass at maturity. Hormones regulating bone turnover during lactation may influence bone recovery in adolescent mothers.
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Affiliation(s)
- Flávia F Bezerra
- Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química, Universidade Federal do Rio de Janeiro, Brazil
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FFPRHC Guidance (October 2004) Contraceptive choices for young people. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2004; 30:237-50; quiz 251. [PMID: 15530221 DOI: 10.1783/0000000042177018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vargas Zapata CL, Donangelo CM, Woodhouse LR, Abrams SA, Spencer EM, King JC. Calcium homeostasis during pregnancy and lactation in Brazilian women with low calcium intakes: a longitudinal study. Am J Clin Nutr 2004; 80:417-22. [PMID: 15277164 DOI: 10.1093/ajcn/80.2.417] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physiologic adjustments in calcium homeostasis during pregnancy and lactation in women with marginal calcium intakes have not been described. OBJECTIVE The objective was to examine longitudinal changes in various aspects of calcium homeostasis during pregnancy and lactation in 9 healthy Brazilian women who habitually consumed approximately 500 mg Ca/d. DESIGN Calcium homeostasis was assessed at 3 time points: 10-12 (early pregnancy, EP) and 34-36 (late pregnancy, LP) wk of pregnancy and 7-8 wk postpartum (early lactation, EL). At each time point, the following variables were measured: dietary calcium intake with a 3-d weighed food record, 24-h urinary calcium excretion (UCa), intestinal calcium absorption (%CaAbs) via administration of stable calcium isotopes with a breakfast meal, serum 1,25-dihydroxyvitamin D, parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and biochemical markers of bone turnover. RESULTS Dietary calcium did not change during the study. %CaAbs increased from 69.7 +/- 5.4% ( +/- SEM) during EP to 87.6 +/- 4.5% during LP (P < 0.05) and returned to 65.1 +/- 6.2% during EL. Compared with EP, UCa decreased 22% during LP and 68% during EL (P < 0.05). The net mean change in calcium retention was 212 mg/d during LP and 182 mg/d during EL. Several significant associations were found between the main outcome variables (%CaAbs, UCa, and markers of bone turnover) and serum hormones, especially IGF-I and PTH. CONCLUSIONS Calcium homeostasis appears to be attained by a more efficient intestinal calcium absorption during pregnancy and by renal calcium conservation during both pregnancy and lactation. IGF-I and PTH seem to play major roles in the adjustment of calcium metabolism during pregnancy and lactation.
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Chang SC, O'Brien KO, Nathanson MS, Caulfield LE, Mancini J, Witter FR. Fetal femur length is influenced by maternal dairy intake in pregnant African American adolescents. Am J Clin Nutr 2003; 77:1248-54. [PMID: 12716679 DOI: 10.1093/ajcn/77.5.1248] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pregnant adolescents may compete with their developing fetuses for the nutrients required for optimal bone mineralization. OBJECTIVE The objective of this study was to determine the effect in pregnant African American adolescents of maternal dairy intake at entry into prenatal care on fetal femur development between 20 and 34 wk of gestation. DESIGN A 10-y retrospective chart review was carried out in 1120 pregnant African American adolescents (<or= 17 y of age) who had received care at an inner-city maternity clinic between 1990 and 2000. Generalized multiple linear regression models were used to address significant determinants of fetal femur length after control for gestational age, biparietal diameter, maternal age and height, and prepregnancy body mass index. Dairy intake was estimated at entry into prenatal care on the basis of 24-h dietary recall and a food-frequency questionnaire. Data from 350 subjects, for whom data on all variables were available, were included in the model. RESULTS In these pregnant adolescents with a mean (+/- SD) age of 15.9 +/- 1.1 y (range: 12.7-17.9 y), dairy intake had a significant positive effect on fetal femur growth after adjustment for gestational age, biparietal diameter, maternal age and height, and prepregnancy body mass index (P = 0.001, R(2) = 0.97). Fetal femur length was significantly lower in the lowest dairy-intake group (< 2 servings/d) than in the highest dairy-intake group (> 3 servings/d), and a dose-response relation was suggested in the intermediate dairy-intake group (2-3 servings/d; P = 0.089). CONCLUSION These data suggest that consumption of < 2 servings of dairy products/d by pregnant adolescents may negatively affect fetal bone development by limiting the amount of calcium provided to the fetus.
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Affiliation(s)
- Shih-Chen Chang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Ribeiro-Alves MA, Trugo LC, Donangelo CM. Use of oral contraceptives blunts the calciuric effect of caffeine in young adult women. J Nutr 2003; 133:393-8. [PMID: 12566473 DOI: 10.1093/jn/133.2.393] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Caffeine consumption increases the urinary excretion of calcium and other minerals. Factors that affect caffeine metabolism such as steroid hormones may modify this effect. The purpose of this study was to evaluate the influence of oral contraceptive (OC) use on the 4-h urinary excretion of calcium, phosphorus, magnesium, zinc, sodium, potassium and caffeine metabolites in response to a high caffeine dose given as coffee beverage. Adult women, 20-29 y, users (+OC, n = 15) and nonusers (-OC, n = 15) of oral contraceptives, with calcium intake approximately 500 mg/d, participated in two tests, caffeine load (5 mg/kg body weight) and no-caffeine control, in a randomized crossover design. The net increase (caffeine load corrected by no caffeine) in urinary excretion of most minerals was significantly higher in -OC than in +OC (P < 0.05), with the larger group difference for calcium (ninefold) followed by magnesium (twofold), zinc (onefold) and potassium (onefold). Net increases in urinary excretion of 1-methylurate and paraxanthine were about three- and fivefold higher, respectively, in -OC than in +OC (P < 0.05) whereas net increases in urinary excretion of 5-acetylamino-6-formylamino-3-methyluracil (AFMU) and 1,7-dimethylurate were over twofold higher in the +OC than in -OC (P < 0.05). Following the caffeine load, most urinary minerals showed negative correlation with urinary 1-methylurate in -OC (R </= -0.78, P < 0.01), and with urinary AFMU and 1,7-dimethylurate in +OC (R </= -0.84, P < 0.01). Oral contraceptives appear to limit the renal effect of caffeine on mineral excretion possibly by reducing paraxanthine excretion, the most active caffeine metabolite.
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Affiliation(s)
- Mirna A Ribeiro-Alves
- Laboratório de Bioquímica Nutricional e de Alimentos, Departamento de Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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