Calcium homeostasis in second trimester fetuses

Reduced fetal vitamin D status by maternal undernutrition during discrete gestational windows in sheep

Placental transport of vitamin D and other nutrients (e.g. amino acids, fats and glucose) to the fetus is sensitive to maternal and fetal nutritional cues. We studied the effect of maternal calorific restriction on fetal vitamin D status and the placental expression of genes for nutrient transport [aromatic T-type amino acid transporter-1 (TAT-1); triglyceride hydrolase/lipoprotein uptake facilitator lipoprotein lipase (LPL)] and vitamin D homeostasis [CYP27B1; vitamin D receptor (VDR)], and their association with markers of fetal cardiovascular function and skeletal muscle growth. Pregnant sheep received 100% total metabolizable energy (ME) requirements (control), 40% total ME requirements peri-implantation [PI40, 1-31 days of gestation (dGA)] or 50% total ME requirements in late gestation (L, 104-127 dGA). Fetal, but not maternal, plasma 25-hydroxy-vitamin D (25OHD) concentration was lower in PI40 and L maternal undernutrition groups (P<0.01) compared with the control group at 0.86 gestation. PI40 group placental CYP27B1 messenger RNA (mRNA) levels were increased (P<0.05) compared with the control group. Across all groups, higher fetal plasma 25OHD concentration was associated with higher skeletal muscle myofibre and capillary density (P<0.05). In the placenta, higher VDR mRNA levels were associated with higher TAT-1 (P<0.05) and LPL (P<0.01) mRNA levels. In the PI40 maternal undernutrition group only, reduced fetal plasma 25OHD concentration may be mediated in part by altered placental CYP27B1. The association between placental mRNA levels of VDR and nutrient transport genes suggests a way in which the placenta may integrate nutritional cues in the face of maternal dietary challenges and alter fetal physiology.

Strontium biokinetic model for the pregnant woman and fetus: application to Techa River studies

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.

Bone development and mineral homeostasis in the fetus and neonate: roles of the calciotropic and phosphotropic hormones

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, the placenta meets the fetal need for mineral by actively transporting calcium, phosphorus, and magnesium from the maternal circulation. These minerals are maintained in the fetal circulation at higher concentrations than in the mother and normal adult, and such high levels appear necessary for the developing skeleton to accrete a normal amount of mineral by term. Parathyroid hormone (PTH) and calcitriol circulate at low concentrations in the fetal circulation. Fetal bone development and the regulation of serum minerals are critically dependent on PTH and PTH-related protein, but not vitamin D/calcitriol, fibroblast growth factor-23, calcitonin, or the sex steroids. After birth, the serum calcium falls and phosphorus rises before gradually reaching adult values over the subsequent 24-48 h. The intestines are the main source of mineral for the neonate, while the kidneys reabsorb mineral, and bone turnover contributes mineral to the circulation. This switch in the regulation of mineral homeostasis is triggered by loss of the placenta and a postnatal fall in serum calcium, and is followed in sequence by a rise in PTH and then an increase in calcitriol. Intestinal calcium absorption is initially a passive process facilitated by lactose, but later becomes active and calcitriol-dependent. However, calcitriol's role can be bypassed by increasing the calcium content of the diet, or by parenteral administration of calcium.

Calcium metabolism in pregnancy

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.

Calcium Homeostasis in Human Placenta: Role of Calcium‐Handling Proteins

The human placenta is a transitory organ, representing during pregnancy the unique connection between the mother and her fetus. The syncytiotrophoblast represents the specialized unit in the placenta that is directly involved in fetal nutrition, mainly involving essential nutrients, such as lipids, amino acids, and calcium. This ion is of particular interest since it is actively transported by the placenta throughout pregnancy and is associated with many roles during intrauterine life. At term, the human fetus has accumulated about 25-30 g of calcium. This transfer allows adequate fetal growth and development, since calcium is vital for fetal skeleton mineralization and many cellular functions, such as signal transduction, neurotransmitter release, and cellular growth. Thus, there are many proteins involved in calcium homeostasis in the human placenta.

Perinatal calcium metabolism: physiology and pathophysiology

Disturbances in mineral homeostasis are common in the neonatal period, especially in premature infants and infants who are hospitalised in an intensive care unit. In many cases these disturbances are thought to be exaggerated responses to the normal physiological transition from the intrauterine environment to neonatal independence. By contrast, some disturbances in calcium homeostasis are the result of genetic defects, which in many instances can now be identified at the molecular level. In other cases hypocalcaemia or hypercalcaemia may result from pathological intrauterine conditions, birth trauma or stress, or fetal immaturity. Diagnosis and management of hypocalcaemia and hypercalcaemia in the neonate and infant requires specific knowledge of perinatal mineral physiology and the unique clinical and biochemical features of newborn mineral metabolism. In this chapter we will provide a brief overview of calcium metabolism with an emphasis on the neonatal transition, followed by discussion of the common causes of hypercalcaemia and hypocalcaemia.

Optimum inorganic ion concentrations for hematopoiesis cultures

Current limitations in the ability to culture hematopoietic cells may be due to the use of ion concentrations that reflect those in the general circulation rather than those expected at hematopoietic sites. Expected changes in calcium, phosphate and hydroxyl ion are calculated indirectly using published data. Results indicate doubling of normal concentrations for the first week, followed by 2 weeks of smaller elevations as the osteon undergoes resorption and replacement. The period of 3 weeks fits the expected time of the three stages of differentiation and proliferation of erythrocytes to the maturation phase. Mimicking the high concentrations of these ions in vitro may require the development of dynamic flow cultures because of problems with precipitation of calcium phosphate crystals. After 3 weeks 10% less than normal concentrations is expected as the bone mineral is replaced over a period of months, allowing a static system for maturation.

Effects of cadmium on trophoblast calcium transport

Maternal exposure to cadmium (Cd) during pregnancy has been linked to low fetal birthweight, which may be attributed to placental damage and/or dysfunction in nutrient transport. Previous studies have suggested that Cd is accumulated in the placenta, and that placental transport of calcium (Ca) and zinc (Zn) is perturbed by Cd. To investigate the mechanism of Cd perturbation of Ca transport, we used JEG-3, a human choriocarcinoma cell line which exhibits trophoblastic properties, to analyse Cd effects in vitro. Treatment with Cd at low, physiologically relevant concentrations (e.g. 0.04 microM) did not result in obvious changes in cell morphology or integrity, whereas higher concentrations (> or = 0.16 microM) affected cell integrity. With lower concentrations of Cd treatment for 24 h, activities of cellular Ca uptake and transport, and Ca2+ binding were decreased, and intracellular [Ca2+] ([Ca2+]i) profile was also altered; however, membrane-associated Ca(2+)-activated ATPase activity remained relatively unchanged. Interestingly, cellular Ca uptake activity was unaffected by short-term (30 min) Cd pretreatment. The 24-h Cd treatment also resulted in elevated expression of the metal-binding protein, metallothionein, whereas the expression of a trophoblast-specific cytosolic Ca(2+)-binding protein (HCaBP) was drastically reduced. These results strongly suggest that Cd exposure significantly compromises the Ca handling ability of trophoblastic cells; this effect is probably not due to perturbations in Ca channel or membrane Ca pump activities, but rather a consequence of alterations in subcellular, cytosolic Ca2+ binding activities.

Primary Hyperparathyroidism During Pregnancy

OBJECTIVE

To provide an up-to-date review of primary hyperparathyroidism (HPT) as a complication of pregnancy.

METHODS

We discuss the initial manifestations of primary HPT in pregnant patients, the diagnosis, the differential diagnosis of hypercalcemia, and the recommended treatment strategies.

RESULTS

In the nonpregnant state, 50 to 80% of patients with primary HPT are asymptomatic. In contrast, pregnant patients with primary HPT have a wide variety of symptoms and findings: gastrointestinal symptoms (nausea, vomiting, and anorexia), weakness and fatigue, headaches and confusion, nephrolithiasis, bone disease, pancreatitis, urinary tract infection, and hypertension. Occasionally, neonatal hypocalcemia is the initial manifestation of maternal HPT. Diagnosis of primary HPT during pregnancy is dependent on the clinical history and laboratory findings. In general, management of maternal primary HPT during pregnancy should be individualized and based on the patient's symptoms, general medical condition, severity of disease, and gestational stage at the time of diagnosis. If HPT is diagnosed during the first two trimesters, surgical intervention is the treatment of choice.

CONCLUSION

Although uncommon, HPT during pregnancy may be associated with maternal and perinatal complications. Therefore, clinicians should be aware of the usual characteristics of this disorder and the preferred management options.

Fetal urine biochemistry in the assessment of obstructive uropathy

In 60 fetuses with obstructive uropathy, sodium, total calcium, urea, and creatinine were measured in samples obtained by "urodochocentesis" or pyelocentesis at 16 to 36 weeks' gestation. The patients were retrospectively assigned into two groups on the basis of outcome. Group 1 (n = 20) included infants who either had normal postnatal renal function or absence of prenatal renal dysplasia. Group 2 included infants who either had histologic evidence of renal dysplasia or subsequently developed renal failure. In group 1 the urinary sodium decreased and creatinine increased with gestation, demonstrating maturation in fetal renal function. In group 2 the urinary sodium and calcium were higher and the urinary urea and creatinine were lower than in group 1. The best predictor of outcome was the combination of either high calcium or high sodium with a positive predictive value of 91.3% and negative predictive value of 77.7%. In the antenatal evaluation of obstructive uropathy, fetal urinary biochemistry provides useful information for more accurate counseling of the parents and a rational basis for selecting patients who may benefit from intrauterine therapeutic interventions.

Calcium and phosphorus metabolism in the premature infant

During the last trimester of pregnancy, there is a sixfold increase in fetal calcium and phosphorus accumulation. Unsupplemented human breast milk may not provide sufficient calcium and phosphorus for the rapidly growing preterm infant to match the accumulation that should have taken place in utero and to permit normal bone mineralization. Rickets of prematurity may present clinically between the 6th and 12th postnatal week. The clinical diagnosis may be confirmed using simple biochemical tests. Inadequate mineral substrate intake, particularly of phosphorus, is the most common cause, although a delay in the maturation of the renal enzyme, 1-alpha hydroxylase, with low plasma concentrations of 1,25-dihydroxyvitamin D, may also occur. The biochemical response to treatment can be determined by documenting a fall in plasma alkaline phosphatase activity and a rise in plasma phosphate concentration and urinary phosphate excretion.

Development of endocrine pathways in the regulation of calcium homeostasis

The mammalian fetus is maintained hypercalcaemic relative to its mother by the action of a calcium pump believed to be located at the basement membranes of the epithelial cells of the fetal chorion. It has recently been demonstrated that the activity of this putative pump is stimulated by a new fetal hormone, parathyroid hormone-related protein, described originally as the product of a human BEN cell line which was derived from a lung tumour associated with hypercalcaemia of malignancy. Whereas the circulating level of immunoreactive parathyroid hormone in the fetus is very low, in keeping with the hypercalcaemia, the plasma concentrations of bioactive parathyroid hormone and parathyroid hormone-related protein can be measured using a sensitive cytochemical bioassay and the separate concentrations assessed by pre-incubation with appropriate antisera. The total plasma concentration of both hormones is inversely related to the prevailing calcium ion concentration but the set point of parathyroid hormone-related protein is probably higher than that for parathyroid hormone. Probably as a result of the hypercalcaemia, the circulating concentration of calcitonin is also higher than in maternal plasma and may serve to limit bone resorption to favour net bone accretion as part of the overall growth of the fetus. Vitamin D and its most active metabolite, 1,25(OH)2D, can pass across the placenta in either direction, in contrast to most peptide hormones. In addition to the supply of some 1,25(OH)2D by the mother to her fetus, the fetal placenta and fetal kidneys can all synthesize 1,25(OH)2D. The relative concentrations circulating in maternal and fetal plasma pools vary with the species, presumably as a result of differing importance of the three sources of supply to the fetus and the relative concentrations of vitamin D-binding protein circulating in mother and fetus. The importance of parathyroid hormone-related protein derived from fetal parathyroid glands has been clearly demonstrated in the fetal sheep. Such animals develop rickets following the removal of their parathyroid glands, despite the demonstration of this substance in fetal placental membranes. However, the relative importance of the parathyroid glands versus the placenta and its membranes as the principal source of parathyroid hormone-related protein remains to be elucidated and may vary with species.