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Eli S, Gal SG, Adnan Z. Comparison between surgical and non-surgical management of primary hyperparathyroidism during pregnancy: a systematic review. Endocrine 2024:10.1007/s12020-024-03930-0. [PMID: 38918290 DOI: 10.1007/s12020-024-03930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE The management of primary hyperparathyroidism (PHPT) during pregnancy may be surgical or conservative. This study compared adverse outcomes between surgical and non-surgical treatments. Additionally, the study investigated the correlation between serum calcium values and complication rates. METHODS A systematic review of retrospective studies, case series, and case reports. Biochemical parameters, interventions, and outcomes of each pregnancy were recorded. The study population comprised two groups: the non-surgical and surgical groups. Adverse outcomes were categorized as maternal, obstetric, or neonatal. RESULTS The surgical and non-surgical groups consisted of 163 and 185 patients, respectively. A positive correlation was observed between the mean maternal gestational calcium value and both maternal and obstetric complication. Neonatal complications were more prevalent in patients treated conservatively across all maternal calcium values (p < 0.001). No significant differences were observed in maternal outcomes and overall obstetric outcomes between the study groups, albeit a higher mean serum calcium value in the surgical group (12.3 mg/dL) compared with the non-surgical group (11.1 mg/dL). CONCLUSIONS Given the significantly lower neonatal adverse outcomes in the non-surgical group compared to the surgical group, along with non-inferior maternal and obstetric outcomes in the surgical group, the overall data of this study suggest that parathyroidectomy is favorable to non-surgical management even in cases of mild hypercalcemia.
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Affiliation(s)
- Shezifi Eli
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel
- Laniado Hospital, Netanya, Israel
| | - Shlomo Gozlan Gal
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaina Adnan
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel.
- Division of Endocrinology and Metabolism, Clalit Medical Health Care Services, Haifa and Western Galilee District, Zvulon Medical Center, Haifa, Israel.
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2
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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [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: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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3
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Ramirez Zegarra R, Degennaro V, Brandi ML, Cagninelli G, Casciaro S, Celora G, Conversano F, Lombardi FA, Pisani P, Ghi T. Longitudinal changes of the femoral bone mineral density from first to third trimester of pregnancy: bone health assessment by means of non-ionizing REMS technology. Aging Clin Exp Res 2024; 36:31. [PMID: 38334854 PMCID: PMC10858072 DOI: 10.1007/s40520-023-02677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Throughout the pregnancy, there is a substantial transfer of calcium from the maternal skeleton to the fetus, which leads to a transient net reduction of the maternal bone mineral density. AIMS To assess longitudinally the changes in the bone mineral density at the femoral neck between the first and third trimester of pregnancy in a cohort of healthy participants using Radiofrequency Echographic Multi Spectrometry (REMS) technology. METHODS Prospective, cohort study conducted at the University hospital of Parma, Italy between July 2022 and February 2023. We recruited healthy participants with an uncomplicated singleton pregnancy before 14 completed weeks of gestation. All included participants were submitted to a sonographic examination of the femoral neck to assess the bone mineral density (and the corresponding Z-score values) using REMS at 11-13 and 36-38 weeks of pregnancy. The primary outcome was the change in the bone mineral density values at the maternal femoral neck between the first and third trimester of pregnancy. RESULTS Over a period of 7 months, a total of 65 participants underwent bone mineral density measurement at the femoral neck at first and third trimester of the pregnancy using REMS. A significant reduction of the bone mineral density at the femoral neck (0.723 ± 0.069 vs 0.709 ± 0.069 g/cm2; p < 0.001) was noted with a mean bone mineral density change of - 1.9 ± 0.6% between the first and third trimester of pregnancy. At multivariable linear regression analysis, none of the demographic or clinical variables of the study population proved to be independently associated with the maternal bone mineral density changes at the femoral neck. CONCLUSIONS Our study conducted on a cohort of healthy participants with uncomplicated pregnancy demonstrates that there is a significant reduction of bone mineral density at femoral neck from early to late gestation.
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Affiliation(s)
- Ruben Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Valentina Degennaro
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Maria Luisa Brandi
- Fondazione Italiana per la Ricerca sulle Malattie dell'Osso (F.I.R.M.O.), Florence, Italy
| | - Greta Cagninelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Sergio Casciaro
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | - Gabriella Celora
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy
| | - Francesco Conversano
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
- Echolight Spa, Lecce, Italy
| | | | - Paola Pisani
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Viale A. Gramsci 14, 43126, Parma, Italy.
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Zhang Y, Li R, Zhang J, Zhou W, Yu F. Changes in Serum Concentrations of Bone Turnover Markers in Healthy Pregnant Women. Int J Clin Pract 2023; 2023:8466349. [PMID: 38145116 PMCID: PMC10748724 DOI: 10.1155/2023/8466349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/24/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023] Open
Abstract
Background Changes in bone metabolism during pregnancy have not received sufficient attention because of the lack of effective screening tools. Bone turnover markers (BTMs) could reflect the changes of bone metabolism. Currently, reference intervals for bone metabolism during normal pregnancy are inconclusive. This study aimed to determine reference intervals for BTMs in pregnant women taking prenatal care and to facilitate clinical research on diseases affecting bone metabolism during pregnancy. Methods We surveyed 120 low-risk pregnant women attending routine antenatal care from January 2020 to March 2020. The serum levels of procollagen type I N-propeptide (PINP), N-terminal osteocalcin (N-MID), and C-terminal telopeptide of type I collagen (β-CTX) were measured in the first trimester (<13 weeks), second trimester (14-27 weeks), and third trimester (>28 weeks). Reference intervals for BTMs during pregnancy were analyzed. The Kruskal-Wallis test and paired t-test are used to analyze differences between groups. Spearman correlation coefficients expressed the measure of linear association. Results The bone resorption marker β-CTX in third trimester increases compared to the first trimester and the second trimester (P < 0.001, P < 0.001). The bone formation markers PINP and N-MID were decreased from the first trimester to the second trimester (P = 0.01, P < 0.001) and then raised from the second trimester to the third trimester (P < 0.001, P < 0.001). Two indices of bone turnover rate, β-CTX/PINP and β-CTX/N-MID, were increased from the first trimester to the second trimester (P < 0.001, P < 0.001) and then decreased from the second trimester to the third trimester (P = 0.02, P < 0.001). Conclusion This study established reference intervals for BTMs in pregnant women and observed the changes in BTMs during the different trimesters of pregnancy. The present findings can help in clinical monitoring of the effects of pregnancy diseases on the bone metabolism of pregnant women.
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Affiliation(s)
- Yiduo Zhang
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ruiying Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jing Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Wenjie Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Fan Yu
- Department of Laboratory Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Nerius L, Vogel M, Ceglarek U, Kiess W, Biemann R, Stepan H, Kratzsch J. Bone turnover in lactating and nonlactating women. Arch Gynecol Obstet 2023; 308:1853-1862. [PMID: 37707552 PMCID: PMC10579129 DOI: 10.1007/s00404-023-07189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE During lactation, bone turnover increases, reflecting the mobilization of Calcium from maternal skeletal stores and resulting in bone loss. However, mechanisms are not yet fully understood, and previous studies have been comparatively small. We aim to assess bone metabolism during lactation by comparing bone-metabolism-related-parameters between large cohorts of lactating and nonlactating women. METHODS In a retrospective cohort study, we recruited 779 postpartum women and 742 healthy, nonpregnant, nonlactating controls. Postpartum women were examined 3 and 6 months after delivery and retrospectively assigned to either the exclusively breastfeeding (exc-bf) group if they had exclusively breastfed or the nonexclusively breastfeeding (nonexc-bf) group if they had not exclusively breastfed up to the respective visit. Serum levels of PTH, Estradiol, total Calcium, Phosphate, and bone turnover markers (ßCTX, P1NP, Osteocalcin) were compared between the groups. RESULTS Bone turnover markers were significantly increased in exc-bf and nonexc-bf women compared with the controls (all ps < .001). ßCTX was approximately twice as high in exc-bf women than in the controls. PTH levels were marginally higher in exc-bf (p < .001) and nonexc-bf women (p = .003) compared with the controls (6 months). Estradiol was suppressed in exc-bf women compared with the controls (p < .001, 3 months). CONCLUSION Exc-bf and even nonexc-bf states are characterized by an increase in bone formation and resorption markers. The PTH data distribution of exc-bf, nonexc-bf, and control groups in the underpart of the reference range suggest that lactational bone loss is relatively independent of PTH.
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Affiliation(s)
- Lena Nerius
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
| | - Mandy Vogel
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
| | - Uta Ceglarek
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Leipzig Research Center for Civilization Diseases, University of Leipzig, 04103, Leipzig, Germany
- Department of Women and Child Health, Hospital for Children and Adolescents and Center for Pediatric Research, University of Leipzig, 04103, Leipzig, Germany
| | - Ronald Biemann
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany
| | - Holger Stepan
- Department of Obstetrics, University of Leipzig, 04103, Leipzig, Germany
| | - Jürgen Kratzsch
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig, Paul-List-Str. 13-15, 04103, Leipzig, Germany.
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6
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Toussia-Cohen S, Eshed I, Segal O, Schonfeld M, Meyer R, Axelrod M, Gat I, Dulitzky M. Transient osteoporosis of the hip in pregnancy - a case series. J Matern Fetal Neonatal Med 2023; 36:2175659. [PMID: 36755441 DOI: 10.1080/14767058.2023.2175659] [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: 02/10/2023]
Abstract
OBJECTIVE Transient Osteoporosis of the Hip is a self-limiting disorder of severe hip joint pain presenting in pregnancy or postpartum, of which magnetic resonance imaging (MRI) is the modality of choice for diagnosis. Clinical data regarding transient osteoporosis of the hip is limited, precluding evidence-based decision-making such as recommended mode of delivery. In this case-series retrospective study, we aim to describe the natural course of transient osteoporosis of the hip during pregnancy and the postpartum period including implications of the mode of delivery. METHODS All women diagnosed with unilateral/bilateral transient osteoporosis of the hip by MRI during pregnancy or postpartum between 2010 and 2019 at a single tertiary medical center were retrospectively studied. All MRI scans were reviewed by an experienced radiologist at the same single tertiary medical center. Data obtained from patients' electronic medical records and telephone questionnaires included maternal baseline characteristics, obstetric history, and current pregnancy obstetric and clinical outcome characteristics. Outcomes of normal vaginal delivery (NVD) and cesarean delivery (CD) were compared and analyzed. RESULTS Thirty-four women were diagnosed with unilateral or bilateral transient osteoporosis of the hip during pregnancy (17 women) and postpartum (17 women). The mean maternal age was 34.18 ± 4.75 years. A family history of osteoporosis was reported in a rate of 29.4%. The rate of smokers was 47.1%, 32.4% of pregnancies were conceived by in-vitro fertilization (IVF), pre-pregnancy and term body mass index (BMI) were 22.03 and 27.6, respectively. No significant differences were found between NVD and CD in all parameters evaluated. Of 15 women with a sequential pregnancy, two were diagnosed with transient osteoporosis of the hip (13.3%). CONCLUSION Women diagnosed with transient osteoporosis of the hip had advanced maternal age, low BMI, family history of osteoporosis, prevalent smoking and IVF pregnancies. Transient osteoporosis of the hip was bilateral in 25% and presented postpartum in 50% of cases. There was no significant difference in maternal outcomes between NVD and CD. Higher awareness of this potential diagnosis during pregnancy and postpartum may improve patient management and outcomes.
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Affiliation(s)
- Shlomi Toussia-Cohen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Iris Eshed
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Radiology, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Omri Segal
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matan Schonfeld
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raanan Meyer
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michal Axelrod
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itay Gat
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechay Dulitzky
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Ramat-Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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7
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Fricke HP, Krajco CJ, Perry MJ, Brettingen LJ, Wake LA, Charles JF, Hernandez LL. Fluoxetine treatment during the postpartal period may have short-term impacts on murine maternal skeletal physiology. Front Pharmacol 2023; 14:1244580. [PMID: 38074149 PMCID: PMC10701399 DOI: 10.3389/fphar.2023.1244580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Postpartum depression affects many individuals after parturition, and selective serotonin reuptake inhibitors (SSRIs) are often used as the first-line treatment; however, both SSRIs and lactation are independently associated with bone loss due to the role of serotonin in bone remodeling. Previously, we have established that administration of the SSRI fluoxetine during the peripartal period results in alterations in long-term skeletal characteristics. In the present study, we treated mice with either a low or high dose of fluoxetine during lactation to determine the consequences of the perturbation of serotonin signaling during this time period on the dam skeleton. We found that lactational fluoxetine exposure affected both cortical and trabecular parameters, altered gene expression and circulating markers of bone turnover, and affected mammary gland characteristics, and that these effects were more pronounced in the dams that were exposed to the low dose of fluoxetine in comparison to the high dose. Fluoxetine treatment during the postpartum period in rodents had short term effects on bone that were largely resolved 3 months post-weaning. Despite the overall lack of long-term insult to bone, the alterations in serotonin-driven lactational bone remodeling raises the question of whether fluoxetine is a safe option for the treatment of postpartum depression.
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Affiliation(s)
- Hannah P. Fricke
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Chandler J. Krajco
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Molly J. Perry
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Lauren J. Brettingen
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Lella A. Wake
- Departments of Orthopedics and Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Julia F. Charles
- Departments of Orthopedics and Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Laura L. Hernandez
- Endocrinology and Reproductive Physiology Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Animal and Dairy Sciences, University of Wisconsin-Madison, Madison, WI, United States
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8
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Augustine M, Boudreau R, Cauley JA, Majchel D, Nagaraj N, Roe LS, Sood P, Stewart AF, Horwitz MJ. Bone Mineral Density During and After Lactation: A Comparison of African American and Caucasian Women. Calcif Tissue Int 2023; 113:426-436. [PMID: 37640959 PMCID: PMC10516787 DOI: 10.1007/s00223-023-01125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
During lactation, changes in maternal calcium metabolism are necessary to provide adequate calcium for newborn skeletal development. The calcium in milk is derived from the maternal skeleton through a process thought to be mediated by the actions of parathyroid hormone-related protein (PTHrP) in combination with decreased circulating estrogen concentrations. After weaning, bone lost during lactation is rapidly regained. Most studies of bone metabolism in lactating women have been performed in Caucasian subjects. There are well-documented differences between African American (AA) and Caucasian (C) bone metabolism, including higher bone mineral density (BMD), lower risk of fracture, lower 25-hydroxyvitamin D (25(OH) D), and higher PTH in AA compared to C. In this prospective paired cohort study, BMD and markers of bone turnover were compared in self-identified AA and C mothers during lactation and after weaning. BMD decreased in both AA and C women during lactation, with similar decreases at the lumbar spine (LS) and greater bone loss in the C group at the femoral neck (FN) and total hip (TH), demonstrating that AA are not resistant to PTHrP during lactation. BMD recovery compared to the 2 week postpartum baseline was observed 6 months after weaning, though the C group did not have complete recovery at the FN. Increases in markers of bone formation and resorption during lactation were similar in AA and C. C-terminal telopeptide (CTX) decreased to 30% below post-pregnancy baseline in both groups 6 months after weaning, while procollagen type 1 N-terminal (P1NP) returned to baseline in the AA group and fell to below baseline in the C group. Further investigation is required to determine impacts on long term bone health for women who do not fully recover BMD before a subsequent pregnancy.
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Affiliation(s)
| | - Robert Boudreau
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Jane A Cauley
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | | | | | - Lauren S Roe
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | | | | | - Mara J Horwitz
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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9
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John Levy Barnett M. A Scoping Review of the Apparent Phenomenon of the Improvement in Hypoparathyroidism in Pregnant and Postpartum Females. Cureus 2023; 15:e46123. [PMID: 37790033 PMCID: PMC10544865 DOI: 10.7759/cureus.46123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
Hypoparathyroidism requires management with both calcium supplementation and active vitamin D to avert a state of hypocalcemia. During late gestation and the postpartum period (specifically lactation), there is an under-recognized, yet intriguing occurrence of apparent 'pseudohyperparathyroidism', whereby supplementation dosages may need to either be reduced or discontinued, to prevent hypercalcemia. The explanation for this apparent phenomenon of improved parathyroid status ('remission' or 'resolution') is incompletely understood; the purpose of this review is to analyze the case reports of this enigma within the medical (and grey) literature, providing an overall pathophysiological explanation and recommendation for the management of such patients. A literature search was conducted through PubMed/Medline, CINAHL, Cochrane Library Database, Scopus, UpToDate, Google Scholar, and the grey literature without a time-restricted period, analyzing all available articles within the literature describing an apparent improvement in parathyroid status in late-gestation and postpartum (lactating) females. Non-hypoparathyroid case reports were also included to further analyze and synthesize an overall likely pathophysiological explanation. Through the literature search, 24 papers were identified covering such a phenomenon in patients with hypoparathyroidism, alongside multiple additional reports of a similar occurrence in patients without underlying hypoparathyroidism. The pathophysiology is believed to occur due to the placental production of parathyroid hormone-related peptide (PTHrP) during gestation, with further production from the lactating mammary glands during the postpartum period. A typical pattern is observed, with increased PTHrP and suppressed PTH throughout both gestation and lactation (present in both normal and hypoparathyroid subjects). The concept of PTHrP-induced hypercalcemia is further demonstrated in patients without hypoparathyroidism, including subjects with placental hypersecretion and mammary gland enlargement. It is evident that patients with hypoparathyroidism may require a dosage reduction during late gestation and lactation, due to the risk for hypercalcemia. In addition to patients with hypoparathyroidism, this pathophysiological phenomenon occurs in unsuspecting patients, demonstrating the need for all clinicians in contact with pregnant females to be aware of this uncommon - yet perilous - occurrence.
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10
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Athonvarangkul D, Wysolmerski JJ. Crosstalk within a brain-breast-bone axis regulates mineral and skeletal metabolism during lactation. Front Physiol 2023; 14:1121579. [PMID: 36875035 PMCID: PMC9979219 DOI: 10.3389/fphys.2023.1121579] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
To support the increased calcium demands for milk production during lactation, a dramatic and reversible physiological response occurs to alter bone and mineral metabolism. This coordinated process involves a brain-breast-bone axis that integrates hormonal signals that allow for adequate calcium delivery to milk yet also protects the maternal skeletal from excessive bone loss or decreases in bone quality or function. Here, we review the current knowledge on the crosstalk between the hypothalamus, mammary gland, and skeleton during lactation. We discuss the rare entity of pregnancy and lactation associated osteoporosis and consider how the physiology of bone turnover in lactation may impact the pathophysiology of postmenopausal osteoporosis. Further understanding of the regulators of bone loss during lactation, particularly in humans, may provide insights into new therapies for osteoporosis and other diseases of excess bone loss.
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Affiliation(s)
- Diana Athonvarangkul
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States
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11
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Tung PW, Kennedy EM, Burt A, Hermetz K, Karagas M, Marsit CJ. Prenatal lead (Pb) exposure is associated with differential placental DNA methylation and hydroxymethylation in a human population. Epigenetics 2022; 17:2404-2420. [PMID: 36148884 PMCID: PMC9665158 DOI: 10.1080/15592294.2022.2126087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022] Open
Abstract
Prenatal lead (Pb) exposure is associated with adverse developmental outcomes and to epigenetic alterations such as DNA methylation and hydroxymethylation in animal models and in newborn blood. Given the importance of the placenta in foetal development, we sought to examine how prenatal Pb exposure was associated with differential placental DNA methylation and hydroxymethylation and to identify affected biological pathways linked to developmental outcomes. Maternal (n = 167) and infant (n = 172) toenail and placenta (n = 115) samples for prenatal Pb exposure were obtained from participants in a US birth cohort, and methylation and hydroxymethylation data were quantified using the Illumina Infinium MethylationEPIC BeadChip. An epigenome-wide association study was applied to identify differential methylation and hydroxymethylation associated with Pb exposure. Biological functions of the Pb-associated genes were determined by overrepresentation analysis through ConsensusPathDB. Prenatal Pb quantified from maternal toenail, infant toenail, and placenta was associated with 480, 27, and 2 differentially methylated sites (q < 0.05), respectively, with both increases and decreases associated with exposure. Alternatively, we identified 2, 1, and 14 differentially hydroxymethylated site(s) associated with maternal toenail, infant toenail, and placental Pb, respectively, with most showing increases in hydroxymethylation with exposure. Significantly overrepresented pathways amongst genes associated with differential methylation and hydroxymethylation (q < 0.10) included mechanisms pertaining to nervous system and organ development, calcium transport and regulation, and signalling activities. Our results suggest that both methylation and hydroxymethylation in the placenta can be variable based on Pb exposure and that the pathways impacted could affect placental function.
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Affiliation(s)
- Pei Wen Tung
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Elizabeth M. Kennedy
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Amber Burt
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Karen Hermetz
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
| | - Margaret Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, Lebanon
| | - Carmen J. Marsit
- Gangarosa Department of Environmental Health, Emory University, Atlanta, GA, USA
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12
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KIANI AYSHAKARIM, DHULI KRISTJANA, DONATO KEVIN, AQUILANTI BARBARA, VELLUTI VALERIA, MATERA GIUSEPPINA, IACONELLI AMERIGO, CONNELLY STEPHENTHADDEUS, BELLINATO FRANCESCO, GISONDI PAOLO, BERTELLI MATTEO. Main nutritional deficiencies. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E93-E101. [PMID: 36479498 PMCID: PMC9710417 DOI: 10.15167/2421-4248/jpmh2022.63.2s3.2752] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nutrition is the source of energy that is required to carry out all the processes of human body. A balanced diet is a combination of both macro- and micronutrients. "Nutritional inadequacy" involves an intake of nutrients that is lower than the estimated average requirement, whereas "nutritional deficiency" consists of severely reduced levels of one or more nutrients, making the body unable to normally perform its functions and thus leading to an increased risk of several diseases like cancer, diabetes, and heart disease. Malnutrition could be caused by environmental factors, like food scarcity, as well as disease conditions, like anorexia nervosa, fasting, swallowing inability, persistent vomiting, impaired digestion, intestinal malabsorption, or other chronic diseases. Nutritional biomarkers - like serum or plasma levels of nutrients such as folate, vitamin C, B vitamins, vitamin D, selenium, copper, zinc - could be used for the evaluation of nutrient intake and dietary exposure. Macronutrients deficiencies could cause kwashiorkor, marasmus, ketosis, growth retardation, wound healing, and increased infection susceptibility, whereas micronutrient - like iron, folate, zinc, iodine, and vitamin A - deficiencies lead to intellectual impairment, poor growth, perinatal complications, degenerative diseases associated with aging and higher morbidity and mortality. Preventing macro- and micronutrient deficiency is crucial and this could be achieved through supplementation and food-based approaches.
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Affiliation(s)
| | | | - KEVIN DONATO
- MAGI EUREGIO, Bolzano, Italy
- Correspondence: Kevin Donato, MAGI EUREGIO, Bolzano,
39100, Italy. E-mail:
| | - BARBARA AQUILANTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli
IRCCS, Rome, Italy
| | - VALERIA VELLUTI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli
IRCCS, Rome, Italy
| | - GIUSEPPINA MATERA
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli
IRCCS, Rome, Italy
| | - AMERIGO IACONELLI
- UOSD Medicina Bariatrica, Fondazione Policlinico Agostino Gemelli
IRCCS, Rome, Italy
| | - STEPHEN THADDEUS CONNELLY
- San Francisco Veterans Affairs Health Care System,
Department of Oral & Maxillofacial Surgery, University of
California, San Francisco, CA, USA
| | - FRANCESCO BELLINATO
- Section of Dermatology and Venereology, Department of
Medicine, University of Verona, Verona,
Italy
| | - PAOLO GISONDI
- Section of Dermatology and Venereology, Department of
Medicine, University of Verona, Verona,
Italy
| | - MATTEO BERTELLI
- MAGI EUREGIO, Bolzano, Italy
- MAGI’S LAB, Rovereto (TN),
Italy
- MAGISNAT, Peachtree Corners (GA),
USA
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13
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Siva S, Liao Q, Abbas A, Periasamy K. Bilateral atraumatic femoral neck fractures resulting from transient osteoporosis of the hip. BMJ Case Rep 2022; 15:e247967. [PMID: 36253010 PMCID: PMC9577900 DOI: 10.1136/bcr-2021-247967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A woman in her mid-30s presented to the orthopaedic team, unable to mobilise, shortly after her caesarean section. On questioning, she reported 10 weeks of atraumatic right hip pain. A radiograph revealed a displaced right subcapital neck of femur fracture. An MRI confirmed this, as well as identifying a minimally displaced left subcapital neck of femur fracture. She underwent a right total hip replacement and internal fixation of the left hip. A dual energy X-ray absorptiometry (DEXA) scan showed severe osteoporosis, and a diagnosis of transient osteoporosis of the hip was made. She was seen by the bone metabolism team and given calcium and vitamin D medication. Although atraumatic hip fractures are rare in young patients, disproportionate or persisting hip pain in pregnant patients should raise the index of suspicion and prompt further investigation in the form of an MRI. This will allow timely management of hip fractures and improve patient outcomes.
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Affiliation(s)
- Soorya Siva
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
| | - Quintin Liao
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
| | - Ammar Abbas
- Orthopaedics, Wishaw General Hospital, Wishaw, UK
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14
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Mayer CA, Roos B, Teske J, Wells N, Martin RJ, Chang W, Pabelick CM, Prakash YS, MacFarlane PM. Calcium-sensing receptor and CPAP-induced neonatal airway hyperreactivity in mice. Pediatr Res 2022; 91:1391-1398. [PMID: 33958714 PMCID: PMC8571113 DOI: 10.1038/s41390-021-01540-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) in preterm infants is initially beneficial, but animal models suggest longer term detrimental airway effects towards asthma. We used a neonatal CPAP mouse model and human fetal airway smooth muscle (ASM) to investigate the role of extracellular calcium-sensing receptor (CaSR) in these effects. METHODS Newborn wild type and smooth muscle-specific CaSR-/- mice were given CPAP for 7 days via a custom device (mimicking CPAP in premature infants), and recovered in normoxia for another 14 days (representing infants at 3-4 years). Airway reactivity was tested using lung slices, and airway CaSR quantified. Role of CaSR was tested using NPS2143 (inhibitor) or siRNA in WT mice. Fetal ASM cells stretched cyclically with/without static stretch mimicking breathing and CPAP were analyzed for intracellular Ca2+ ([Ca2+]i) responses, role of CaSR, and signaling cascades. RESULTS CPAP increased airway reactivity in WT but not CaSR-/- mice, increasing ASM CaSR. NPS2143 or CaSR siRNA reversed CPAP effects in WT mice. CPAP increased fetal ASM [Ca2+]I, blocked by NPS2143, and increased ERK1/2 and RhoA suggesting two mechanisms by which stretch increases CaSR. CONCLUSIONS These data implicate CaSR in CPAP effects on airway function with implications for wheezing in former preterm infants. IMPACT Neonatal CPAP increases airway reactivity to bronchoconstrictor agonist. CPAP increases smooth muscle expression of the extracellular calcium-sensing receptor (CaSR). Inhibition or absence of CaSR blunts CPAP effects on contractility. These data suggest a causal/contributory role for CaSR in stretch effects on the developing airway. These data may impact clinical recognition of the ways that CPAP may contribute to wheezing disorders of former preterm infants.
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Affiliation(s)
- Catherine A Mayer
- Department of Pediatrics, Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Benjamin Roos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Jacob Teske
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Natalya Wells
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Richard J Martin
- Department of Pediatrics, Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Wenhan Chang
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Christina M Pabelick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - YS Prakash
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Peter M MacFarlane
- Department of Pediatrics, Division of Neonatology, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
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15
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Kazama K, Nishio T, Nagane M, Arai S, Onda K. Relationship of parathyroid hormone-related protein and neonatal mineral metabolism in dairy cow placentas. Anim Sci J 2022; 93:e13723. [PMID: 35470917 DOI: 10.1111/asj.13723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/12/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
Parathyroid hormone-related protein (PTHrP) plays essential roles in placental calcium (Ca) transport, and it has been speculated that PTHrP in the placenta is regulated by calcium-sensing receptors (CaSR). This study clarified the relationship between PTHrP in the placenta of dairy cows and minerals in the fetal blood. Blood samples were obtained from 21 Holstein cows and 17 neonatal calves as well as 12 umbilical veins and arteries during cesarean section. After fetus removal, 13 caruncles and cotyledons were obtained. Concentrations of plasma PTHrP and serum minerals were measured. Real-time polymerase chain reaction (RT-qPCR) analyzed the gene expression of PTHrP and CaSR in the placenta. As a result, serum Ca and inorganic phosphorus concentrations in the neonate, umbilical vein, and artery were significantly higher than in the mother. Additionally, plasma PTHrP was detected in the bovine neonatal jugular vein, umbilical artery, and vein. PTHrP gene expression was significantly higher in the caruncles than in cotyledons; however, CaSR gene expression was higher in the cotyledons than in caruncles. These findings suggest that the PTHrP obtained from the placenta influences Ca homeostasis in the bovine fetus.
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Affiliation(s)
- Kei Kazama
- School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Takuma Nishio
- School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Masaki Nagane
- School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Sachiko Arai
- School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Ken Onda
- School of Veterinary Medicine, Azabu University, Sagamihara, Japan
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16
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Ishida T, Yuri H, Nakamura E, Isoda K, Wada Y, Kotani T, Takeuchi T. Low pre-pregnant body mass index is a risk factor for the decrease of postpartum bone mineral density in systemic lupus erythematosus patients received glucocorticoid therapy. Lupus 2022; 31:848-854. [PMID: 35440212 DOI: 10.1177/09612033221094710] [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: 11/16/2022]
Abstract
OBJECTIVES This study investigated postpartum bone mineral density (BMD) in patients with systemic lupus erythematosus (SLE) receiving long-term glucocorticoid (GC) therapy, assessed risk factors for decreased postpartum BMD, and evaluated change of BMD after postpartum initiation or restarting of osteoporosis drugs. METHODS We retrospectively examined 30 SLE patients who gave birth and 31 non-pregnant SLE patients. In the postpartum SLE patients, BMD was measured after delivery and 1 year later. Multivariate analyses were performed to assess risk factors for decreased BMD in postpartum SLE patients. RESULTS Patient age at pregnancy was 34.5 ± 4.5 years, and SLE duration was 9.7 ± 6.0 years. The mean prednisolone dose was 9.7 ± 3.2 mg/day. Body mass index (BMI) was 21.6 ± 2.2 kg/m2, with 13 women (43%) experiencing their first delivery. Postpartum BMD was 1.080 ± 0.120 g/cm2 in the lumbar spine and 0.834 ± 0.109 g/cm2 in the total hip. Bone loss occurred in six patients (21%) in the lumbar spine and 11 patients (37%) in the total hip. Postpartum lumbar spine BMD was significantly reduced compared to that in the non-pregnant group (1.143 ± 0.120 g/cm2, p = 0.048). Multivariate analysis identified gestational age and low BMI before pregnancy as risk factors for hip bone loss. CONCLUSION Postpartum BMD significantly decrease in SLE patients receiving long-term GC, and low BMI before pregnancy was a risk factor for the decrease. Preconception care to prevent osteoporosis and that regularly monitors BMD after delivery are needed.
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Affiliation(s)
- Takaaki Ishida
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.,Department of Internal Medicine, Santamaria Hospital, Osaka, Japan
| | - Hiramatsu Yuri
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Eri Nakamura
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Kentaro Isoda
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan.,Department of Rheumatology and Allergology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan
| | - Yumiko Wada
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Takuya Kotani
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Tohru Takeuchi
- Division of Rheumatology, Department of Internal Medicine (IV), 13010Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
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17
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Khattar V, Wang L, Peng JB. Calcium selective channel TRPV6: Structure, function, and implications in health and disease. Gene 2022; 817:146192. [PMID: 35031425 PMCID: PMC8950124 DOI: 10.1016/j.gene.2022.146192] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022]
Abstract
Calcium-selective channel TRPV6 (Transient Receptor Potential channel family, Vanilloid subfamily member 6) belongs to the TRP family of cation channels and plays critical roles in transcellular calcium (Ca2+) transport, reuptake of Ca2+ into cells, and maintaining a local low Ca2+ environment for certain biological processes. Recent crystal and cryo-electron microscopy-based structures of TRPV6 have revealed mechanistic insights on how the protein achieves Ca2+ selectivity, permeation, and inactivation by calmodulin. The TRPV6 protein is expressed in a range of epithelial tissues such as the intestine, kidney, placenta, epididymis, and exocrine glands such as the pancreas, prostate and salivary, sweat, and mammary glands. The TRPV6 gene is a direct transcriptional target of the active form of vitamin D and is efficiently regulated to meet the body's need for Ca2+ demand. In addition, TRPV6 is also regulated by the level of dietary Ca2+ and under physiological conditions such as pregnancy and lactation. Genetic models of loss of function in TRPV6 display hypercalciuria, decreased bone marrow density, deficient weight gain, reduced fertility, and in some cases alopecia. The models also reveal that the channel plays an indispensable role in maintaining maternal-fetal Ca2+ transport and low Ca2+ environment in the epididymal lumen that is critical for male fertility. Most recently, loss of function mutations in TRPV6 gene is linked to transient neonatal hyperparathyroidism and early onset chronic pancreatitis. TRPV6 is overexpressed in a wide range of human malignancies and its upregulation is strongly correlated to tumor aggressiveness, metastasis, and poor survival in selected cancers. This review summarizes the current state of knowledge on the expression, structure, biophysical properties, function, polymorphisms, and regulation of TRPV6. The aberrant expression, polymorphisms, and dysfunction of this protein linked to human diseases are also discussed.
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Affiliation(s)
- Vinayak Khattar
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Lingyun Wang
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Ji-Bin Peng
- Division of Nephrology, Department of Medicine, Nephrology Research and Training Center, Department of Urology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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18
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Scurt FG, Morgenroth R, Bose K, Mertens PR, Chatzikyrkou C. Pr-AKI: Acute Kidney Injury in Pregnancy – Etiology, Diagnostic Workup, Management. Geburtshilfe Frauenheilkd 2022; 82:297-316. [PMID: 35250379 PMCID: PMC8893985 DOI: 10.1055/a-1666-0483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/09/2021] [Indexed: 10/29/2022] Open
Abstract
AbstractDespite significant improvements in inpatient and outpatient management, pregnancy-related acute kidney injury (Pr-AKI) remains an important risk factor for early and late maternal and
fetal morbidity and mortality. There is a discrepancy between the incidence of Pr-AKI in developing and in developed countries, with the former experiencing a decrease and the latter an
increase in Pr-AKI in recent decades. Whereas septic and hemorrhagic complications predominated in the past, nowadays hypertensive disorders and thrombotic microangiopathy are the leading
causes of Pr-AKI. Modern lifestyles and the availability and widespread use of in-vitro fertilization techniques in industrialized countries have allowed more women of advanced age to become
pregnant. This has led to a rise in the percentage of high-risk pregnancies due to the disorders and comorbidities inherent to or accompanying aging, such as diabetes, arterial hypertension
and preexisting chronic kidney disease. Last but not least, the heterogeneity of symptoms, the often overlapping clinical and laboratory characteristics and the pathophysiological changes
related to pregnancy make the diagnosis and management of Pr-AKI a difficult and challenging task for the treating physician. In addition to general supportive management strategies such as
volume substitution, blood pressure control, prevention of seizures or immediate delivery, each disease entity requires a specific therapy to reduce maternal and fetal complications. In this
review, we used the current literature to provide a summary of the physiologic and pathophysiologic changes in renal physiology which occur during pregnancy. In the second part, we present
common and rare disorders which lead to Pr-AKI and provide an overview of the available treatment options.
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Affiliation(s)
- Florian G. Scurt
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Ronnie Morgenroth
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Katrin Bose
- Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Peter R. Mertens
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Christos Chatzikyrkou
- PHV-Dialysezentrum, Halberstadt, Germany
- Klinik für Nephrologie, Medizinische Hochschule Hannover, Hannover, Germany
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19
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Koumakis E, Cormier-Daire V, Dellal A, Debernardi M, Cortet B, Debiais F, Javier RM, Thomas T, Mehsen-Cetre N, Cohen-Solal M, Fontanges E, Laroche M, Porquet-Bordes V, Marcelli C, Benachi A, Briot K, Roux C, Cormier C. Osteogenesis Imperfecta: characterization of fractures during pregnancy and post-partum. Orphanet J Rare Dis 2022; 17:22. [PMID: 35090500 PMCID: PMC8796450 DOI: 10.1186/s13023-021-02148-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Pregnancy and breastfeeding are associated with bone density loss. Fracture occurrence during pregnancy and post-partum, and its determinants, remain poorly known in Osteogenesis Imperfecta (OI). The aim of this study was to characterize fractures that occurred during pregnancy and post-partum in OI patients. Results We conducted a retrospective multicentric study including a total of 50 previously pregnant OI women from 10 Bone Centers in France. Among these patients, 12 (24%) patients experienced fractures during pregnancy or in the 6 months following delivery, and 38 (76%) did not experience any fracture. The most frequent localizations were: proximal femur (25%), spine (25%), distal femur (12.5%), and pelvis (12.5%). Fractures during pregnancy occurred during the third trimester and post-partum fractures occurred with a mean delay of 2 months following delivery. No fractures occurred during childbirth. We next compared the 12 patients with pregnancy or post-partum fractures with the 38 patients without fractures. Mean age at pregnancy was 32.7 ± 3.1 years-old in the fractured group, vs 29.3 ± 5.0 years-old in the non-fractured group (p = 0.002). Breastfeeding was reported in 85.7% of patients in the fractured group, vs 47.1% in the non-fractured group (p = 0.03). All patients with post-partum fractures were breastfeeding. Bone mineral density was significantly lower in patients with pregnancy-related fractures compared with other patients: spine Z-score − 2.9 ± 1.6DS vs − 1.5 ± 1.7DS (p = 0.03), and total hip Z-score − 2.0 ± 0.7DS vs − 0.5 ± 1.4DS (p = 0.04). At least one osteoporosis-inducing risk factor or disease other than OI was identified in 81.8% vs 58.6% of fractured vs non-fractured patients (not significant). Fracture during pregnancy or post-partum was not associated with the severity of OI. Bisphosphonates before pregnancy were reported in 16.7% and 21.1% of patients with pregnancy-related fractures and non-fractured patients, respectively (not significant). Conclusions OI management during pregnancy and post-partum should aim for optimal control of modifiable osteoporosis risk factors, particularly in patients with low BMD. Breastfeeding should be avoided.
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Affiliation(s)
- Eugénie Koumakis
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France.
| | - Valérie Cormier-Daire
- Clinical Genetics, Reference Center for bone disorders, INSERM UMR 1163, Imagine Institute, Necker Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - Azeddine Dellal
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marc Debernardi
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Bernard Cortet
- Department of Rheumatology and ULR 4490 (MABLAB), Competence Center for Rare Genetic Bone Disorders, University-Hospital of Lille, 59000, Lille, France
| | - Françoise Debiais
- Department of Rheumatology, CHU Poitiers; CNRS ERL7003, University of Poitiers, Poitiers, France
| | - Rose-Marie Javier
- Rheumatology Department, Competence Center for Rare Genetic Bone Disorders, University-Hospital of Strasbourg, 67098, Strasbourg, France
| | - Thierry Thomas
- Department of Rheumatology, CHU Saint-Etienne, INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - Nadia Mehsen-Cetre
- Service de Rhumatologie, Centre de Compétence MOC et Dysplasie Fibreuse, CHU Bordeaux-Tripode, Bordeaux, France
| | - Martine Cohen-Solal
- Biocar Inserm U1132 and Université de Paris, Hôpital Lariboisière, 75010, Paris, France
| | - Elisabeth Fontanges
- Department of Rheumatology, Hôpital Edouard Herriot, CHU de Lyon, Lyon, France
| | - Michel Laroche
- Centre de Rhumatologie, CHU Purpan, 1 place du Dr Baylac, 31059, Toulouse Cedex, France
| | - Valérie Porquet-Bordes
- Endocrine, Bone Diseases, and Genetics Unit, Reference Centre for Rare Diseases of the Calcium and Phosphate Metabolism, ERN BOND, OSCAR Network, Children's Hospital, Toulouse University Hospital, Toulouse, France
| | | | - Alexandra Benachi
- Departement of Obstetrics, Gynecology and Reproductive Medicine, Hôpital Antoine-Béclère - Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Karine Briot
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Christian Roux
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.,INSERM UMR 1153, INSERM, PRESS Sorbonne Paris-Cité, Paris, France
| | - Catherine Cormier
- Rheumatology Department, Cochin Hospital, Paris, AP-HP Centre-Paris University, Reference Center for Rare Genetic Bone Disorders-Cochin-constitutive site, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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20
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Gharibeh N, Razaghi M, Vanstone CA, Wei S, McNally D, Rauch F, Jones G, Kaufmann M, Weiler HA. Maternal Vitamin D Status and Gestational Weight Gain as Correlates of Neonatal Bone Mass in Healthy Term Breastfed Young Infants from Montreal, Canada. Nutrients 2021; 13:nu13124189. [PMID: 34959742 PMCID: PMC8708298 DOI: 10.3390/nu13124189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/12/2022] Open
Abstract
The implications of maternal gestational weight gain (GWG) and vitamin D status to neonatal bone health are unclear. We tested whether maternal 25-hydroxyvitamin D (25(OH)D) and GWG relate to neonatal bone mineral content (BMC) and bone mineral density (BMD). Healthy term appropriate for gestational age breastfed neonates (n = 142) and their mothers were recruited 24–36 h after delivery and followed at 1.0 ± 0.5 month. At birth, obstetric data were collected and newborn serum 25(OH)D was measured. At 1 month, neonatal whole-body (WB) BMC, WB BMC relative to body weight (WB BMC/kg), lumbar spine BMC and BMD, maternal and neonatal 25(OH)D concentrations, and anthropometry were measured. Infant BMC and BMD between maternal 25(OH)D (<50, ≥50 nmol/L) and GWG (insufficient, adequate, and excessive) categories were compared. Maternal 25(OH)D was not related to infant whole-body BMC, BMC/kg, lumbar spine BMC, and BMD. Infants in the excessive maternal GWG category had greater (p = 0.0003) whole-body BMC and BMC/kg and lumbar spine BMC and BMD than inadequate GWG, and greater (p = 0.0063) whole-body BMC/kg and lumbar spine BMC and BMD than adequate GWG. These results suggest that maternal GWG, but not vitamin D status, modestly relates to bone mass in neonates.
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Affiliation(s)
- Nathalie Gharibeh
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - Maryam Razaghi
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - Catherine A. Vanstone
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
| | - ShuQin Wei
- Institut National de santé Publique du Québec, Montréal, QC G1V 5B3, Canada;
| | - Dayre McNally
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON K1H 8L1, Canada;
| | - Frank Rauch
- Shriners Hospital for Children, Montréal, QC H4A 0A9, Canada;
| | - Glenville Jones
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (G.J.); (M.K.)
| | - Martin Kaufmann
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada; (G.J.); (M.K.)
| | - Hope A. Weiler
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (N.G.); (M.R.); (C.A.V.)
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, ON K1A 0K9, Canada
- Correspondence: ; Tel.: +1-613-297-6158
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21
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Femoral µCT Analysis, Mechanical Testing and Immunolocalization of Bone Proteins in β-Hydroxy β-Methylbutyrate (HMB) Supplemented Spiny Mouse in a Model of Pregnancy and Lactation-Associated Osteoporosis. J Clin Med 2021; 10:jcm10214808. [PMID: 34768327 PMCID: PMC8584851 DOI: 10.3390/jcm10214808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
A metabolite of leucine, ß-hydroxy-ß-methylbutyrate (HMB), used as a dietary supplement effects muscle tissue gain and bone tissue quality. Since there are no studies on the effects of HMB during pregnancy yet, the aim of the current study was to determine the effects of HMB supplementation during pregnancy on osteoporotic bone quality postpartum and post-lactation using spiny mice (Acomys cahirinus) as the animal models. The six-month-old dams were divided into four groups: pregnant and lactating controls, and pregnant and lactating HMB-treated (during the second trimester of pregnancy) females. The intensity of the immunoreaction of osteocalcin (OC), osteoprotegerin (OPG), bone morphogenetic protein 2 (BMP-2), tissue inhibitor of metalloproteinases 2 (TIMP-2), matrix metalloproteinase 8 and 13 (MMP-8 and MMP-13) and proteins involved in bone turnover, was measured in femoral trabecular and compact bone, as well as in the hyaline and epiphyseal cartilage of the femora. The analysis of the trabecular bone microarchitecture showed that the administration of HMB to pregnant females, by influencing the proteins responsible for bone cell activity and collagen remodeling, can provide protection from bone loss. Based on the results of the current study it can be assumed that HMB administration to pregnant females has a more positive impact on trabecular than compact bone.
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Mitsiakos G, Katsaras GN, Chatziioannidis I, Gkampeta A, Mitsiakou C, Nikolaidis N. A neonate with late-onset hypocalcemia due to unrecognized maternal hyperparathyroidism and a systematic overview of similar cases. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2021; 19:Doc09. [PMID: 34539299 PMCID: PMC8422796 DOI: 10.3205/000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/03/2021] [Indexed: 11/30/2022]
Abstract
Objective: Neonatal seizures are alarming manifestations of an underlying significant disorder demanding immediate attention and intervention. Hypocalcemia, although rare, must be considered in the differential diagnosis of neonatal seizures. Method: We present an unusual case of a 10-day-old infant with unexplained symptomatic hypocalcemia, experiencing multiple episodes of focal tonic-clonic seizures, born by an entirely asymptomatic mother. Moreover, we conducted a systematic search in PubMed and Scopus databases to present a clinical overview of all similar cases. Result: Maternal laboratory investigation revealed markedly increased calcium levels with concomitant high parathyroid hormone levels due to a parathyroid adenoma, undiagnosed during antenatal checkup. Conclusion: This is one of the few cases in the literature where neonatal symptomatology led to the diagnosis of undiagnosed maternal hyperparathyroidism. Early detection and appropriate management of neonatal hypocalcemia could eliminate serious maternal and fetal morbidity.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
| | - Georgios N Katsaras
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
| | - Ilias Chatziioannidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
| | - Anastasia Gkampeta
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
| | - Christina Mitsiakou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
| | - Nikolaos Nikolaidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Greece
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Zhang L, Piao X. Use of 25-hydroxyvitamin D 3 in diets for sows: A review. ACTA ACUST UNITED AC 2021; 7:728-736. [PMID: 34466677 PMCID: PMC8379139 DOI: 10.1016/j.aninu.2020.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/08/2020] [Accepted: 11/21/2020] [Indexed: 12/19/2022]
Abstract
Dietary supplementation with 25-hydroxyvitamin D3 (25OHD3), as an alternative source of vitamin D, is becoming increasingly popular due to its commercialization and more efficient absorbability. The addition of 25OHD3 rather than its precursor vitamin D3 can circumvent the 25-hydroxylation reaction in the liver, indicating that supplementation of 25OHD3 can rapidly improve the circulating vitamin D status of animals. Emerging experiments have reported that maternal 25OHD3 supplementation could increase sow performances and birth outcomes and promote circulating vitamin D status of sows and their offspring. Increased milk fat content was observed in many experiments; however, others demonstrated that adding 25OHD3 to lactating sow diets increased the contents of milk protein and lactose. Although an inconsistency between the results of different experiments exists, these studies suggested that maternal 25OHD3 supplementation could alter milk composition via its effects on the mammary gland. Previous studies have demonstrated that adding 25OHD3 to sow diets could improve the mRNA expressions of insulin-induced gene 1 (INSIG1) and sterol regulatory element-binding protein 1 (SREBP1) in the mammary gland cells from milk and increase the mRNA expressions of acetyl-CoA carboxylase α (ACCα) and fatty acid synthase (FAS) in the mammary gland tissue. Maternal 25OHD3 supplementation promotes skeletal muscle development of piglets before and after parturition, and improves bone properties including bone density and bone breaking force in lactating sows and their piglets. Interestingly, 25OHD3 supplementation in sow diets could improve neonatal bone development via regulation of milk fatty acid composition related to bone metabolism and mineralization. In this review, we also discuss the effects of adding 25OHD3 to sow diets on the gut bacterial metabolites of suckling piglets, and propose that butyrate production may be associated with bone health. Therefore, to better understand the nutritional functions of maternal 25OHD3 supplementation, this paper reviews advances in the studies of 25OHD3 for sow nutrition and provides references for practical application.
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Affiliation(s)
- Lianhua Zhang
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Xiangshu Piao
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
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Sirico A, Dell’Aquila M, Tartaglione L, Moresi S, Farì G, Pitocco D, Arena V, Lanzone A. PTH-rP and PTH-R1 Expression in Placentas from Pregnancies Complicated by Gestational Diabetes: New Insights into the Pathophysiology of Hyperglycemia in Pregnancy. Diagnostics (Basel) 2021; 11:diagnostics11081356. [PMID: 34441291 PMCID: PMC8394866 DOI: 10.3390/diagnostics11081356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/20/2021] [Accepted: 07/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background: this study investigated the expression of parathyroid hormone-related protein (PTH-rP) and PTH/PTH-rP receptor PTH-R1 in placentas from women with gestational DM (GDM), and the relationship between PTH-R1 and PTH-rP expression and pregnancy characteristics. Methods: we prospectively enrolled 78 pregnant women with GDM, and immunochemistry for PTH-rP and PTH-R1 was performed on placentas. Patients were grouped according to the positivity of PTH-R1 or PTH-rP expression, and pregnancy characteristics were compared between the two groups. Results: PTH-rP and PTH-R1 expression were highest in the extravillous cytotrophoblast and in the decidua. In extravillous cytotrophoblast, PTH-rP expression was higher in women with abnormal at fasting glycemia compared to women with abnormal 60′ or 120′ glycemia (25/25, 50% vs. 6/28, 21.4%, χ2 = 6.12, p = 0.01), and PTH-R1 expression was higher in women with abnormal oral glucose tolerance test (OGTT) at fasting glycemia compared to women with abnormal 60′ or 120′ glycemia (37/50, 74% vs. 15/28, 53.6%, χ2 = 3.37, p = 0.06). In syncytiotrophoblast, PTH-rP-positive placentas were characterized by higher incidence of 1 min Apgar score < 7 (2/9, 22.2% vs. 2/69, 2.9%, χ2 = 6.11, p = 0.01) and maternal obesity (4/9, 44.4% vs. 11/69, 16.7%, χ2 = 3.81, p = 0.05). Conclusion: placental PTH-rP and PTH-R1 expression is dependent on the type of maternal hyperglycemia, and it is associated with adverse pregnancy outcomes.
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Affiliation(s)
- Angelo Sirico
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (S.M.); (A.L.)
- Correspondence: ; Tel.: +39-06-30155897
| | - Marco Dell’Aquila
- Pathology Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (M.D.); (V.A.)
| | - Linda Tartaglione
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (L.T.); (D.P.)
| | - Sascia Moresi
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (S.M.); (A.L.)
| | - Giorgia Farì
- Institute of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy;
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Dario Pitocco
- Diabetology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (L.T.); (D.P.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Vincenzo Arena
- Pathology Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (M.D.); (V.A.)
| | - Antonio Lanzone
- Obstetrics and High-Risk Pregnancy Unit, Department of Woman, Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; (S.M.); (A.L.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy
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25
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Savard C, Bielecki A, Plante AS, Lemieux S, Gagnon C, Weiler HA, Morisset AS. Longitudinal Assessment of Vitamin D Status across Trimesters of Pregnancy. J Nutr 2021; 151:1937-1946. [PMID: 33830266 PMCID: PMC8245879 DOI: 10.1093/jn/nxab060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The evolution of vitamin D status across pregnancy trimesters and its association with prepregnancy body mass index (ppBMI; in kg/m2) remain unclear. OBJECTIVES We aimed to 1) assess trimester-specific serum total 25-hydroxyvitamin D [25(OH)D] concentrations, 2) compare those concentrations between ppBMI categories, and 3) examine associations between 25(OH)D concentrations, ppBMI, and vitamin D intake. METHODS As part of a prospective cohort study, 79 pregnant women with a mean age of 32.1 y and ppBMI of 25.7 kg/m2 were recruited in their first trimester (average 9.3 weeks of gestation). Each trimester, vitamin D intake was assessed by 3 Web-based 24-h recalls and a Web questionnaire on supplement use. Serum total 25(OH)D was measured by LC-tandem MS. Repeated-measures ANOVA was performed to assess the evolution of 25(OH)D concentrations across trimesters of pregnancy and comparisons of 25(OH)D concentrations between ppBMI categories were assessed by 1-factor ANOVAs. Stepwise regression analyses were used to identify determinants of 25(OH)D concentrations in the third trimester. RESULTS Mean ± SD serum total 25(OH)D concentrations increased across trimesters, even after adjustments for ppBMI, seasonal variation, and vitamin D intake from supplements (67.5 ± 20.4, 86.5 ± 30.9, and 88.3 ± 29.0 nmol/L at mean ± SD 12.6 ± 0.8, 22.5 ± 0.8, and 33.0 ± 0.6 weeks of gestation, respectively; P < 0.0001). In the first and third trimesters, women with a ppBMI ≥30 had lower serum total 25(OH)D concentrations than women with a ppBMI <25 (P < 0.05); however, most had concentrations >40nmol/L by the second trimester. Vitamin D intake from supplements was the strongest determinant of third-trimester serum total 25(OH)D concentrations (r2 = 0.246, β = 0.51; P < 0.0001). CONCLUSIONS There was an increase in serum total 25(OH)D concentrations across trimesters, independent of ppBMI, seasonal variation, and vitamin D intake from supplements. Almost all women had serum total 25(OH)D concentrations over the 40- and 50-nmol/L thresholds, thus our study supports the prenatal use of a multivitamin across pregnancy.
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Affiliation(s)
- Claudia Savard
- School of Nutrition, Laval University, Québec City, Québec, Canada
- Endocrinology and Nephrology Unit, CHU of Québec Research Center-Laval University, Québec City, Québec, Canada
- NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
| | - Agnieszka Bielecki
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Anne-Sophie Plante
- Endocrinology and Nephrology Unit, CHU of Québec Research Center-Laval University, Québec City, Québec, Canada
- NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
| | - Simone Lemieux
- School of Nutrition, Laval University, Québec City, Québec, Canada
- NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU of Québec Research Center-Laval University, Québec City, Québec, Canada
- Department of Medicine, Laval University, Québec City, Québec, Canada
| | - Hope A Weiler
- Nutrition Research Division, Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Anne-Sophie Morisset
- School of Nutrition, Laval University, Québec City, Québec, Canada
- Endocrinology and Nephrology Unit, CHU of Québec Research Center-Laval University, Québec City, Québec, Canada
- NUTRISS Research Center, Institute of Nutrition and Functional Foods, Laval University, Québec City, Québec, Canada
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Cherian KE, Kapoor N, Paul TV, Asha HS. Functioning Endocrine Tumors in Pregnancy: Diagnostic and Therapeutic Challenges. Indian J Endocrinol Metab 2021; 25:299-304. [PMID: 35136736 PMCID: PMC8793957 DOI: 10.4103/ijem.ijem_310_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/25/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
The occurrence of endocrine tumors in pregnancy poses several diagnostic and therapeutic challenges. Although rare, functioning tumors involving the pituitary, thyroid, adrenal, and pancreas are reported in the literature. Timely diagnosis and management of these tumors are essential as they might lead to adverse maternal and fetal outcomes if left untreated. This review is an attempt to characterize various functioning tumors that could occur in pregnancy, their clinical features, diagnosis, and management.
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Affiliation(s)
- Kripa E. Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamilnadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamilnadu, India
| | - Thomas V. Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamilnadu, India
| | - Hesarghatta S. Asha
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Tamilnadu, India
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27
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Rodrigo N, Learoyd D, Glastras SJ. Complexities surrounding the diagnosis and management of hypercalcaemia in pregnancy. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200163. [PMID: 33982664 PMCID: PMC8185537 DOI: 10.1530/edm-20-0163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Hypercalcaemia in pregnancy is uncommon, with associated adverse obstetric and perinatal outcomes for both the mother and the fetus. Determination of causality is central to its management. Diagnostic imaging techniques are limited during pregnancy and the diagnosis is made more complex by physiological changes in calcium and vitamin D homeostasis in pregnancy. Further, therapeutic options are limited due to safety considerations for the pregnant woman and the developing foetus. Three cases of hypercalcaemia in pregnancy will be presented, highlighting the distinct aetiologies and management strategies for hypercalcaemia in pregnancy and the importance of early measurement of serum calcium in pregnancy screening. LEARNING POINTS There are complex physiological changes in calcium balance in pregnancy, including increased calcium intestinal absorption and renal excretion. Hypercalcaemia in pregnancy is uncommon but has important potential maternal and foetal complications, making a compelling argument for routine antenatal, calcium screening. Identifying the cause of hypercalcaemia in pregnancy can be challenging due to the complex placental interplay in biochemical test interpretation and due to safety constraints restricting imaging and surgery. Acute medical management of hypercalcaemia must be considered in the context of both maternal and foetal well-being, along with gestational age and specific consideration for the safety of the developing fetus in late gestation.
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Affiliation(s)
- Natassia Rodrigo
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Diana Learoyd
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Sarah J Glastras
- Department of Diabetes and Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, Department of Medicine, University of Sydney, Australia
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
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Arnold A, Dennison E, Kovacs CS, Mannstadt M, Rizzoli R, Brandi ML, Clarke B, Thakker RV. Hormonal regulation of biomineralization. Nat Rev Endocrinol 2021; 17:261-275. [PMID: 33727709 DOI: 10.1038/s41574-021-00477-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2021] [Indexed: 01/31/2023]
Abstract
Biomineralization is the process by which organisms produce mineralized tissues. This crucial process makes possible the rigidity and flexibility that the skeleton needs for ambulation and protection of vital organs, and the hardness that teeth require to tear and grind food. The skeleton also serves as a source of mineral in times of short supply, and the intestines absorb and the kidneys reclaim or excrete minerals as needed. This Review focuses on physiological and pathological aspects of the hormonal regulation of biomineralization. We discuss the roles of calcium and inorganic phosphate, dietary intake of minerals and the delicate balance between activators and inhibitors of mineralization. We also highlight the importance of tight regulation of serum concentrations of calcium and phosphate, and the major regulators of biomineralization: parathyroid hormone (PTH), the vitamin D system, vitamin K, fibroblast growth factor 23 (FGF23) and phosphatase enzymes. Finally, we summarize how developmental stresses in the fetus and neonate, and in the mother during pregnancy and lactation, invoke alternative hormonal regulatory pathways to control mineral delivery, skeletal metabolism and biomineralization.
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Affiliation(s)
- Andrew Arnold
- Division of Endocrinology & Metabolism and Center for Molecular Oncology, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Christopher S Kovacs
- Faculty of Medicine - Endocrinology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Maria Luisa Brandi
- Department of Biochemical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Bart Clarke
- Mayo Clinic Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, USA
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Mapping the expression of transient receptor potential channels across murine placental development. Cell Mol Life Sci 2021; 78:4993-5014. [PMID: 33884443 PMCID: PMC8233283 DOI: 10.1007/s00018-021-03837-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
Transient receptor potential (TRP) channels play prominent roles in ion homeostasis by their ability to control cation influx. Mouse placentation is governed by the processes of trophoblast proliferation, invasion, differentiation, and fusion, all of which require calcium signaling. Although certain TRP channels have been shown to contribute to maternal–fetal transport of magnesium and calcium, a role for TRP channels in specific trophoblast functions has been disregarded. Using qRT-PCR and in situ hybridisation, the spatio-temporal expression pattern of TRP channels in the mouse placenta across gestation (E10.5–E18.5) was assessed. Prominent expression was observed for Trpv2, Trpm6, and Trpm7. Calcium microfluorimetry in primary trophoblast cells isolated at E14.5 of gestation further revealed the functional activity of TRPV2 and TRPM7. Finally, comparing TRP channels expression in mouse trophoblast stem cells (mTSCs) and mouse embryonic stem cells (mESC) confirmed the specific expression of TRPV2 during placental development. Moreover, TRP channel expression was similar in mTSCs compared to primary trophoblasts and validate mTSC as a model to study TRP channels in placental development. Collectivity, our results identify a specific spatio-temporal TRP channel expression pattern in trophoblasts, suggesting a possible involvement in regulating the process of placentation.
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Ryan BA, Kovacs CS. Maternal and fetal vitamin D and their roles in mineral homeostasis and fetal bone development. J Endocrinol Invest 2021; 44:643-659. [PMID: 32772256 DOI: 10.1007/s40618-020-01387-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 01/11/2023]
Abstract
During pregnancy, female physiology adapts to meet the additional mineral demands of the developing fetus. Meanwhile, the fetus actively transports minerals across the placenta and maintains high circulating levels to mineralize the rapidly developing skeleton. Most of this mineral is accreted during the last trimester, including 30 g of calcium, 20 g of phosphate and 0.8 g of magnesium. Given the dependence of calcium homeostasis on vitamin D and calcitriol in the adult and child, it may be expected that vitamin D sufficiency would be even more critical during pregnancy and fetal development. However, the pregnant mother and fetus appear to meet their mineral needs independent of vitamin D. Adaptations in maternal mineral and bone metabolism during pregnancy appear to be invoked independent of maternal vitamin D, while fetal mineral metabolism and skeletal development appear to be protected from vitamin D deficiency and genetic disorders of vitamin D physiology. This review discusses key data from both animal models and human studies to address our current knowledge on the role of vitamin D and calcitriol during pregnancy and fetal development.
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Affiliation(s)
- B A Ryan
- Faculty of Medicine - Endocrinology, Health Sciences Centre, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
| | - C S Kovacs
- Faculty of Medicine - Endocrinology, Health Sciences Centre, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.
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Ali DS, Dandurand K, Khan AA. Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management. J Clin Med 2021; 10:jcm10071378. [PMID: 33805460 PMCID: PMC8038023 DOI: 10.3390/jcm10071378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Hypoparathyroidism is an uncommon endocrine disorder. During pregnancy, multiple changes occur in the calcium-regulating hormones, which may affect the requirements of calcium and active vitamin D during pregnancy in patients with hypoparathyroidism. Close monitoring of serum calcium during pregnancy and lactation is ideal in order to optimize maternal and fetal outcomes. In this review, we describe calcium homeostasis during pregnancy in euparathyroid individuals and also review the diagnosis and management of hypoparathyroidism during pregnancy and lactation. Methods: We searched the MEDLINE, CINAHL, EMBASE, and Google scholar databases from 1 January 1990 to 31 December 2020. Case reports, case series, book chapters, and clinical guidelines were included in this review. Conclusions: During pregnancy, rises in 1,25-dihydroxyvitamin D (1,25-(OH)2-D3) and PTH-related peptide result in suppression of PTH and enhanced calcium absorption from the bowel. In individuals with hypoparathyroidism, the requirements for calcium and active vitamin D may decrease. Close monitoring of serum calcium is advised in women with hypoparathyroidism with adjustment of the doses of calcium and active vitamin D to ensure that serum calcium is maintained in the low-normal to mid-normal reference range. Hyper- and hypocalcemia should be avoided in order to reduce the maternal and fetal complications of hypoparathyroidism during pregnancy and lactation. Standard of care therapy consisting of elemental calcium, active vitamin D, and vitamin D is safe during pregnancy.
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β-Hydroxy-β-Methylbutyrate (HMB) Supplementation Prevents Bone Loss during Pregnancy-Novel Evidence from a Spiny Mouse ( Acomys cahirinus) Model. Int J Mol Sci 2021; 22:ijms22063047. [PMID: 33802646 PMCID: PMC8002460 DOI: 10.3390/ijms22063047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to determine the effects of ß-hydroxy-ß-methylbutyrate (HMB) supplementation during pregnancy on postpartum bone tissue quality by assessing changes in trabecular and compact bone as well as in hyaline and epiphyseal cartilage. The experiment was carried out on adult 6-month-old female spiny mice (Acomys cahirinus) divided into three groups: pregnant control (PregCont), pregnant HMB-treated (supplemented with 0.02 g/kg b.w of HMB during the second trimester of pregnancy, PregHMB), and non-pregnant females (NonPreg). Cross-sectional area and cortical index of the femoral mid-shaft, stiffness, and Young modulus were significantly greater in the PregHMB group. Whole-bone mineral density was similar in all groups, and HMB supplementation increased trabecular number. Growth plate cartilage was the thinnest, while the articular cartilage was the thickest in the PregHMB group. HMB supplementation increased the content of proteoglycans in the articular cartilage and the percentage of immature collagen content in metaphyseal trabeculae and compact bone. In summary, dietary HMB supplementation during the second trimester of pregnancy intensifies bone metabolic processes and prevents bone loss during pregnancy.
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33
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Roesler AM, Ravix J, Bartman CM, Patel BS, Schiliro M, Roos B, Nesbitt L, Pabelick CM, Martin RJ, MacFarlane PM, Prakash YS. Calcium-Sensing Receptor Contributes to Hyperoxia Effects on Human Fetal Airway Smooth Muscle. Front Physiol 2021; 12:585895. [PMID: 33790802 PMCID: PMC8006428 DOI: 10.3389/fphys.2021.585895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Supplemental O2 (hyperoxia), necessary for maintenance of oxygenation in premature infants, contributes to neonatal and pediatric airway diseases including asthma. Airway smooth muscle (ASM) is a key resident cell type, responding to hyperoxia with increased contractility and remodeling [proliferation, extracellular matrix (ECM) production], making the mechanisms underlying hyperoxia effects on ASM significant. Recognizing that fetal lungs experience a higher extracellular Ca2+ ([Ca2+]o) environment, we previously reported that the calcium sensing receptor (CaSR) is expressed and functional in human fetal ASM (fASM). In this study, using fASM cells from 18 to 22 week human fetal lungs, we tested the hypothesis that CaSR contributes to hyperoxia effects on developing ASM. Moderate hyperoxia (50% O2) increased fASM CaSR expression. Fluorescence [Ca2+]i imaging showed hyperoxia increased [Ca2+]i responses to histamine that was more sensitive to altered [Ca2+]o, and promoted IP3 induced intracellular Ca2+ release and store-operated Ca2+ entry: effects blunted by the calcilytic NPS2143. Hyperoxia did not significantly increase mitochondrial calcium which was regulated by CaSR irrespective of oxygen levels. Separately, fASM cell proliferation and ECM deposition (collagens but not fibronectin) showed sensitivity to [Ca2+]o that was enhanced by hyperoxia, but blunted by NPS2143. Effects of hyperoxia involved p42/44 ERK via CaSR and HIF1α. These results demonstrate functional CaSR in developing ASM that contributes to hyperoxia-induced contractility and remodeling that may be relevant to perinatal airway disease.
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Affiliation(s)
- Anne M Roesler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jovanka Ravix
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Colleen M Bartman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Brijeshkumar S Patel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Marta Schiliro
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Benjamin Roos
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lisa Nesbitt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Christina M Pabelick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.,Department Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
| | - Richard J Martin
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Peter M MacFarlane
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Y S Prakash
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.,Department Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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Appelman-Dijkstra NM, Ertl DA, Zillikens MC, Rjenmark L, Winter EM. Hypercalcemia during pregnancy: management and outcomes for mother and child. Endocrine 2021; 71:604-610. [PMID: 33544354 PMCID: PMC8016748 DOI: 10.1007/s12020-021-02615-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus' calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands.
| | - Diana- Alexandra Ertl
- Department for Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Center of Expertise for Rare Disorders of Bone, Growth and Mineralization, Vienna Bone and Growth Center, Vienna, Austria
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC Bone Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lars Rjenmark
- Department of Clinical Medicine; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth M Winter
- Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, the Netherlands
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35
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Bai X, Wang G, Xu G, Wang B. Malleolar fracture in pregnancy and lactation-associated osteoporosis: a case report and literature review. Arch Osteoporos 2021; 16:36. [PMID: 33611644 DOI: 10.1007/s11657-021-00908-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The incidence of fractures in pregnancy and lactation-associated osteoporosis (PLO) is very low. Some fracture cases of PLO are associated with vertebral compression fractures, while malleolar fractures in patients with PLO are rarely reported before. CASE REPORT A 31-year-old Han Chinese patient presented with a malleolar fracture 3 months after delivery, while she was still breastfeeding. Temporary closed reduction and plaster external fixation were performed in the emergency room. Then the patient was admitted to the orthopedic trauma ward for surgery and diagnosed as PLO by dual-energy X-ray absorptiometry (DEXA). After preoperative evaluation, the patient underwent open reduction and internal fixation. With the diagnosis of PLO, the patient was treated with weaning, bisphosphonate, and supplementation of calcium carbonate and vitamin D. During the 12-month follow-up period, the results of DEXA and laboratory examination improved gradually, and the internal fixation was removed 12 months after surgery. CONCLUSION Orthopedic doctors should not ignore the possibility of PLO to avoid misdiagnosis of perinatal women with fractures. Improvement of functional recovery of fractures can be achieved with accurate diagnosis and individual treatment.
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Affiliation(s)
- Xiaodong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Gang Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Guoqiang Xu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
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36
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Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Premature Neonates: An Unmet Challenge. J Clin Res Pediatr Endocrinol 2020; 12:332-339. [PMID: 31674171 PMCID: PMC7711645 DOI: 10.4274/jcrpe.galenos.2019.2019.0091] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Metabolic bone disease (MBD) is an important cause of morbidity in premature, very low birth weight (VLBW) and sick infants and, if left undiagnosed, may lead to structural deformities and spontaneous fractures. MBD is defined as impaired bone mineralization in a neonate with lower than expected bone mineral levels in either a fetus or a neonate of comparable gestational age and/or weight, coupled with biochemical abnormalities with or without accompanying radiological manifestations. MBD has been reported to occur in 16% to 40% of extremely low birth weight neonates and presents by 6-16 weeks after birth. Insufficient calcium and phosphorous stores during the phase of accelerated growth predispose to MBD in neonates along with the use of some medications such as caffeine or steroids, prolonged parenteral nutrition and chronic immobilization. Enhanced physical activity in preterm infants facilitates bone mineralization and weight gain. Biochemical abnormalities tend to worsen significantly, as the severity of disease progresses. These abnormalities may include hypocalcemia, hypophosphatemia, hyperphosphatasia and secondary hyperparathyroidism. In addition, urinary phosphate wasting and hypovitaminosis D can be additional complications. Conversely, biochemical abnormalities may not be accompanied by rachitic changes. Newer diagnostic modalities include non-invasive bone densitometry by quantitative ultrasound over the mid-tibial shaft. The management of MBD includes adequate calcium, phosphorous and vitamin D supplementation, along with optimum nutrition and physical activity. Similarly, preventive strategies for MBD should target nutritional enhancement in combination with enhanced physical activity. MBD usually results in preventable morbidity in preterm and VLBW neonates. Treatment consists of optimum nutritional supplementation and enhanced physical activity.
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Affiliation(s)
- Swathi Chacham
- All India Institute of Institute of Medical Sciences, Rishikesh, India,* Address for Correspondence: All India Institute of Institute of Medical Sciences, Rishikesh, India Phone: +91-98494-47306 E-mail:
| | - Rachna Pasi
- Himalayan Institute of Medical Sciences, Dehradun, India
| | | | - Najeeb Ahmad
- All India Institute of Institute of Medical Sciences, Rishikesh, India
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37
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Wang G, Bai X. Barton Fracture of the Distal Radius in Pregnancy and Lactation-Associated Osteoporosis: A Case Report and Literature Review. Int J Gen Med 2020; 13:1043-1049. [PMID: 33192088 PMCID: PMC7656778 DOI: 10.2147/ijgm.s278536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/15/2020] [Indexed: 01/09/2023] Open
Abstract
Objective Pregnancy and lactation-associated osteoporosis (PLO) is very rare, which typically occurs during the third trimester or during lactation. Many cases of PLO are associated with vertebral compression fractures or hip fractures, while distal radius fractures in patients with PLO are rarely reported. Case Report A 36-year-old patient presented with Barton fracture at 37 weeks of gestation. Temporary closed reduction and plaster external fixation were performed in emergency room. At 38 weeks of gestation, she gave birth to a healthy boy and began breastfeeding after delivery. Three days after delivery, the patient was admitted to the orthopedic ward for surgery and was diagnosed as PLO. The patient underwent open reduction and internal fixation and treated with weaning and supplementation of calcium carbonate and vitamin D. During the 1-year follow-up period, the results of laboratory tests and bone mineral density gradually returned to normal. Conclusion Clinicians should be alert to the possibility of PLO to avoid missed diagnosis. Accurate diagnosis and individualized treatment are of great significance for relieving pain and functional recovery of patients.
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Affiliation(s)
- Gang Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Xiaodong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
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38
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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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39
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Validation and Determination of 25(OH) Vitamin D and 3-Epi25(OH)D3 in Breastmilk and Maternal- and Infant Plasma during Breastfeeding. Nutrients 2020; 12:nu12082271. [PMID: 32751196 PMCID: PMC7469027 DOI: 10.3390/nu12082271] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/22/2022] Open
Abstract
Vitamin D deficiency in pregnant women and their offspring may result in unfavorable health outcomes for both mother and infant. A 25hydroxyvitamin D (25(OH)D) level of at least 75 nmol/L is recommended by the Endocrine Society. Validated, automated sample preparation and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods were used to determine the vitamin D metabolites status in mother-infant pairs. Detection of 3-Epi25(OH)D3 prevented overestimation of 25(OH)D3 and misclassification of vitamin D status. Sixty-three percent of maternal 25(OH)D plasma levels were less than the recommended level of 25(OH)D at 3 months. Additionally, breastmilk levels of 25(OH)D decreased from 60.1 nmol/L to 50.0 nmol/L between six weeks and three months (p < 0.01). Furthermore, there was a positive correlation between mother and infant plasma levels (p < 0.01, r = 0.56) at 3 months. Accordingly, 31% of the infants were categorized as vitamin D deficient (25(OH)D < 50 nmol/L) compared to 25% if 3-Epi25(OH)D3 was not distinguished from 25(OH)D3. This study highlights the importance of accurate quantification of 25(OH)D. Monitoring vitamin D metabolites in infant, maternal plasma, and breastmilk may be needed to ensure adequate levels in both mother and infant in the first 6 months of infant life.
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40
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Winter EM, Ireland A, Butterfield NC, Haffner-Luntzer M, Horcajada MN, Veldhuis-Vlug AG, Oei L, Colaianni G, Bonnet N. Pregnancy and lactation, a challenge for the skeleton. Endocr Connect 2020; 9:R143-R157. [PMID: 32438342 PMCID: PMC7354730 DOI: 10.1530/ec-20-0055] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
In this review we discuss skeletal adaptations to the demanding situation of pregnancy and lactation. Calcium demands are increased during pregnancy and lactation, and this is effectuated by a complex series of hormonal changes. The changes in bone structure at the tissue and whole bone level observed during pregnancy and lactation appear to largely recover over time. The magnitude of the changes observed during lactation may relate to the volume and duration of breastfeeding and return to regular menses. Studies examining long-term consequences of pregnancy and lactation suggest that there are small, site-specific benefits to bone density and that bone geometry may also be affected. Pregnancy- and lactation-induced osteoporosis (PLO) is a rare disease for which the pathophysiological mechanism is as yet incompletely known; here, we discuss and speculate on the possible roles of genetics, oxytocin, sympathetic tone and bone marrow fat. Finally, we discuss fracture healing during pregnancy and lactation and the effects of estrogen on this process.
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Affiliation(s)
- E M Winter
- Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden, the Netherlands
- Correspondence should be addressed to E M Winter:
| | - A Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - N C Butterfield
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, Commonwealth Building, DuCane Road, London, United Kingdom
| | - M Haffner-Luntzer
- Institute of Orthopaedic Research and Biomechanics, University Medical Center Ulm, Ulm, Germany
| | - M-N Horcajada
- Nestlé Research, Department of Musculoskeletal Health, Innovation EPFL Park, Lausanne, Switzerland.
| | - A G Veldhuis-Vlug
- Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology, Center for Bone Quality, Leiden, the Netherlands
- Jan van Goyen Medical Center, Department of Internal Medicine, Amsterdam, the Netherlands
| | - L Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Colaianni
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - N Bonnet
- Nestlé Research, Department of Musculoskeletal Health, Innovation EPFL Park, Lausanne, Switzerland.
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41
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Jones AR, Hare MJ, Brown J, Yang J, Meyer C, Milat F, Allan CA. Familial Hypocalciuric Hypercalcemia in Pregnancy: Diagnostic Pitfalls. JBMR Plus 2020; 4:e10362. [PMID: 32537548 PMCID: PMC7285754 DOI: 10.1002/jbm4.10362] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
Familial hypocalciuric hypercalcemia (FHH) is a group of autosomal dominant disorders caused by dysfunction of the calcium sensing receptor (CaSR) and its downstream signaling proteins, leading to generally asymptomatic hypercalcemia. During pregnancy, distinguishing FHH from primary hyperparathyroidism (PHPT) is important, as the latter is associated with adverse outcomes and can be treated surgically during pregnancy, whereas the former is benign. This case report highlights the difficulties in diagnosing FHH during pregnancy. A 32‐year‐old woman was found to have asymptomatic hypercalcemia at 14‐weeks’ gestation. Investigations showed a corrected calcium (cCa) of 2.61 mmol/L (2.10 to 2.60), ionized Ca (iCa) of 1.40 mmol/L (1.15 to 1.28), 25OHD of 33 nmol/L (75 to 250), and PTH of 9.5 pmol/L (1.5 to 7.0). The patient was treated with 2000 IU cholecalciferol daily with normalization of 25OHD. The urine calcium / creatinine clearance ratio (CCCR) was 0.0071, and neck US did not visualize a parathyroid adenoma. Upon a retrospective review of the patient's biochemistry from 2 years prior, hypercalcemia was found that was not investigated. The patient was monitored with serial iCa levels and obstetric US. She delivered a healthy boy at 38‐weeks’ gestation. Postnatal iCa was 1.48 mmol/L and remained elevated. Her son had elevated iCa at birth of 1.46 mmol/L (1.15 to 1.33), which rose to 1.81 mmol/L by 2 weeks. He was otherwise well. Given the familial hypercalcemia, a likely diagnosis of FHH was made. Genetic testing of the son revealed a missense mutation, NM_000388.3(CASR):c.2446A > G, in exon 7 of the CaSR, consistent with FHH type 1. To our knowledge, there are only three existing reports of FHH in pregnancy. When differentiating between FHH and PHPT in pregnancy, interpretation of biochemistry requires an understanding of changes in Ca physiology, and urine CCCR may be unreliable. If the decision is made to observe, clinical symptoms, calcium levels, and fetal US should be monitored, with biochemistry and urine CCCR performed postpartum, once lactation is completed © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Alicia R Jones
- Monash Centre for Health Research and Implementation Monash University Melbourne Australia.,Department of Endocrinology Monash Health Melbourne Australia
| | - Matthew Jl Hare
- Department of Endocrinology Monash Health Melbourne Australia.,Wellbeing and Chronic Preventable Diseases Division Menzies School of Health Research Darwin Australia
| | - Justin Brown
- Department of Paediatrics Monash University Melbourne Australia.,Department of Paediatric Endocrinology and Diabetes Monash Health Melbourne Australia
| | - Jun Yang
- Department of Endocrinology Monash Health Melbourne Australia.,Hudson Institute of Medical Research, Clayton Melbourne Australia.,Department of Medicine Monash University Melbourne Australia
| | - Caroline Meyer
- Department of Endocrinology St Vincent's Hospital Melbourne Australia
| | - Frances Milat
- Department of Endocrinology Monash Health Melbourne Australia.,Hudson Institute of Medical Research, Clayton Melbourne Australia.,Department of Medicine Monash University Melbourne Australia
| | - Carolyn A Allan
- Department of Endocrinology Monash Health Melbourne Australia.,Hudson Institute of Medical Research, Clayton Melbourne Australia.,Department of Obstetrics and Gynaecology Monash University Melbourne Australia
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42
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Liao MZ, Flood Nichols SK, Ahmed M, Clark S, Hankins GD, Caritis S, Venkataramanan R, Haas D, Quinney SK, Haneline LS, Tita AT, Manuck T, Wang J, Thummel KE, Brown LM, Ren Z, Easterling TR, Hebert MF. Effects of Pregnancy on the Pharmacokinetics of Metformin. Drug Metab Dispos 2020; 48:264-271. [PMID: 31980499 PMCID: PMC7076518 DOI: 10.1124/dmd.119.088435] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022] Open
Abstract
This study's primary objective was to fully characterize the pharmacokinetics of metformin in pregnant women with gestational diabetes mellitus (GDM) versus nonpregnant controls. Steady-state oral metformin pharmacokinetics in pregnant women with GDM receiving either metformin monotherapy (n = 24) or a combination with glyburide (n = 30) as well as in nonpregnant women with type 2 diabetes mellitus (T2DM) (n = 24) were determined utilizing noncompartmental techniques. Maternal and umbilical cord blood samples were collected at delivery from 38 women. With both 500- and 1000-mg doses, metformin bioavailability, volume of distribution beta (V β ), clearance, and renal clearance were significantly increased during pregnancy. In addition, in the women receiving metformin 500 mg, significantly higher metformin apparent oral clearance (CL/F) (27%), weight-adjusted renal secretion clearance (64%), and apparent oral volume of distribution beta (V β /F) (33%) were seen during pregnancy. Creatinine clearance was significantly higher during pregnancy. Increasing metformin dose from 500 to 1000 mg orally twice daily significantly increased V β /F by 28%, weight-adjusted V β /F by 32% and CL/F by 25%, and weight-adjusted CL/F by 28% during pregnancy. Mean metformin umbilical cord arterial-to-venous plasma concentration ratio was 1.0 ± 0.1, venous umbilical cord-to-maternal concentration ratio was 1.4 ± 0.5, and arterial umbilical cord-to-maternal concentration ratio was 1.5 ± 0.5. Systemic exposure after a 500-mg dose of metformin was lower during pregnancy compared with the nonpregnant women with T2DM. However, in patients receiving metformin 1000 mg, changes in estimated bioavailability during pregnancy offset the changes in clearance leading to no significant change in CL/F with the higher dose. SIGNIFICANCE STATEMENT: Gestational diabetes mellitus complicates 5%-13% of pregnancies and is often treated with metformin. Pregnant women undergo physiological changes that alter drug disposition. Preliminary data suggest that pregnancy lowers metformin concentrations, potentially affecting efficacy and safety. This study definitively describes pregnancy's effects on metformin pharmacokinetics and expands the mechanistic understanding of pharmacokinetic changes across the dosage range. Here we report the nonlinearity of metformin pharmacokinetics and the increase in bioavailability, clearance, renal clearance, and volume of distribution during pregnancy.
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Affiliation(s)
- Michael Z Liao
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Shannon K Flood Nichols
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Mahmoud Ahmed
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Shannon Clark
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Gary D Hankins
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Steve Caritis
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Raman Venkataramanan
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - David Haas
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Sara K Quinney
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Laura S Haneline
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Alan T Tita
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Tracy Manuck
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Joanne Wang
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Kenneth E Thummel
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Linda Morris Brown
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Zhaoxia Ren
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Thomas R Easterling
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
| | - Mary F Hebert
- University of Washington, Departments of Pharmaceutics (M.Z.L., J.W., K.E.T.), Obstetrics and Gynecology (T.R.E., M.F.H.), and Pharmacy (T.R.E., M.F.H.), Seattle, Washington; Madigan Army Medical Center, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tacoma, Washington (S.K.F.N.); University of Texas Medical Branch in Galveston, Department of Obstetrics and Gynecology, Galveston, Texas (M.A., S.Cl., G.D.H.); University of Pittsburgh, Departments of Obstetrics and Gynecology (S.Ca.), Pharmacy and Pharmaceutical Sciences (R.V.), Pittsburgh, Pennsylvania; Indiana University, Departments of Obstetrics and Gynecology (D.H., S.K.Q.) and Pediatrics (L.S.H.), Indianapolis, Indiana; University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, Alabama (A.T.T.); University of North Carolina, Department of Obstetrics and Gynecology, Chapel Hill, North Carolina (T.M.); Biostatistics and Epidemiology Division, Environmental and Health Science Unit, RTI International, Rockville, Maryland (L.M.B.); and Obstetric and Pediatric Pharmacology and Therapeutic Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Z.R.)
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Mason AE, Grier D, Smithson SF, Burren CP, Gradhand E. Post-mortem histology in transient receptor potential cation channel subfamily V member 6 (TRPV6) under-mineralising skeletal dysplasia suggests postnatal skeletal recovery: a case report. BMC MEDICAL GENETICS 2020; 21:64. [PMID: 32228492 PMCID: PMC7106792 DOI: 10.1186/s12881-020-01007-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
Background The calcium-selective channel TRPV6 (transient receptor potential cation channel subfamily V member 6) is crucial for maternal-fetal calcium transport across the placenta. TRPV6 mutations have recently been associated with an antenatally severe under-mineralising skeletal dysplasia accompanied by postnatal biochemical abnormalities. This is the first post-mortem report in a patient with TRPV6 skeletal dysplasia. Case presentation The female infant had severe antenatal and postnatal skeletal abnormalities by 20 weeks gestation and was ventilator-dependent from birth. These skeletal abnormalities were apparent at an earlier gestational age than in previous reported cases and a more severe clinical course ensued. Biochemical and skeletal abnormalities, including bone density, improved postnatally but cardiac arrest at 4 months of age led to withdrawal of intensive care. Compound heterozygous TRPV6 variants (c.1978G > C p.(Gly660Arg) and c.1528C > T p.(Arg510Ter)) were identified on exome sequencing. Post-mortem identified skeletal abnormalities but no specific abnormalities in other organ systems. No placental pathology was found, multi-organ histological features reflected prolonged intensive care only. Post-mortem macroscopic examination indicated reduced thoracic size and short, pale and pliable ribs. Histological examination identified reduced number of trabeculae in the diaphyses (away from the growth plates), whereas metaphyses showed adequate mineralisation and normal number of trabeculae, but with slightly enlarged reactive chondrocytes, indicating post-natal skeletal growth recovery. Post-mortem radiological findings demonstrated improved bone density, improved rib width, healed fractures, although ribs were still shorter than normal. Long bones (especially humerus and femur) had improved from initial poorly defined metaphyses and reduced bone density to sharply defined metaphyses, prominent growth restart lines in distal diaphyses and bone-in-bone appearance along diaphyses. Conclusions This case provide bone histological confirmation that human skeletal development is compromised in the presence of TRPV6 pathogenic variants. Post-mortem findings were consistent with abnormal in utero skeletal mineralisation due to severe calcium deficit from compromised placental calcium transfer, followed by subsequent phenotypic improvement with adequate postnatal calcium availability. Significant skeletal recovery occurs in the early weeks of postnatal life in TRPV6 skeletal dysplasia.
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Affiliation(s)
- Anna E Mason
- Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK
| | - David Grier
- Department of Radiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah F Smithson
- Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK.,Department of Clinical Genetics, St Michaels Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christine P Burren
- Bristol Medical School Translational Health Sciences, University of Bristol, Bristol, UK.,Department of Paediatric Endocrinology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elise Gradhand
- Severn Pathology, Paediatric and Perinatal Pathology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK. .,Dr. Senckenberg. Institut für Pathologie, Universitätsklinikum Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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Lee SJ, Song SY, Rhee Y. Skeletal changes during lactation and after weaning in osteocyte-specific sclerostin overexpressed mice. J Bone Miner Metab 2020; 38:172-178. [PMID: 31501981 DOI: 10.1007/s00774-019-01044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Lactation inevitably leads to a state of rapid bone loss; however, maternal bone undergoes rapid remineralization after weaning. Sclerostin, encoded by the gene SOST, is exclusively secreted from osteocytes and plays important roles in bone remodeling. However, there are few studies about the effect of sclerostin during lactation and weaning on bone microstructures. Therefore, we conducted the study to demonstrate any possible association of sclerostin with bone metabolism and skeletal changes during lactation and after weaning. MATERIALS AND METHODS We analyzed bone mineral density (BMD) by dual-energy X-ray absorptiometry at the spine and femur, bone microstructure by micro-computed tomography (μCT) at the distal and mid-shaft of the femur and biochemical markers such as sclerostin and bone turnover markers at 1 week and 3 weeks of lactation and 2 weeks post-weaning in osteocyte-specific sclerostin-overexpressed transgenic mice, and compared them with wild type. RESULTS Lactation significantly resulted in decreased spine and femur BMD at day 7 and day 21 of breastfeeding; specifically, cortical microstructure (cross-sectional thickness and cross-sectional area) at the mid-shaft of the femur had significantly deteriorated. At day 14 after weaning, femur BMD and cortical microstructure at the mid-shaft of the femur in both the wild and DMP-SOST mice had incompletely recovered; however, spine BMD and trabecular microstructures at the distal femur recovered in wild type mice. CONCLUSIONS Sclerostin, secreted by osteocytes, played a role in bone loss during lactation and also in the recovery of trabecular bone compartment by activating bone formation after weaning.
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Affiliation(s)
- Su Jin Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Yong Song
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Naser AM, Wang Q, Shamsudduha M, Chellaraj G, Joseph G. Modeling the Relationship of Groundwater Salinity to Neonatal and Infant Mortality From the Bangladesh Demographic Health Survey 2000 to 2014. GEOHEALTH 2020; 4:e2019GH000229. [PMID: 32159051 PMCID: PMC7025866 DOI: 10.1029/2019gh000229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
We evaluated the relationship of drinking water salinity to neonatal and infant mortality using Bangladesh Demographic Health Surveys of 2000, 2004, 2007, 2011, and 2014. Point data of groundwater electrical conductivity (EC)- a measure of salinity-were collated from the Bangladesh Water Development Board and digitizing salinity contour map. Data for groundwater dissolved elements (sodium, calcium, magnesium, and potassium) data came from a national hydrochemistry survey in Bangladesh. Point EC and dissolved minerals data were then interpolated over entire Bangladesh and extracted to each cluster location, the primary sampling unit of Bangladesh Demographic Health Surveys. We used restricted cubic splines and survey design-specific logistic regression models to determine the relationship of water salinity to neonatal and infant mortality. A U-shaped association between drinking water salinity and neonatal and infant mortality was found, suggesting higher mortality when salinity was very low and high. Compared to mildly saline (EC ≥0.7 and < 2 mS/cm) water drinkers, freshwater (EC < 0.7 mS/cm) drinkers had 1.37 (95% CI: 1.01, 1.84) times higher neonatal mortality and 1.43 (95% CI: 1.08, 1.89) times higher infant mortality. Compared to mildly saline water drinkers, severe-saline (EC ≥10 mS/cm) water drinkers had 1.77 (95% CI: 1.17, 2.68) times higher neonatal mortality and 1.93 (95% CI: 1.35, 2.76) times higher infant mortality. We found that mild-salinity water had a high concentration of calcium and magnesium, whereas severe-salinity water had a high concentration of sodium. Freshwater had the least concentrations of salubrious calcium and magnesium.
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Affiliation(s)
- Abu Mohd Naser
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Mohammad Shamsudduha
- Institute for Risk and Disaster ReductionUniversity College LondonLondonUK
- Department of GeographyUniversity of SussexBrightonUK
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Estradiol-17β-Induced Changes in the Porcine Endometrial Transcriptome In Vivo. Int J Mol Sci 2020; 21:ijms21030890. [PMID: 32019139 PMCID: PMC7037416 DOI: 10.3390/ijms21030890] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/09/2020] [Accepted: 01/21/2020] [Indexed: 12/23/2022] Open
Abstract
Estradiol-17β (E2) is a key hormone regulating reproductive functions in females. In pigs, E2, as the main conceptus signal, initiates processes resulting in prolonged corpus luteum function, embryo development, and implantation. During early pregnancy the endometrium undergoes morphological and physiological transitions that are tightly related to transcriptome changes. Recently, however, the importance of E2 as a primary conceptus signal in the pig has been questionable. Thus, the aim of the present study was to determine the effects of E2 on the porcine endometrial transcriptome in vivo and to compare these effects with transcriptome profiles on day 12 of pregnancy. Microarray analysis revealed differentially expressed genes (DEGs) in response to E2 with overrepresented functional terms related to secretive functions, extracellular vesicles, cell adhesion, proliferation and differentiation, tissue rearrangements, immune response, lipid metabolism, and many others. Numerous common DEGs and processes for the endometrium on day 12 of pregnancy and E2-treated endometrium were identified. In summary, the present study is the first evidence for the effect of E2 on transcriptome profiles in porcine endometrium in vivo in the period corresponding to the maternal recognition of pregnancy. The presented results provide a valuable resource for further targeted studies considering genes and pathways regulated by conceptus-derived estrogens and their role in pregnancy establishment.
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Association between breastfeeding and osteoporotic hip fracture in women: a dose-response meta-analysis. J Orthop Surg Res 2020; 15:15. [PMID: 31948457 PMCID: PMC6966889 DOI: 10.1186/s13018-019-1541-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Approximately 300 mg of calcium a day is provided into infants to maintain the physical development of infants, and 5 to 10% bone loss occurs in women during breastfeeding. Hip fractures are considered the most serious type of osteoporotic fracture. We performed this meta-analysis to investigate the association between breastfeeding and osteoporotic hip fractures. Material and methods PubMed and Embase were searched until May 1, 2019, for studies evaluating the relationship between breastfeeding and osteoporotic hip fracture in women. The quality of the included studies was evaluated by the methodological index for non-randomized studies (MINORS). For the dose-response meta-analysis, we used the “generalized least squares for trend estimation” method proposed by Greenland and Longnecker to take into account the correlation with the log RR estimates across the duration of breastfeeding. Results Seven studies were moderate or high quality, enrolling a total of 103,898 subjects. The pooled outcomes suggested that breastfeeding can decrease the incidence of osteoporotic hip fracture (RR = 0.64 (95% CI 0.43, 0.95), P = 0.027). Dose-response analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the increase of breastfeeding time. The RR and 95% CI for 3 months, 6 months, 12 months, and 24 months were RR = 0.93, 95% CI 0.88, 0.98; RR = 0.87, 95% CI 0.79, 0.96; RR = 0.79, 95% CI 0.67, 0.92; and RR = 0.76, 95% CI 0.59, 0.98, respectively, whereas no significant relationship was found between them when the duration of breastfeeding time was more than 25 months. Conclusions Our meta-analysis demonstrated that the incidence of osteoporotic hip fracture decreased with the extension of breastfeeding time. However, there is no significant relationship between them when the duration of breastfeeding time was more than 25 months.
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Yoshikata H, Tsugawa N, Watanabe Y, Tsuburai T, Chaki O, Hirahara F, Miyagi E, Sakakibara H, Uenishi K, Okano T. 25-Hydroxyvitamin D profiles and maternal bone mass during pregnancy and lactation in Japanese women. J Bone Miner Metab 2020; 38:99-108. [PMID: 31432265 DOI: 10.1007/s00774-019-01032-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/13/2019] [Indexed: 01/28/2023]
Abstract
Vitamin D deficiency is observed worldwide and represents a health hazard for mothers, infants and elderly persons. We know that many young Japanese women experience vitamin D insufficiency; however, there is a lack of knowledge regarding the serum 25-hydroxyvitamin D [25(OH)D] profile of pregnant Japanese women and of the association between maternal 25(OH)D level and maternal bone mass during pregnancy and lactation. In this longitudinal study, 160 pregnant Japanese women were enrolled; of them, 68 have been followed-up from the first trimester through at least 1 year of breast-feeding. We estimated serum 25(OH)D levels, intact PTH levels, calcaneus quantitative ultrasound (QUS: T score) scores, bone mineral density at the distal one-third of the radius, dietary intakes according to the Food Frequency Questionnaire, and sunlight exposure times. We found that Vitamin D deficiency is prevalent in Japanese women, irrespective of pregnancy or lactation, and our analysis suggested that 25(OH)D levels and BMI in the first trimester were related to the lactating women's bone mass from after delivery to 1 year after delivery.
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Affiliation(s)
- Hiromi Yoshikata
- Yoshikata Obstetrics and Gynecology Clinic, 2430 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, 222-0036, Japan.
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan.
| | | | - Yuna Watanabe
- Niigata University of Health and Welfare, Niigata, Japan
| | - Taku Tsuburai
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Osamu Chaki
- Department of Gynecology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Fumiki Hirahara
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Hideya Sakakibara
- Department of Gynecology, Yokohama City University Medical Center Hospital, Yokohama, Japan
| | - Kazuhiro Uenishi
- Laboratory of Physiological Nutrition, Kagawa Nutrition University, Sakado, Japan
| | - Toshio Okano
- Department of Hygienic Sciences, Kobe Pharmaceutical University, Kobe, Japan
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Olvera D, Stolzenfeld R, Fisher E, Nolan B, Caird MS, Kozloff KM. Pamidronate Administration During Pregnancy and Lactation Induces Temporal Preservation of Maternal Bone Mass in a Mouse Model of Osteogenesis Imperfecta. J Bone Miner Res 2019; 34:2061-2074. [PMID: 31310351 PMCID: PMC6854294 DOI: 10.1002/jbmr.3831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/25/2019] [Accepted: 07/03/2019] [Indexed: 01/25/2023]
Abstract
During pregnancy and lactation, the maternal skeleton undergoes significant bone loss through increased resorption to provide the necessary calcium supply to the developing fetus and suckling neonate. This period of skeletal vulnerability has not been clearly associated with increased maternal fracture risk, but these physiological conditions can exacerbate an underlying metabolic bone condition like osteogenesis imperfecta. Although bisphosphonates (BPs) are commonly used in postmenopausal women, there are cases where premenopausal women taking BPs become pregnant. Given BPs' long half-life, there is a need to establish how BPs affect the maternal skeleton during periods of demanding metabolic bone changes that are critical for the skeletal development of their offspring. In the present study, pamidronate- (PAM-) amplified pregnancy-induced bone mass gains and lactation-induced bone loss were prevented. This preservation of bone mass was less robust when PAM was administered at late stages of lactation compared with early pregnancy and first day of lactation. Pregnancy-induced osteocyte osteolysis was also observed and was unaffected with PAM treatment. No negative skeletal effects were observed in offspring from PAM-treated dams despite lactation-induced bone loss prevention. These findings provide important insight into (1) a treatment window for when PAM is most effective in preserving maternal bone mass, and (2) the maternal changes in bone metabolism that maintain calcium homeostasis crucial for fetal and neonatal bone development. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Diana Olvera
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Stolzenfeld
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Emily Fisher
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Bonnie Nolan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michelle S Caird
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth M Kozloff
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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Abstract
Objective: Vitamin D plays a key role during pregnancy and is involved in implantation and maintenance of pregnancy. Its deficiency is associated with pregnancy complications like preeclampsia, characterized by abnormal angiogenesis.Method: The current article summarises studies examining the role of vitamin D in pregnancy, with special emphasis on preeclampsia.Results and conclusion: An imbalance in pro- and anti-angiogenic factors is reported in women with preeclampsia. Cell culture studies have demonstrated that vitamin D can influence the process of angiogenesis. However, the role of maternal vitamin D in influencing placental angiogenesis in preeclampsia is unclear and needs to be explored.
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Affiliation(s)
- Juhi Nema
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University) , Pune , India
| | - Deepali Sundrani
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University) , Pune , India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University) , Pune , India
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