Calcium intake in winter pregnancy attenuates impact of vitamin D inadequacy on urine NTX, a marker of bone resorption

O’Brien, Eileen C.; Kilbane, Mark; McKenna, Malachi J.; Segurado, Ricardo; Geraghty, Aisling A.; McAuliffe, Fionnuala M.

doi:10.1007/s00394-017-1385-3

Cited by 15 publications

(5 citation statements)

References 23 publications

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“…The improvement in nutrient intakes suggests better diet quality among women in the intervention group, a finding that is comparable with the improvement in Healthy Eating Index score in the LIMIT trial (11). The specific dietary modifications that resulted in a lower calcium intake in the intervention group vs. controls at 28 weeks' gestation requires further exploration, however, the calcium intake of both groups is comparable to previous studies of pregnant women (39). Improvements in stage-of-change score support evidence that provision of physical activity advice during pregnancy increases the proportion of women in stages 4 (action) or 5 (maintenance) (36).…”

Section: Discussionsupporting

confidence: 73%

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity

et al. 2020

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Background: Diet quality and physical activity positively impact pregnancy outcomes among women with obesity, but successful lifestyle interventions require intense clinician time. We aimed to investigate the impact of a behavioral-lifestyle intervention (PEARS) supported by a smartphone app among pregnant women with overweight and obesity, on nutrient intake, behavioral stage-of-change and physical activity. Methods: Pregnant women (BMI 25-39.9 kg/m 2 , measured, n = 565) were randomized at 15.6 weeks' gestation to the intervention (n = 278), or a control group (n = 287) (ISRCTN29316280). The intervention was grounded in behavior-change theory. Participants received nutrition (low glycaemic index and healthy eating) and exercise advice, a smartphone app and fortnightly emails. The control group received usual care which does not include dietary advice. At baseline and 28 weeks' gestation, dietary data were obtained through 3-day food diaries (n = 290 matched), and stage-of-change and physical activity data were self-reported. App usage data were collected. Results: There were no differences between the groups at baseline. Compared with the control group, the intervention group had improved dietary intakes post-intervention with; lower glycaemic index (MD −1.75); free sugars (%TE) (MD −0.98); fat (%TE) (MD −1.80); and sodium (mg) (MD −183.49). Physical activity (MET-minutes/week) was higher in the intervention group post-intervention (MD 141.4; 95% CI 62.9, 219.9). The proportion of participants at "maintenance" stage-of-change for physical activity was higher in the intervention group (56.3 vs. 31.2%). App use was associated with lower glycaemic index and less energy from free sugars, but not with physical activity. Conclusion: A behavioral-lifestyle intervention in pregnancy supported by a smartphone app improved dietary intakes, physical activity, and motivation to engage in exercise.

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Section: Discussionsupporting

confidence: 73%

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity

et al. 2020

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“…66 The sixth study was excluded as the data collection date was before 2004. 109 The characteristics informing the risk of bias assessment are summarised in Figure S1 and Table S3. Most studies clearly defined their objective (91, 86.7%) and the eligibility criteria (70, 66.7%), had a sample of at least 100 individuals or a sample size calculation (66, 62.9%), used a data collection tool defined with references to the sources (43, 41.0%), or without references (57, 54.3%), had a welldefined outcome (87, 82.9%), presented the results clearly (77, 73.3%), and demonstrated consistency between the research question and outcome reporting (83, 79.0%).…”

Section: Resultsmentioning

confidence: 99%

Global inequities in dietary calcium intake during pregnancy: a systematic review and meta‐analysis

Cormick

Betrán

Romero

et al. 2018

BJOG

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Background Evidence shows that adequate calcium intake during pregnancy reduces the risk of hypertensive disorders of pregnancy. In most low‐ and middle‐income countries ( LMIC s) the daily calcium intake is well below recommendations. Mapping calcium intake during pregnancy worldwide and identifying populations with low calcium intake will provide the evidence base for more targeted actions to improve calcium intake. Objective To assess dietary calcium intake during pregnancy worldwide. Search strategy MEDLINE and EMBASE (from July 2004 to November 2017). Selection criteria Cross‐sectional, cohort, and intervention studies reporting calcium intake during pregnancy. Data collection and analysis Five reviewers working in pairs independently performed screening, extraction, and quality assessment. We reported summary measures of calcium intake and calculated the weighted arithmetic mean for high‐income countries ( HIC s) and LMIC s independently, and for geographic regions, among studies reporting country of recruitment, mean intake, and total number of participants. When available, inadequate intakes were reported. Main results From 1880 citations 105 works met the inclusion criteria, providing data for 73 958 women in 37 countries. The mean calcium intake was 948.3 mg/day (95% CI 872.1–1024.4 mg/day) for HIC s and 647.6 mg/day (95% CI 568.7–726.5 mg/day) for LMIC s. Calcium intakes below 800 mg/day were reported in five (29%) countries from HIC s and in 14 (82%) countries from LMIC s. Conclusion These results are consistent with a lack of improvement in calcium dietary intake during pregnancy and confirm the gap between HIC s and LMIC s, with alarmingly low intakes recorded for pregnant women in LMIC s. From the public health perspective, in the absence of specific local data, calcium supplementation of pregnant women in these countries should be universal. Tweetable abstract Despite dietary recommendations, women in LMIC s face pregnancy with diets low in calcium.

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“…Factors responsible for this are calcitriol and placental lactogen among other things. Several changes become apparent more obviously during the 3 rd trimester and during lactation: free calcitriol levels rise (16), maternal bone resorption becomes evident (due to an increase in urine cross-linked N-telopeptides of type I collagen, especially during the winter) (17), and PTHrP levels, which rise steadily during pregnancy, undergo further elevation during lactation (18).…”

Section: Discussionmentioning

confidence: 99%

Humoral hypercalcemia of pregnancy treated with bisphosphonates

Koren¹,

Neeman²,

Koren³

et al. 2018

Archives of Endocrinology and Metabolism

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Hypercalcemia can be hazardous during pregnancy, most cases being due to primary hyperparathyroidism. We report a case of hypercalcemia with suppressed PTH levels necessitating treatment with bisphosphonates during pregnancy. A 38-year-old woman at the 26th week gestation was admitted because of symptomatic hypercalcemia. She did not take any medication that could influence her calcium levels. Physical examination was unremarkable. Laboratory tests on admission were: calcium 12.7 mg/dL (8.5-10.5 mg/dL), phosphorus 1.8 mg/dL (2.5-4.5 mg/dL) and PTH on 3 consecutive tests 1.2, 1.3 and 1.2 pg/mL (15-65 pg/mL). Her 24h urine calcium was 900 mg, 25-OH-D 40 ng/mL (30-58 ng/mL) and 1,25-OH-D 99 pg/mL (80-146 for women in the third trimester). Abdominal ultrasound revealed multiple hypervascular liver lesions consistent with hemangiomas by MRI. Breast and neck ultrasound were normal, and chest CT revealed few non-significant 0.3-0.7 cm pulmonary nodules with no change after an interval of 3 months. She was treated with isotonic saline, loop diuretics and calcitonin. Despite this treatment, calcium levels remained high (14.1 mg/dL), and pamidronate was initiated. On 35th week gestation, she underwent a cesarean section complicated by hypocalcemia of the newborn. Eight weeks after delivery, her calcium levels are 9.4 mg/dL and PTH 18 mg/dL. According to the extensive workup and the post-partum normalization of PTH and calcium levels, we conclude that excessive secretion of placental PTHrP was the cause of hypercalcemia in this patient. No significant adverse effect of bisphosphonate on the mother or baby were seen at the short term follow up.

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Calcium intake in winter pregnancy attenuates impact of vitamin D inadequacy on urine NTX, a marker of bone resorption

Cited by 15 publications

References 23 publications

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT—An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity

Global inequities in dietary calcium intake during pregnancy: a systematic review and meta‐analysis

Humoral hypercalcemia of pregnancy treated with bisphosphonates

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