Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study

Møller, Ulla; Streym, S.; Mosekilde, Leif; Heickendorff, Lene; Flyvbjerg, Allan; Frystyk, Jan; Jensen, Lars Thorbjørn; Rejnmark, Lars

doi:10.1007/s00198-012-2062-2

Cited by 90 publications

(81 citation statements)

References 51 publications

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“…The situation may slightly change in late pregnancy, as some investigators have described stabilization in the slope in weeks just before delivery (22). Also in concurrence with histological studies, markers of bone formation remain stable or decrease up to the third trimester, when significant increases have been detected (18,22,66). This response is consistent with the increase in bone formation detected in biopsies and with the elevation in the circulating levels of PGH and IGF1 during that period.…”

Section: Bone Biochemical Markerssupporting

confidence: 70%

“…The oscillations are small during the first and second trimesters, but then the peptide increases during the third trimester and decreases post partum (18,22,29). These changes seem to be influenced by active participation of PGH, which gradually replaces the control in the synthesis of IGF1 during the second half of pregnancy (30).…”

Section: Igf1 and Pghmentioning

confidence: 97%

“…However, it is now known that hypocalcemia derives from the physiological hypoalbuminemia of pregnancy, which coexists with unaltered levels of free calcium, the real reset regulator of PTH levels (17). Moreover, there is no change in phosphate levels, and more reliable immunoassays, either immunoradiometry with the use of a double-antibody technique or electrochemiluminescence, confirm that the circulating PTH level slightly decreases during pregnancy and normalizes at the end of this state (18). Murine models further exclude the participation of the hormone in the increase in calcitriol level during pregnancy or the recovery of bone mass after lactation (19).…”

Section: Pth and Pthrpmentioning

confidence: 99%

“…Changes in BBMs present the first and the second trimesters of pregnancy as periods of increased bone resorption (18,22,63,66,74,75). The situation may slightly change in late pregnancy, as some investigators have described stabilization in the slope in weeks just before delivery (22).…”

Section: Bone Biochemical Markersmentioning

confidence: 99%

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ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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Changes in bone density and bone markers suggest that pregnancy is associated with deterioration of bone mass in the mother. The metabolism of calcium resets to allow for the needs imposed by the building of the fetal skeleton. The fetus contributes to the process through the output of regulators from the placenta. Understanding of the whole process is limited, but some changes are unambiguous. There is an increase in the circulating levels of vitamin D, but its functional impact is unclear. Fetal parathyroid hormone (PTH) and PTH-related peptide (PTHrp) play an indirect role through support of a calcium gradient that creates hypercalcemia in the fetus. Placental GH, which increases up to the end of pregnancy, may exert some anabolic effects, either directly or through the regulation of the IGF1 production. Other key regulators of bone metabolism, such as estrogens or prolactin, are elevated during pregnancy, but their role is uncertain. An increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL) to osteoprotegerin (OPG) acts as an additional pro-resorbing factor in bone. The increase in bone resorption may lead to osteoporosis and fragility fracture, which have been diagnosed, although rarely. However, the condition is transitory as long-term studies do not link the number of pregnancies with osteoporosis. Prevention is limited by the lack of identifiable risk factors. When fractures are diagnosed, rest, analgesics, or, when indicated, orthopedic intervention have demonstrated efficacy. Systemic treatment with anti-osteoporotic drugs is effective, but the potential harm to the fetus imposes caution in their use.

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Section: Bone Biochemical Markerssupporting

confidence: 70%

Section: Igf1 and Pghmentioning

confidence: 97%

Section: Pth and Pthrpmentioning

confidence: 99%

Section: Bone Biochemical Markersmentioning

confidence: 99%

See 2 more Smart Citations

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

Sanz-Salvador

Garcı́a-Pérez

Tarı́n

et al. 2015

European Journal of Endocrinology

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“…Calcitropic hormones undergo significant changes throughout pregnancy (18). Calcitriol initially rises while PTH falls; after delivery, PTH increases to above prepregnancy levels and has been interpreted as a secondary response to relative calcium deficiency from lactation.…”

mentioning

confidence: 99%

PTH-Vitamin D-Glycemia Interactions Reloaded

Lee

2014

Diabetes

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Vitamin D supplementation for women during pregnancy

De-Regil

Palacios

Lombardo

et al. 2016

Cochrane Database of Systematic Reviews

446

302

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BACKGROUND: Vitamin D deficiency or insufficiency is thought to be common among pregnant women. Vitamin D supplementation during pregnancy has been suggested as an intervention to protect against adverse pregnancy outcomes. OBJECTIVES: To examine whether oral supplements with vitamin D alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes. METHODS: Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 February 2015), the International Clinical Trials Registry Platform (31 January 2015), the Networked Digital Library of Theses and Dissertations (28 January 2015) and also contacted relevant organisations (31 January 2015). Selection criteria: Randomized and quasi-randomized trials with randomization at either individual or cluster level, evaluating the effect of supplementation with vitamin D alone or in combination with other micronutrients for women during pregnancy. Data collection and analysis: Two review authors independently i) assessed the eligibility of studies against the inclusion criteria ii) extracted data from included studies, and iii) assessed the risk of bias of the included studies. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS: In this updated review we included 15 trials assessing a total of 2833 women, excluded 27 trials, and 23 trials are still ongoing or unpublished. Nine trials compared the effects of vitamin D alone versus no supplementation or a placebo and six trials compared the effects of vitamin D and calcium with no supplementation. Risk of bias in the majority of trials was unclear and many studies were at high risk of bias for blinding and attrition rates. • Vitamin D alone versus no supplementation or a placebo Data from seven trials involving 868 women consistently show that women who received vitamin D supplements alone, particularly on a daily basis, had higher 25-hydroxyvitamin D than those receiving no intervention or placebo, but this response was highly heterogeneous. Also, data from two trials involving 219 women suggest that women who received vitamin D supplements may have a lower risk of pre-eclampsia than those receiving no intervention or placebo (8.9% versus 15.5%; risk ratio (RR) 0.52; 95% CI 0.25 to 1.05, low quality). Data from two trials involving 219 women suggest a similar risk of gestational diabetes among those taking vitamin D supplements or no intervention/ placebo (RR 0.43; 95% CI 0.05, 3.45, very low quality). There were no clear differences in adverse effects, with only one reported case of nephritic syndrome in the control group in one study (RR 0.17; 95% CI 0.01 to 4.06;

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Changes in calcitropic hormones, bone markers and insulin-like growth factor I (IGF-I) during pregnancy and postpartum: a controlled cohort study

Cited by 90 publications

References 51 publications

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

ENDOCRINOLOGY IN PREGNANCY: Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture

PTH-Vitamin D-Glycemia Interactions Reloaded

Vitamin D supplementation for women during pregnancy

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