Hypoparathyroidism in pregnancy

Shah, Krupa H; Bhat, Seetharama M; Shetty, Seema; Umakanth, Shashikiran

doi:10.1136/bcr-2015-210228

Cited by 13 publications

(32 citation statements)

References 20 publications

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“…In contrast to these reports of improved or stable calcium metabolism, other reports have found that hypoparathyroidism significantly worsens during pregnancy: serum calcium falls, hypocalcemic symptoms may or may not increase, and the doses of supplemental calcium and vitamin D, 1␣-hydroxyvitamin D, or calcitriol have been increased (96,141,148,411,434,510,517,600,669,790,796,821,837,884,936). In one woman the endogenous calcitriol level was low at mid-pregnancy, but measurements in the third trimester were not reported (510).…”

Section: Human Datamentioning

confidence: 49%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains ϳ30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.

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Section: Human Datamentioning

confidence: 49%

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Kovacs

2016

Physiological Reviews

383

524

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“…Indeed, the increased demand of calcium for skeletal mineralization in the last trimester increases the requirement of calcitriol to avoid hypocalcemia. In case reports, oral elemental calcium varies from 800 to 1,500 mg at the beginning of pregnancy to 2,000 to 3,200 mg in the third gestational trimester (C) (142,143). During pregnancy, the daily recommended dose of calcitriol is between 0.25-3 µg.…”

Section: How Should Hypoparathyroidism Be Managed During Pregnancy Anmentioning

confidence: 99%

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

Maeda¹,

Moreira²,

Borba³

et al. 2018

Archives of Endocrinology and Metabolism

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Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type. Conclusion An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.

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“…Until now, only limited case reports or case series of pregnant/lactating hypoparathyroid women have been published (1,20,22,24,(29)(30)(31)(32)(33). Among these, the largest case series described 12 cases with HypoPT (20,33), while for women with pseudo-hypoPT, only case reports are available (34)(35)(36)38).…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 99%

“…Parathyroid hormone (PTH) is essential for calcium homoeostasis, and pregnancy is known for an increased calcium requirement (1). During pregnancy and breastfeeding, physiological changes of maternal calcium metabolism take place to ensure both an adequate fetal skeleton mineralization, with approximately 80% of the mineral accruing in the fetus in the third trimester (9), and a su cient amount of calcium in the breast milk (10,11).…”

Section: Introductionmentioning

confidence: 99%

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Hypoparathyroidism and Pseudohypoparathyroidism in Pregnancy: An Italian Retrospective Observational Study

Marcucci

Altieri

Benvenga

et al. 2020

Preprint

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Background: Hypoparathyroidism (HypoPT) or pseudo-hypoparathyroidism (pseudo-HypoPT) during pregnancy may cause maternal and fetal/neonatal complications. In this regard, only a few case reports or case series of pregnant or lactating women have been published. The purpose of this study was to describe clinical and biochemical course, pharmacological management, and potential adverse events during pregnancy and post-partum in pregnant women with HypoPT or pseudo-HypoPT. This was a retrospective, observational, multicenter, study involving nine Italian referral centers for endocrine diseases affiliated with the Italian Society of Endocrinology and involved in “Hypoparathyroidism Working Group”.Results: This study identified a cohort of 28 women (between 2005 and 2018) with HypoPT (n=25, 80% postsurgical) and pseudo-HypoPT (n=3). The mean calcium carbonate and calcitriol doses of both groups were increased during pregnancy compared to pre-pregnancy period. During the three trimesters of pregnancy the mean calcium carbonate and calcitriol doses were variable, remaining unchanged throughout gestation respectively in 40% and 60% of women with HypoPT, whilst tended to decrease from the third trimester to the post-partum six months. Most identified women (~70%) did not display maternal complications and (~90%) maintained mean serum albumin-corrected total calcium levels within the low-to-mid normal reference range (8.5±0.8 mg/dl) during pregnancy. The main complications related to pregnancy period included: preterm birth (n=3 HypoPT women), and history of miscarriages (n=6 HypoPT women and n=2 pseudo-HypoPT women). Conclusion: This study shows that mean serum albumin-corrected total calcium levels were carefully monitored during pregnancy and post-pregnancy, with limited evaluation of other biochemical parameters, such as serum phosphate, 24h urinary calcium, 25-OH vitamin D, and creatinine clearance. To avoid complications in mothers and offspring, intense biochemical, clinical and pharmacological monitoring during pregnancy and breastfeeding is highly recommended.

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Hypoparathyroidism in pregnancy

Cited by 13 publications

References 20 publications

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism

Hypoparathyroidism and Pseudohypoparathyroidism in Pregnancy: An Italian Retrospective Observational Study

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