Chapter 21 - Control of Mineral and Skeletal Homeostasis During Pregnancy and Lactation

Abstract

Pregnancy and lactation invoke a substantial demand on the mother to supply calcium and other minerals to her offspring, and this is met by different adaptations within each time period. The development of genetically engineered mouse models has enabled detailed study of the regulation of maternal mineral homeostasis during pregnancy and lactation. A limited number of clinical trials and observational studies have provided human data. Intestinal calcium absorption more than doubles during pregnancy, whereas the maternal skeleton is resorbed to provide most of the calcium content of breast milk during lactation. These maternal adaptations affect the presentation, diagnosis, and management of disorders of mineral and bone metabolism, such as primary hyperparathyroidism, hypoparathyroidism, and vitamin D deficiency. Some women may experience fragility fractures during pregnancy or lactation, but for most women these acute changes in mineral metabolism do not affect long-term fragility or maintenance of bone mass.