Abstract
There is a plethora of research on the association of parity and duration of lactation with bone mineral density (BMD) during and after pregnancy. However, there are no consensus conclusions on the impact of the duration of lactation on BMD. The aim of this study was to examine the effect of pregnancy, and the duration of lactation on BMD during pregnancy, postpartum phase and 12 months post-delivery. The search terms 'parity' 'lactation' 'BMD' were searched for using PubMed, CINAHL, SCOPUS and EMBASE databases in English language. Two independent reviewers assessed the quality of the included studies using Critical Appraisal Skills Program (CASP) appraisal tool and extracted data on BMD (g/cm2) in Excel. A meta-analysis was conducted with a random effect model using Cochrane Review Manager (Rev 5.4) to analyse the outcome. Heterogeneity was assessed with Chi Squared and I2 test. The duration of lactation was grouped into short lactation duration (SLD), ≤4 months and longer lactation duration (LLD)>6 months. Twenty-one studies were included in this review with four studies included in the meta-analysis. BMD reduced during pregnancy and lactation. Recovery and net gains in BMD followed weaning. However, at 12 months postpartum, women in the LLD group had significant losses at the lumbar spine while those in the SLD recovered BMD. Between the SLD and LLD groups, the change in BMD was not significant 0.48g/cm2 (95% CI -0.14, 1.10, p=0.13). BMD losses were greater in primiparous women than multiparous women. Women who breastfed for >6 months had significantly reduced BMD. However, compared to women that breastfed for a ≤4 months there was no significant change in BMD. Further investigation is needed to clarify the association between lactation and BMD in a postpartum population in those women extending breastfeeding beyond one year.
Highlights
In pregnancy, there is a high demand for an adequate supply of calcium for the skeletal development of the foetus [1,2]
The inconsistencies and/or the absence of results in women postpartum led to these hypotheses: 1) the loss and recovery of bone mineral density (BMD) is influenced by the parity and duration of lactation in the postpartum phase, 2) BMD lost in the postpartum phase due to longer duration of lactation is not fully recovered with BMD in a shorter duration of lactation
After dividing the duration of lactation into short lactation duration (SLD), those who breastfed for 4 months and LLD groups, those who breastfed for more than !6 months, the women with longer lactation duration still had significant BMD losses compared with baseline BMD measurements and the SLD group at the lumbar spine
Summary
There is a high demand for an adequate supply of calcium for the skeletal development of the foetus [1,2]. 690e1122 mg/day [3,4] This demand leads to changes in calcium and bone metabolism resulting in changes in bone mineral density (BMD) [4]. Six weeks after delivery (clinically the postpartum phase) and beyond, lactation demands more calcium and is supplied to the infant through breastmilk [7]. Aims: The aim of this study was to examine the effect of pregnancy, and the duration of lactation on BMD during pregnancy, postpartum phase and 12 months post-delivery. At 12 months postpartum, women in the LLD group had significant losses at the lumbar spine while those in the SLD recovered BMD.
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