Calcium In Pregnancy Research Articles

THU473 Acute Hypercalcemia In The Setting Of Acute Fatty Liver Of Pregnancy, A Case Report

Abstract Disclosure: M. Ahmad: None. M. Mack: None. A. Arif: None. L.A. Tejada: None. U. Siddiqui: None. Introduction: Hypercalcemia in pregnancy is rare and often goes unrecognized due to the overlapping symptoms of hypercalcemia and pregnancy. The most common cause of hypercalcemia in pregnant patients is primary hyperparathyroidism, with malignancy, milk alkali syndrome and familial hypocalciuric hypercalcemia being less common. Additionally, endogenous PTHrP production by breast and placental tissue have also been described as rare causes of hypercalcemia in pregnancy. We describe an interesting case of severe hypercalcemia in a pregnant woman presenting with acute fatty liver of pregnancy (AFLP) which rapidly corrected after delivery. Case description: The patient was a 32-year-old female with a past medical history of hypothyroidism and type 2 diabetes mellitus who presented to the emergency department at 32 weeks gestation due to four days of nausea, vomiting and epigastric pain. The patient’s vital signs were as follows: blood pressure: elevated to 133/79 mmHg, heart rate: 75 beats per minute, temperature: 36.7 C, and respiratory rate: 12 breaths per minute. On physical exam, the patient had diffuse abdominal tenderness with no vaginal bleeding. The patient’s blood work was significant for: bicarbonate: 17 mmol/L, creatinine: 1.26 mg/dL (baseline 0.7 mg/dL), corrected calcium of 15.1 mg/dL, ALP: 438 IU/L, AST: 653 IU/L, ALT: 666IU/L, total bilirubin: 2.3 mg/dL, INR 1.3, and ammonia: 43 mcmol/L. She was taken to the operating room for emergent cesarian delivery for concerns of AFLP. Further workup of the patient’s hypercalcemia, revealed a low normal PTH level of 11 pg/dL (normal 11-65 mg/dL), PTHrP level of <5 mg/dL, TSH of 1.37 uIU/ml, 25-OH vitamin D 55 ng/ml, and 1,25-OH vitamin D: 20 pg/ml. After delivery, the patient had alleviation of her symptoms and was kept on dextrose 5% with lactated ringers at 100 cc/h for a total of two days and had complete resolution of her hypercalcemia (corrected calcium of 10.2 mg/dL on discharge). The patient follows with endocrinology as an outpatient and since has had normal calcium levels. Discussion: Hypercalcemia in pregnancy is rare, only affecting 0.03% of women in the reproductive age group, with primary hyperparathyroidism being the most common cause. Hypercalcemia in pregnancy can often be missed due to the hemodilution of serum calcium in pregnancy and also the nonspecific symptoms present in pregnant patients. Our case describes a patient presentation of severe hypercalcemia with AFLP, who had rapid correction of her calcium levels after delivery. The exact mechanism of her severe hypercalcemia developed remains unclear, however, given its rapid resolution with delivery of the placenta potential etiologies include the AFLP itself or possibly the placenta contributing to hypercalcemia. Through this case report, we hope to highlight a possible association between AFLP and hypercalcemia. Presentation: Thursday, June 15, 2023

Abnormal Calcium Levels are Associated With Worse Maternal and Fetal Outcomes; Results From an Exploratory Study.

Precise estimates of the incidence of hyper- and hypocalcemia in pregnancy are unknown. Abnormal calcium levels have been associated with unfavorable pregnancy-related outcomes. Determine frequency of hypercalcemia and hypocalcemia in pregnancy when tested and their associations with maternal and fetal outcomes. Exploratory retrospective cohort study. Single tertiary care maternity unit. Pregnant women with expected delivery date between 2017 and 2019 and a second additional cohort of pregnant women with hypercalcemia between 2014 and 2016 and 2020 and 2021. Observational. (1) Incidence of hyper- and hypocalcemia when calcium tested; (2) maternal outcomes: incidence of preterm delivery, emergency cesarean section, and blood loss during delivery; and (3) fetal outcomes: fetal loss (miscarriage/stillbirth), neonatal intensive care unit admission, and fetal birth weight (for term deliveries). Total number of gestations and livebirths recorded were 33 118 and 20 969, respectively, with median [interquartile range] age of 30.1 [25.6-34.3] years. A total of 15.7% (n = 5197) of all gestations had albumin-adjusted calcium tested, and incidence of hypercalcemia and hypocalcemia when tested was 0.8% (n = 42) and 9.5% (n = 495), respectively. Both hypercalcemia (including additional cohort n = 89) and hypocalcemia were associated with increased incidence of preterm delivery (P < .001), emergency cesarean section (P < .001 and .019), blood loss (P < .001), and neonatal intensive care unit admission (P < .001). A total of 27% in the hypercalcemic group had an established diagnosis of primary hyperparathyroidism. Abnormal calcium levels during pregnancy are common and associated with worse pregnancy-related outcomes, which raises the possible need for routine calcium testing. Prospective studies to confirm the incidence, etiology, and effects of abnormal calcium in pregnancy are recommended.

Bone resorption and dietary calcium in pregnancy-a window to future maternal bone health.

Pregnancy is characterized by increased bone turnover and reversible loss of bone mineral density (BMD) to meet fetal calcium demands. The long-term effect of bone turnover and maternal diet in pregnancy on maternal bone is not well established. We aimed to determine if an association exists between [1] bone resorption, [2] dietary calcium, and [3] serum 25-hydroxyvitamin D in pregnancy with maternal BMD 5-year postpartum. This is a prospective, longitudinal study of 107 women recruited to the ROLO low glycemic index dietary intervention trial in pregnancy and followed-up at 13, 28, and 34weeks' gestation and 5years' postpartum. At 13 and 28weeks' gestation, a biomarker of bone resorption, urine cross-linked N-telopeptide of type I collagen (uNTX), was measured. At the 5-year follow-up BMD was measured using dual-energy X-ray absorptiometry. Anthropometry, dietary intakes, and serum 25-hydroxyvitamin D were measured in pregnancy and at 5years. Multiple linear regression, controlling for confounders, was used for analysis. Mean BMD at 5years was 1.208g/cm2. In pregnancy, 24-34% reported dietary calcium intakes <800mg/day. Vitamin D deficiency (< 30nmol/L) was observed in 38-41% of women in pregnancy and in 29% of women at the 5-year follow-up. At 13 and 28weeks' gestation, uNTX levels greater than the median were associated with 0.060 and 0.050g/cm2 lower BMD 5years later, respectively. Dietary calcium <800mg/day in trimester 3 was associated with 0.072g/cm2 lower BMD 5years later. Vitamin D deficiency at 5years, but not in pregnancy, was associated with lower BMD. Higher bone resorption and low dietary calcium in pregnancy were associated with lower BMD 5years later. These findings could enable the identification of women at risk of declining of BMD in later life, but further research is needed. Adequate dietary calcium should be advised in the antenatal setting to promote lifelong maternal bone health.

Bone resorption and calcium in pregnancy – A window to future maternal bone health

Bone resorption and calcium in pregnancy – A window to future maternal bone health

Calcium and Vitamin D Supplementation for Prevention of Preeclampsia: A Systematic Review and Network Meta-Analysis.

Vitamin D supplementation effects with or without calcium in pregnancy for reducing risk of preeclampsia and gestational or pregnancy induced hypertension are controversial. Literature was systematically searched in Medline, Scopus and Cochrane databases from inception to July 2017. Only randomized controlled trials (RCTs) in English were selected if they had any pair of interventions (calcium, vitamin D, both, or placebo). Systematic review with two-step network-meta-analysis was used to indirectly estimate supplementary effects. Twenty-seven RCTs with 28,000 women were eligible. A direct meta-analysis suggested that calcium, vitamin D, and calcium plus vitamin D could lower risk of preeclampsia when compared to placebo with the pooled risk ratios (RRs) of 0.54 (0.41, 0.70), 0.47 (0.24, 0.89) and 0.50 (0.32, 0.78), respectively. Results of network meta-analysis were similar with the corresponding RRs of 0.49 (0.35, 0.69), 0.43 (0.17, 1.11), and 0.57 (0.30, 1.10), respectively. None of the controls were significant. Efficacy of supplementation, which was ranked by surface under cumulative ranking probabilities, were: vitamin D (47.4%), calcium (31.6%) and calcium plus vitamin D (19.6%), respectively. Calcium supplementation may be used for prevention for preeclampsia. Vitamin D might also worked well but further large scale RCTs are warranted to confirm our findings.

Role of Calcium in Hypertensive Disorders of Pregnancy Current Status of Research a Mini Review

Introduction: Some studies have revealed changes in blood/urinary calcium with inverse relationship between calcium intakes during pregnancy, incidence of preeclampsia. So researchers believe that calcium has a role in etiology of hypertensive disorders during pregnancy. With reduced incidence of preeclampsia after calcium supplementation. So prevention of HDsP and/or their severity are being attempted through oral calcium. Objective: To collect existing information about role of calcium in HDsP for translational program or if needed, research. Material Methods: Present article is based on literature search by available search engines like, Pubmed, Google, Update and others. Studies, reviews and short commentaries were looked into to get desired information. Serum urinary cellular calcium: Normally there is increase in intracellular calcium in pregnancy. It has been reported that this effect is exaggerated in preeclampsia due to significant increase in the membranous calcium content. Researchers also reported that preeclampsia in third trimester was associated with hypocalciuria due to increased tubular reabsorption of calcium. Urinary calcium excretion has been found to be reduced in severe preeclampsia, eclampsia, but decrease could not be used to identify severity of preeclampsia, or predict impending eclampsia. Problem seems to be at the cellular level, needs to be investigated further. Calcium supplementation: Some have reported incidence of preeclampsia greater in women given placebo, compared to calcium-treated, although difference was not significant. Also supplementing calcium in women at high risk of pre-eclampsia was likely to reduce incidence of disease. But others reported that extra calcium did not reduce number of women who suffered, however reduced severity of HDsP. Also smooth-muscle relaxation detected in calcium supplemented women might affect labour onset. Conclusion: There are reports of positive relationship and no effect on reduction in HDsP or their severity. In view of contradictory findings, in depth studies are required to investigate altered serum, urine and cellular calcium, in women with HDsP.

Levels of serum vitamin D and calcium in pregnancies complicated with fetal congenital diaphragmatic hernia and normal pregnancies

Objective: Vitamin D (VD) deficiency is a common public health problem worldwide in all age groups. Receptors and enzymes related to VD metabolism have been shown in many cells and tissues of the body. VD plays a crucial role in cellular growth and differentiation during embryogenesis. It has been suggested that VD deficiency may be associated with various diseases, and that lower maternal serum levels may be associated with adverse perinatal outcomes. In this study, we aimed to compare serum VD levels of pregnant women whose pregnancies complicated by congenital diaphragmatic hernia (CDH) with healthy pregnant women. We also evaluated perinatal outcomes of these pregnancies. Methods: Total of 77 patients was included in this prospective and cross-sectional case-controlled study. 24 pregnant women having a fetus with CDH diagnosed prenatally formed the study group, and 53 healthy pregnants were eligible for the control group. Demographics and clinical characteristics of the cases with some laboratory parameters were recorded. Perinatal outcomes were also investigated. Results: No significant differences were observed between two groups in terms of demographics and clinical features. Mean maternal serum VD levels were significantly lower in the study group than in the controls (p: 0.019). Ionized calcium and corrected calcium levels were also found to be lower in pregnant women with CDH (p < 0.001). Moreover, the calcium-rich dietary habits were also more common in the control group. Four (16.7%) patients chose termination and one (4.2%) experienced a stillbirth. Fourteen (58.3%) infants died in the early neonatal period; although some had undergone surgical interventions, only 5 (20.8%) were still alive after surgery. Conclusions: Maternal serum VD and calcium levels were significantly lower in pregnancies complicated by CDH than healthy pregnant women. Hipovitaminosis D may play a vital role in the pathogenesis of CDH.

Metabolic changes in bone and calcium in pregnancy and puerperium

Calcium transfer from the mother to the fetus and neonate during pregnancy and lactation plays an extremely important role in the bone health of the mother and infant. Calcium aids in bone health through all ages but is especially crucial during pregnancy and lactation. Despite facing similar demands for calcium in pregnancy and puerperium, the maternal adaptations differ significantly between these two reproductive periods. Although the studies are underway to establish the conclusion, the changes in the structure and metabolism of bone and calcium during pregnancy and the early stage of postpartum are evaluated by investigating bone mineral density (BMD) , bone histomorphometry and bone markers of human or animal models. The bone resorption increased at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. Vitamin D and parathyroid hormone-related protein (PTHrP) status especially becomes crucial for optimal maternal and fetal outcomes, fetal and neonatal skeletal growth, and maternal health in later life.

Kalziumsupplementation in der Schwangerschaft – ein Muss (?)

The pregnant woman's body provides daily doses between 50 and 330 mg to support the developing fetal skeleton. This high fetal demand for calcium in pregnancy is facilitated by profound physiological interactions between mother and fetus. The D-A-CH organization (which represents the German, Austrian and Swiss Nutrition Offices) and the Institute of Medicine (IOM) of the US recommend a daily consumption of 1000 mg calcium for pregnant and lactating women at an age over 19 years. The average consumption of calcium in western countries is about 800 mg in young women. Therefore calcium consumption in pregnancy should be encouraged, especially during the second and third trimester of pregnancy and during lactation. Proper calcium consumption can be attained by diet with healthy nourishment including 3-4 snacks of milk or milk-derived products such as yogurt and cheese and calcium-rich mineral waters. In these women calcium-supplementation in pregnancy is not necessary. In women with chronic autoimmunologic disorders, low-molecular-weight-heparin therapy during pregnancy, lactose intolerance or in women who prefer to skip milk and milk products due to personal preference the supplementation of 500 to 1000 mg calcium in addition to dietary measures is recommended. Calcium supplementation in pregnancy has been associated with a reduced risk of pregnancy-induced hypertension, but this effect is only seen in persons with a low basal calcium intake. There are reports in literature that calcium supplementation in pregnancy protects against low-birthweight in newborns, which is defined as a birthweight of < 2500 g or that calcium supplementation lowers offspring blood pressure thus helping to prevent hypertension in the next generation. These reports are either preliminary or are not applicable to the Swiss population or need confirmation. Therefore calcium supplementation is only recommended in order to achieve a daily uptake of at least 1000 mg/day in pregnant women.

Calcium supplementation during pregnancy and lactation: Effects on the mother and the fetus

Calcium consumption is essential for bone development and maintenance throughout life, yet more than one half of the female population in the United States does not consume the recommended amount of calcium. Calcium intake is especially crucial during pregnancy and lactation because of the potential adverse effect on maternal bone health if maternal calcium stores are depleted. There is often a transient lowered bone mineral density and increased rate of bone resorption, with the greatest consequence during the third trimester and throughout lactation. Studies indicate that calcium consumption should be encouraged, especially during pregnancy and lactation, to replace maternal skeletal calcium stores that are depleted during these periods. Because the fetus in utero and the neonate through breast-feeding are dependent on maternal sources for the total calcium load, adequate maternal calcium intake also can affect fetal bone health positively. Proper calcium consumption can be attained through the diet by the consumption of dairy products or leafy greens (such as kale), the consumption of fortified foods, or by supplementation with widely available calcium-containing supplement products. Because many women experience heartburn during pregnancy, calcium-based antacids are ideal for providing heartburn relief, and they offer a calcium supplement to ensure maternal and fetal bone health, without the danger of adverse effects on the neonate.

WORLD HEALTH ORGANIZATION SYSTEMATIC REVIEW OF THE LITERATURE AND MULTINATIONAL NUTRITIONAL SURVEY OF CALCIUM INTAKE DURING PREGNANCY

In 1999, the US Food and Nutrition Board revised the Adequate Intake (AI) for calcium in pregnancy and recommended 1000 mg/day for adult pregnant women and 1300 mg/day for adolescent women (&lt;19 years). Our interest, from the perspective of an international health organization, was to assess if pregnant women globally meet those requirements. This is particularly important because, among the various biological functions of calcium, the potential protective effect of adequate calcium intake in pregnancy on the risk of pre-eclampsia may have major public health implications, pre-eclampsia being one of the most important causes of maternal and perinatal mortality world-wide. Therefore, we conducted a systematic review of studies, published from 1991 to 2004, that assessed calcium dietary intake in pregnant women. In addition, we conducted a multicentre survey of calcium dietary intake during pregnancy among nulliparous women attending antenatal care in developing countries. This survey was conducted before starting a large calcium supplementation multicentre trial: the WHO Calcium Supplementation Trial in Low Calcium Intake Women for the Prevention of Pre-eclampsia. This article presents the results of the systematic review and of the multicentre survey.

Protecting baby: Calcium in pregnancy reduces lead exposure

Science NewsVolume 166, Issue 7 p. 100-100 This Week Protecting baby: Calcium in pregnancy reduces lead exposure Carrie Lock, Carrie LockSearch for more papers by this author Carrie Lock, Carrie LockSearch for more papers by this author First published: 02 July 2009 https://doi.org/10.2307/4015403AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume166, Issue714 August 2004Pages 100-100 RelatedInformation

Calcium in pregnancy and lactation.

Pregnancy and lactation are periods of high calcium requirement. This review highlights recent advances in our understanding of calcium and bone metabolism during human pregnancy and lactation and discusses the findings in relation to the calcium nutrition of the mother. The evidence indicates that pregnancy and lactation are characterized by physiological adaptive processes that are independent of maternal calcium intake and that provide the calcium necessary for fetal growth and breast-milk production without requiring an increase in maternal calcium intake. There are firm data that demonstrate that a low calcium intake during lactation does not lead to impaired lactational performance or to exaggerated bone loss. However, more research is required to define whether a low calcium intake prior to or during pregnancy can have deleterious effects on reproductive and lactational performance, and on the long-term health of the mother and child.

Calcium in pregnancy lowers risk of hypertension in offspring

Calcium in pregnancy lowers risk of hypertension in offspring

The concentration of free calcium ions and total calcium in pregnancies at term

The concentration of free calcium ions (cCa2+), total calcium (ctCa) and pH was measured in 46 normal pregnancies at term. Measured with a combined Ca2+-pH electrode system in whole blood, maternal plasma cCa2+ was 1.18 +/- 0.03 mmol/l, and the corresponding plasma pH was 7.37 +/- 0.05 (mean +/- SD). In the cord vein, plasma cCa2+ was 1.44 +/- 0.07 mmol/l and pH 7.37 +/- 0.05. In the cord artery, plasma cCa2+ was 1.47 +/- 0.07 mmol/l and pH 7.29 +/- 0.07.

The concentration of free calcium ions and total calcium in pregnancies at term

The concentration of free calcium ions and total calcium in pregnancies at term

Absorption of Dietary Calcium in Pregnancy

Twenty-five calcium-balance studies were conducted on twelve subjects during their first, second, and third trimesters of pregnancy, on diets that provided about 400 mg calcium daily. Four subjects were in negative calcium balance during the first trimester of pregnancy. During the later stages of pregnancy, these four subjects came into positive balance without any change in the dietary intakes of calcium. In all the subjects, the amount of calcium retained during the second and third trimesters was significantly higher than that during the first trimester. The apparent absorption of calcium markedly increased during the second trimester and this increase was maintained throughout the third trimester of pregnancy. There was a reduction of urinary calcium in the third trimester.