a1 MRC Human Nutrition Research, The Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK
a2 MRC Keneba, The Gambia
Pregnancy and lactation are times of additional demand for Ca. Ca is transferred across the placenta for fetal skeletal mineralisation, and supplied to the mammary gland for secretion into breast milk. In theory, these additional maternal requirements could be met through mobilisation of Ca from the skeleton, increased intestinal Ca absorption efficiency, enhanced renal Ca retention or greater dietary Ca intake. The extent to which any or all of these apply, the underpinning biological mechanisms and the possible consequences for maternal and infant bone health in the short and long term are the focus of the present review. The complexities in the methodological aspects of interpreting the literature in this area are highlighted and the inter-individual variation in the response to pregnancy and lactation is reviewed. In summary, human pregnancy and lactation are associated with changes in Ca and bone metabolism that support the transfer of Ca between mother and child. The changes generally appear to be independent of maternal Ca supply in populations where Ca intakes are close to current recommendations. Evidence suggests that the processes are physiological in humans and that they provide sufficient Ca for fetal growth and breast-milk production, without relying on an increase in dietary Ca intake or compromising long-term maternal bone health. Further research is needed to determine the limitations of the maternal response to the Ca demands of pregnancy and lactation, especially among mothers with marginal and low dietary Ca intake, and to define vitamin D adequacy for reproductive women.
p1 Present address: Department of Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Abbreviations: aBMD, areal bone mineral density; ALP, alkaline phosphatase; BA, bone area; BF, breast-feeding; BMC, bone mineral content; CTx, C-telopeptide; DPA, dual-photon absorptiometry; DXA, dual-energy X-ray absorptiometry; NBF, non-breast-feeding; NPNL, non-pregnant non-lactating; NTx, N-telopeptide; 1,25(OH)2D, 1,25-dihydroxyvitamin D; 25OHD, 25-hydroxyvitamin D; OPG, osteoprotegerin; pQCT, peripheral quantitative computed tomography; QCT, quantitative computed tomography; PTH, parathyroid hormone; PTHrP, parathyroid hormone-related protein; QUS, quantitative ultrasound; SPA, single-photon absorptiometry; vBMD, volumetric bone mineral density