The importance of calcium intake during pregnancy and lactation and the possibilities of its supplementation

Česká verzia

Authors: Miloslav Hronek; Anna Patková; PharmDr. Věra Josková, Ph.D.
Authors place of work: Katedra biologických a lékařských věd Farmaceutické fakulty UK, Hradec Králové
Published in the journal: Prakt Gyn 2015; 19(2): 97-100
Category: Gynecology and Obstetrics: Review Article

Summary

This review article discusses the importance of calcium intake and the essential need of this mineral during pregnancy and lactation. This article describes the specifics of its utilization, the regulatory mechanisms and plasma concentration required for the specific activity of tissues. Also the importance during formation of the fetal skeleton and during lactation for milk production, which is maintained in a stable concentration, independent of the nutritional intake. The recommended daily allowance (RDA) of calcium for pregnant and lactating in the Czech Republic are discussed. The value of 1 000 mg/day according to the authors seem to be low, which corresponds to relatively frequent symptoms of its depletion, both during pregnancy and lactation and in relation to the demineralization of the breast bone. They are also lower than the recommended RDA by WHO and FAO (1 200 mg/day). Part of this article is an overview of the positive and negative factors affecting the calcium utilization in the intestines, both nutritional intake and in the form of supplements. Finally, recommendations are given for calcium supplementation in pregnant and lactating women: with low nutritional calcium intake, or an aversion to milk or dairy products (eg. lactose intolerance, allergies to milk proteins, different forms of vegetarianism), with symptoms associated with the depletion of calcium , prevention of gestational hypertension, preeclampsia prevention, in cases of osteopenia and osteoporosis, in cases of administration of drugs that contribute to depletion of calcium and bone demineralization (e.g. heparin, corticosteroids, aluminum antacids, anticonvulsants, laxatives).

Key words:
calcium– lactation – pregnancy – recommendations for supplementation – supplementation

Zdroje

1. Hronek M. Výživa ženy v obdobích těhotenství a kojení. Maxdorf: Praha 2004. ISBN 80–7345–013–5.

2. Kovacs CS. Calcium and Bone Metabolism During Pregnancy and Lactation. J Mammary Gland Biol Neoplasia. 2005; 10(2): 105–118.

3. Villar J, Say L, Shennan A et al. Methodological and technical issues related to the diagnosis, screening, prevention and treatment of pre-eclampsia and eclampsia. Int J Gynaecol Obstet 2004; 85(Suppl 1): 28–41.

4. National Institute of Medicine. Dietary reference intakes for Calcium and vitamin D. National Academies Press: New York 2011. ISBN 978–0-309–16395–8.

5. Chesney RW, Specker BL, McKay CP. Mineral metabolism during pregnancy and lactation. In: Coe FL, Favus MJ (eds). Disorders of bone and mineral metabolism. 2nd ed. Philadelphia: Lippincott Williams & Wilkins 2002. ISBN 10–0781717892. ISBN 13–9780781717892.

6. Rasmussen N, Frolich A, Hornnes PJ et al. Serum ionized calcium and intact parathyroid hormone levels during pregnancy and postpartum. Br J Obstet Gynaecol 1990; 97(9): 857–859.

7. Turner M, Barre PE, Benjamin A et al. Does the maternal kidney contribute to the increased circulating 1,25-dihydroxyvitamin D concentrations during pregnancy? Miner Electrolyte Metab 1988; 14(4): 246–252.

8. Woodrow JP, Noseworthy CS, Fudge NJ et al. Calcitonin/calcitonin gene-related peptide protect the maternal skeleton from excessive resorption during lactation [abstract]. J Bone Miner Res 2003; 18(Suppl 2): S37.

9. Naylor KE, Iqbal P, Fledelius C et al. The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 2000; 15(1): 129–137.

10. Ulrich U, Miller PB, Eyre DR et al. Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 2003; 268(4): 309–316.

11. Kaur M, Pearson D, Godber I et al. Longitudinal changes in bone mineral density during normal pregnancy. Bone 2003; 32(4): 449–454.

12. Paton LM, Alexander JL, Nowson CA et al. Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: A twin study. Am J Clin Nutr 2003; 77(3): 707–714.

13. Prentice A. Pregnancy and lactation. In: Glorieux FH, Petifor JM, Jüppner H, editors. Pediatric bone: Biology & diseases. Academic Press: New York 2003. ISBN 987–0-12–382040–2.

14. Gibson RS, Cavalli-S, Forza T. Using reference nutrient density goals with food balance sheet data to identify likely micronutrient deficits for fortification planning in countries in the Western Pacific region. Food and Nutrition Bulletin 2012; 33(Suppl. 3): 214–220.

15. Broadley MR, Chilimba AD, Joy EJ et al. Dietary requirements for magnesium, but not calcium, are likely to be met in Malawi based on National Food Supply Data. Int J Vitam Nutr Res 2012; 82(3): 192–199.

16. Hronek M. Doubkova P. Hrnciarikova D. et al. Dietary Intake of Energy and Nutrients in Relation to resting energy expenditure and anthropometric parameters of Czech pregnant women. Eur J Nutr 2013; 52(1): 117–125.

17. Společnost pro výživu o.s. Referenční hodnoty pro příjem živin. Výživaservis s.r.o.: Praha 2011. ISBN 978–80–254–6987–3.

18. Lampoltová L, Chrásková J. Změna stravovacích zvyklostí žen v souvislosti s těhotenstvím. Teória, výskum a vzdelávanie v ošetrovateľstve. Zborník konferencie. Univerzita Komenského v Bratislave, Jesseniova lekárska fakulta v Martine. Martin 2014. ISBN 978–80–89544–69–1.

19. World Health Organization. Food and Agricultural Organization of the United Nations. Vitamin and mineral requirements in human nutrition. 2nd ed. World Health Organization: Geneva 2004. Dostupné z WWW: <http://www.who.int/nutrition/publications/micronutrients/9241546123/en/index>.

20. World Health Organization. Guideline: Calcium supplementation in pregnant women. World Health Organization: Geneva 2013. [cited 2015 April 29]. Dostupné z WWW: <http://www.who.int/nutrition/publications/micronutrients/guidelines/calcium_supplementation/en/>.

21. Hofmeyr GJ, Lawrie TA, Atallah AN et al. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews 2010; (8): CD001059.

22. Van Houten J, Dann P, McGeoch G et al. The calcium-sensing receptor regulates mammary gland parathyroid hormone-related protein production and calcium transport. J Clin Invest 2004; 113}4]: 598–608.

23. Sowers M. Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 1996; 11(8): 1052–1060.

24. Laskey MA, Prentice A, Hanratty LA et al. Bone changes after 3 month of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype. Am J Clin Nutr 1998; 67(4): 685–692.

25. Reid IR, Wattie DJ, Evans MC et al. Postpregnancy osteoporosis associated with hypercalcaemia. Clin Endocrinol 1992; 37(3): 298–303.

26. Kolthoff N, Eiken P, Kristensen B et al. Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci 1998; 94(4): 405–412.

27. Polatti F, Capuzzo E, Viazzo F et al. Bone mineral changes during and after lactation. Obset Gynecol 1999; 94(1): 52–56.

28. Schmidt KH, Wörner UM, Buck HJ. Examination of a new bone growth on aluminium oxide implant contact surfaces alter oral administration of ossein-hydroxyapatite compound to rats. Curr Med Opin 1988; 11(2): 107–115.

29. Warnecke G. Experience with ossein-hydroxyapatite complex (OSSOPAN@) in musculoskeletal disorders of pregnancy. Die Zeitung des Artzes in Klinik und Praxis 1987; 39: 1862–1863.

30. Ringe JD, Keller A. Osteoporoserisiko bei langzeitiger Heparintherapie thromboembolischer Erkrankungen in der Schwangerschaft: Präventionsversuch mit Ossein-Hydroxyapatit. Geburtshilfe und Frauenheilkunde 1992; 52(7): 426–429.