Bone mineral changes during pregnancy and lactation

Abstract

Objective: Significant calcium transfer from the mother to the fetus and infant occurs during pregnancy and lactation, theoretically placing the mother at an increased risk for osteoporosis. The relationship between pregnancy, breast-feeding and low bone mass is controversial. In this study we aimed to elucidate the relationship between pregnancy, breast-feeding and bone mass in third trimester pregnants, at least 3 months lactating mothers, and healthy young nulliporous women by using quantitative ultrasonometry.

Method: The study included 120 women divided in three groups: third trimester pregnants, at least 3 months lactating mothers and healthy young nulliporous women. Demographics, total lactation time, number of pregnancies, births and miscarriages-abortions were recorded. Study groups underwent quantitative ultrasonometry measurement at midtibial shaft. Values of the ultrasonometry variables were calculated and compared for groups.

Results: There were no significant differences among the groups with respect to parameters of age, age at menarche, smoking, alcohol intake and physical exercise in all of the three groups (p?>?0.05). No differences were found among the three groups in analyzed variables, when comparing SOS, T- and Z-scores mid-tibial shaft quantitative ultrasonometry.

Conclusion: No statistically significant associations were found between ultrasonometry variables and pregnancy, breast-feeding or nulliparity.     

Psychotropic medication during pregnancy and lactation

Despite the traditional notion that pregnancy is a time of joy and emotional well being, evidence suggests that it does not protect women against mental illness. Untreated mental illness carries wide-ranging repercussions for mother, child and family that often outweigh those associated with treatment. Clinical management is complex, involving competing risks to mother and offspring; the challenge lies in effectively treating mental illness, whilst minimising exposure of the child to harmful medication. The paucity of robust published evidence on which to base the principles of psychiatric care further compounds the issue. Pregnancy significantly affects plasma drug levels and immature foetal/neonatal physiology renders the child prone to damage from pharmacological agents, all of which cross the placenta/enter breast-milk to varying degrees. Risks include teratogenicity, obstetrical complications, perinatal syndromes, and long-term behavioural problems. Despite evidence that some psychotropic drugs may be safe during pregnancy, knowledge regarding the risks of antenatal exposure to medications remains far from complete. The pregnant or breastfeeding woman requires an individualised risk-benefit analysis with regard to the commencement or continuance of psychotropic medication. If treatment is deemed necessary, monotherapy at the lowest possible dose should be prescribed. More robust safety data is available for older psychotropic drugs, which should be employed in preference to newer agents with unestablished safety profiles. Pregnant/breastfeeding women should also be educated with regard to early detection of signs of drug toxicity in both themselves and their babies. Despite shared responsibility, the ultimate decision with regard to reasonable risk, and what constitutes it, rests with the informed patient. Close psychiatric monitoring and coordinated multidisciplinary care with the obstetrician and paediatrician combine with such informed patient choices to comprise the components of a holistic model of care, targeted at optimizing the complex management of women with psychiatric illness during pregnancy.     

Natural remedies during pregnancy and lactation

Up to date there is a lack of systematically gathered data on the use of natural remedies (phytotherapeutic, homeopathic, anthroposophic, spagyric, Bach and Schussler remedies) during pregnancy and lactation. The aim of this non-representative pilot study on 139 women, who came for delivery to three institutions between mid-1997 and the beginning of 1998, was to receive data about how often and within which spectrum natural remedies are used during pregnancy and lactation. During pregnancy 96% and within the lactation period 84% of the women consumed at least 1 natural remedy. Phytotherapeutic drugs were used most frequently. In contrast to the widespread use of natural remedies by pregnant women and nursing mothers in this study, little information on the effectiveness and possible risks is available. Therefore it seems necessary to examine and evaluate natural remedies used during pregnancy and lactation.     

Bone mineral changes during and after lactation.

OBJECTIVE: To assess bone mineral changes during and after lactation. METHODS: Fifty-nine breast-feeding women, 11 formula-feeding women, and 22 nonpregnant, nonlactating women had dual-energy x-ray absorptiometry measurements of the whole body, spine, hip, and forearm at 0.5 (baseline), 3, 6, and 12 months postpartum, with an additional measurement at 3 months after lactation for women who had breast-fed for more than 9 months. RESULTS: Lactation was associated with decreases in bone mineral at the whole body, spine, femoral neck, total hip, and radial wrist, which reversed as lactation declined and menstruation resumed. These changes were not seen in formula-feeding women. The magnitude and duration of the response were greater for women who breast-fed for a longer time. After lactation had stopped for at least 3 months, bone mineral, adjusted for bone area, had increased significantly above baseline at the whole body (+1.44%; 95% confidence interval [CI] +0.97%, +1.91%; P < .001), spine (+2.66%; 95% CI +1.60%, +3.72%; P < .001), and greater trochanter (+3.55%; 95% CI +2.53%, +4.57%; P < .001), was not different at the total hip and radial shaft, but was lower at the femoral neck (-2.07%; 95% CI -3.21%, -0.93%; P < .001) and radial wrist (-1.23%; 95% CI -1.99%, -0.47%; P < .01). Changes after lactation were largely independent of the duration of lactation or amenorrhea, and similar effects were observed in formula-feeding women. CONCLUSION: Lactation was associated with temporary decreases in bone mineral. After lactation, there were significant residual effects on bone mineral that were unrelated to the duration of lactation and may be related to having been pregnant. The long-term effect of lactation on the femoral neck requires further investigation.     

Bone mineral changes during and after lactation.

OBJECTIVE: To investigate variations in bone mineral density during lactation and throughout the 12 months after scheduled cessation of lactation in relation to the resumption of ovarian function. METHODS: Three hundred eight mothers who decided to lactate were scheduled to fully breast-feed for 6 months, followed by a 1-month weaning period, and then suppress lactation with cabergoline. Their bone mineral density variations were compared with those of a control group of nonlactating mothers during the first 18 months postpartum. Half the lactating women were given daily oral calcium supplements of 1 g in an open design. RESULTS: There was a significant progressive decrease in bone mineral density in lactating women over the first 6 months, followed by recovery of bone mass up to levels that at 18 months were higher than baseline. In nonlactating women, bone mineral density increased progressively after delivery, and at 18 months postpartum had increased by 1.1-1.9% compared with baseline. Compared with lactating women who resumed menstruation within 5 months of delivery, breast-feeding mothers with longer amenorrhea initially lost more bone, but they also gained significantly more bone after resumption of menses, so there were no differences at 18 months postpartum. Oral calcium supplementation decreased bone loss, but had only a transient effect. CONCLUSION: A scheduled lactation period of 6 months, followed by a 1-month weaning period, allowed bone mineral density to reach higher values compared with early postpartum, regardless of calcium supplementation and duration of postpartum amenorrhea.     

Nutritional counseling for vegetarians during pregnancy and lactation

A woman's nutritional status directly affects pregnancy outcome and the quality of breast milk after birth. Clinicians who provide prenatal care have an important role in assessing the nutritional status of women and directing them to appropriate resources while respecting their choices. Vegetarian and vegan diets may present with unique nutrient deficiencies that can be addressed during prenatal nutritional counseling.     

Long-term supplementation of Rhodiola kirilowii extracts during pregnancy and lactation does not affect mother health status

Antibiotics treatment during pregnancy and lactation is problematic. The alternative to the antibiotic treatment is the use of plant-derived supplements, which stimulate immune system to prevent and eliminate bacterial infection. Here, we evaluated the effect of long-term use of Rhodiola kirilowii on the health of mouse mothers. Pregnant mice were fed daily, for whole pregnancy and for 28 days after giving birth, with Rhodiola kirilowii water (RKW) or hydroalcoholic extract (RKW-A) (at 20?mg of extracts/kg). The control group received sterile water. There was no significant change in the total body weight and selected organs weight and in the status of macroscopically evaluated liver, spleen, kidney, brain, and eyes, between the Rhodiola kirilowii groups and the control group. There was also no change in hematological parameters and components of adaptive immunity (level of CD3⁺, CD4⁺, CD8⁺, CD19⁺, CD335⁺ cells). Mice fed with RKW extracts exhibited lower percentage of oxidative burst in the granulocytes. In contrast, the supplementation with RKW-A extract caused increase in the percentage of granulocytes in the blood and the percentage of monocytes with oxidative burst. Other studied components of innate immunity were unaffected. Minor effect on the innate immunity and lack of side effects on hematological parameters and components of immunological system of mouse mothers indicates that both water and 50% hydroalcoholic extracts of Rhodiola kirilowii (in concentration 20?mg/kg per day) could be used as an immunostimulators during pregnancy and nursing. However, to fully assess the effects of Rhodiola kirilowii extracts on the mother and offspring health, further studies in mouse and large animal models and clinical studies in humans are necessary.     

Bone ultrasonometry measurements during pregnancy

Purpose  

During pregnancy we can have changes of the calcium metabolism that can determine a loss of bone mass. Some studies used single-photon absorptiometry (SPA) or dual-energy X-ray absorptiometry, but these exams are inadvisable in pregnancy for the teratogenic effects on the fetus. We used quantitative ultrasonometry (QUS). The aim of this study is to determine prospective changes of bone density with an ultrasonometry measurement during pregnancy in healthy Italian women.     

Investigation of kinetic of lead during pregnancy and lactation.

Lead concentration was estimated in peripheral blood, milk as well as in cord blood in 47 women and their infants, using atomic absorption spectrophotometry. Mean maternal blood lead concentration was 14.9 +/- 4.1 microg/dl, while in milk a mean level of 2.0 +/- 0. 5 microg/dl was estimated. Mean lead concentration in cord blood was 13.1 +/- 3.7 microg/dl. Analysis of these data showed a statistically significant correlation between lead maternal and cord blood concentration (r = 0.413, p = 0.01) or maternal blood and milk (r = 0.543, p < 0.01). The difference between maternal and cord blood might be indicative of a small filtering effect of placental tissue on lead transfer to the fetus. Placenta can determine 57.4% of the level of lead transferred to the fetus in a dynamic modus, while 42.6% depends on the pollution's level of mothers.     

Clinicopathologic study of breast carcinoma occurring during pregnancy and lactation

In a 16-year study of 703 cases of female breast carcinomas seen at the University College Hospital, Ibadan, Nigeria, seven cases were found in pregnant women and another seven cases in lactating women. Thus, pregnancy and lactation complicated breast carcinoma about two times per 100 female breast carcinomas. During the same period there were 51,058 deliveries, for a rate of three breast carcinomas per 10,000 deliveries. When women in the most active reproductive age group (20-40 years) were considered, there were 309 cases of female breast carcinomas. Therefore, 5% of women with breast carcinoma in this age group had concurrent pregnancy or lactation. The patients presented late, and the prognosis was generally poor. While the clinical features of inflammatory carcinoma are similar in most countries, the characteristics of some of the histologic types of breast neoplasia encountered in pregnancy and lactation in Nigerian women appear to differ from those reported in most European and American studies.     

Changes in personality pattern during the first pregnancy and lactation

In order to study personality changes in first pregnancy and lactation, two groups of women (n = 161, mean age 26.8 years) completed the self-report inventory Karolinska Scales of Personality and a scale for emotional dependency during pregnancy and 3 or 6 months after delivery. The results were within normal limits when compared with the normative values. Analysis of variance showed that the subscales Muscular Tension, Somatic Anxiety, and Monotony Avoidance diminished significantly from pregnancy and to the test periods after delivery (all p values < 0.01). Impulsiveness showed the same trend (p = 0.1). The women who had breastfed for at least 8 weeks (91%) differed significantly from those who had not. They had lower scores on the Somatic Anxiety (p = 0.006), Muscular Tension (p = 0.003), Monotony Avoidance (p = 0.039), Suspicion (p = 0.03), Social Desirability (p = 0.045) and the Impulsiveness scale (p = 0.078) and higher scores on the Socialization scale (p = 0.001). Thus, we conclude that most personality traits are stable during first pregnancy and lactation, but some significant changes occur toward a lifestyle interpreted as more relaxed and tolerant to monotony.     

Changes in pancreatic B cell function during late pregnancy, early lactation and postlactation

Oral glucose tolerance tests were performed in 10 normal women during late pregnancy (36 +/- 1 weeks of gestation), early lactation (5 days after delivery) and postlactation (1 week after weaning). A marked decrease in basal plasma insulin and C peptide concentrations, as well as in the B cell secretory response to hyperglycemia, was observed at the 5th day of postpartum, compared to the high values recorded in late pregnancy. Except for a higher basal C peptide level and a lower plasma prolactin concentration, there was no major difference between early lactation and postlactation. At the 5th day after delivery, the insulin response to hyperglycemia was lower in lactating than in nonlactating women (14 subjects in each group). It is concluded that, in normal women, pancreatic B cell function undergoes a rapid normalization during the postpartum, at least when the latter coincides with the onset of lactation.     

Bone remodeling and bone mineral density during pregnancy

INTRODUCTION. The effect of pregnancy upon the maternal skeleton is not fully understood. The information that has been gathered by recent studies is conflicting with regard to overall loss or gain of bone during pregnancy. The aim of the present longitudinal, controlled study, therefore, was to investigate the effect of pregnancy on lumbar spine, wrist, and hip bone mineral density, and to describe bone remodeling during pregnancy as indicated by biochemical markers of both bone resorption and formation. MATERIALS AND METHODS. Thirty healthy women (15 subjects seeking pregnancy and 15 non-pregnant controls) were studied. Bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry before conception and within 2 weeks after parturition. Markers of bone resorption (urinary cross-linked type I collagen N-telopeptides, serum type I collagen C-telopeptides) and bone formation (total and bone specific alkaline phosphatase, osteocalcin), and total serum calcium were analyzed before, during (once in each trimester), and after pregnancy. RESULTS. During pregnancy, BMD decreased significantly by 3.4+/-4.1% at the lumbar spine and 4.3+/-3.9% at the trochanter, while there was a slight but significant increase in BMD at the proximal 1/3 of the forearm (1.3+/-1.9%). Total hip and femoral neck BMD did not change significantly, nor did total and ultradistal forearm BMD. Bone resorption increased during pregnancy with peak levels in the third trimester (N-telopeptides) or post partum (C-telopeptides), respectively. The increase in bone resorption was accompanied by a significant decrease in serum calcium in the third trimester. Markers of bone formation showed a biphasic pattern with decreases from baseline to the first (total and bone specific alkaline phosphatase) or second trimester (osteocalcin), respectively, followed by a significant increase in the third trimester and post partum. There was no change in any parameter in the control group throughout the study. CONCLUSION. In conclusion, pregnancy is characterized by high bone turnover with resorption preceding formation. During the first and second trimester bone remodeling is uncoupled. Serum calcium decreases as bone resorption peaks in late pregnancy. There are significant decreases in bone mineral density at sites rich in trabecular bone, such as the lumbar spine and the trochanter.