Abstract
Summary
In a controlled cohort study, bone mineral density (BMD) was measured in 153 women pre-pregnancy; during pregnancy; and 0.5, 4, 9, and 19 months postpartum. Seventy-five age-matched controls, without pregnancy plans, were followed in parallel. Pregnancy and breastfeeding cause a reversible bone loss, which, initially, is most pronounced at trabecular sites but also involves cortical sites during prolonged breastfeeding.
Introduction
Conflicting results have been reported on effects of pregnancy and breastfeeding on BMD and body composition (BC). In a controlled cohort study, we elucidate changes in BMD and BC during and following a pregnancy.
Methods
We measured BMD and BC in 153 women planning pregnancy (n = 92 conceived), once in each trimester during pregnancy and 15, 129, and 280 days postpartum. Moreover, BMD was measured 19 months postpartum (n = 31). Seventy-five age-matched controls, without pregnancy plans, were followed in parallel.
Results
Compared with controls, BMD decreased significantly during pregnancy by 1.8 ± 0.5% at the lumbar spine, 3.2 ± 0.5% at the total hip, 2.4 ± 0.3% at the whole body, and 4.2 ± 0.7% at the ultra distal forearm. Postpartum, BMD decreased further with an effect of breastfeeding. At 9 months postpartum, women who had breastfed for <9 months had a BMD similar to that of the controls, whereas BMD at the lumbar spine and hip was decreased in women who were still breastfeeding. During prolonged breastfeeding, BMD at sites which consist of mostly trabecular bone started to be regained, whereas BMD at sites rich in cortical bone decreased further. At 19 months postpartum, BMD did not differ from baseline at any site. During pregnancy, fat- and lean-tissue mass increased by 19 ± 22% and 5 ± 6% (p < 0.001), respectively. Postpartum, changes in fat mass differed according to breastfeeding status with a slower decline in women who continued breastfeeding. Calcium and vitamin D intake was not associated with BMD changes.
Conclusion
Pregnancy and breastfeeding cause a reversible bone loss. At 19 months postpartum, BMD has returned to pre-pregnancy level independently of breastfeeding length. Reversal of changes in fat mass depends on breastfeeding status.
Similar content being viewed by others
References
Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563
Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 61:514–523
Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, King JC (1998) A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr 67:693–701
Gallacher SJ, Fraser WD, Owens OJ, Dryburgh FJ, Logue FC, Jenkins A, Kennedy J, Boyle IT (1994) Changes in calciotrophic hormones and biochemical markers of bone turnover in normal human pregnancy. Eur J Endocrinol 131:369–374
Kent GN, Price RI, Gutteridge DH, Allen JR, Rosman KJ, Smith M, Bhagat CI, Wilson SG, Retallack RW (1993) Effect of pregnancy and lactation on maternal bone mass and calcium metabolism. Osteoporos Int 3(Suppl 1):44–47
Gertner JM, Coustan DR, Kliger AS, Mallette LE, Ravin N, Broadus AE (1986) Pregnancy as state of physiologic absorptive hypercalciuria. Am J Med 81:451–456
Lopez JM, Gonzalez G, Reyes V, Campino C, Diaz S (1996) Bone turnover and density in healthy women during breastfeeding and after weaning. Osteoporos Int 6:153–159
Drinkwater BL, Chesnut CH III (1991) Bone density changes during pregnancy and lactation in active women: a longitudinal study. Bone Miner 14:153–160
Karlsson C, Obrant KJ, Karlsson M (2001) Pregnancy and lactation confer reversible bone loss in humans. Osteoporos Int 12:828–834
Laskey MA, Prentice A (1999) Bone mineral changes during and after lactation. Obstet Gynecol 94:608–615
Sohlstrom A, Forsum E (1995) Changes in adipose tissue volume and distribution during reproduction in Swedish women as assessed by magnetic resonance imaging. Am J Clin Nutr 61:287–295
Olausson H, Laskey MA, Goldberg GR, Prentice A (2008) Changes in bone mineral status and bone size during pregnancy and the influences of body weight and calcium intake. Am J Clin Nutr 88:1032–1039
Hopkinson JM, Butte NF, Ellis KJ, Wong WW, Puyau MR, Smith EO (1997) Body fat estimation in late pregnancy and early postpartum: comparison of two-, three-, and four-component models. Am J Clin Nutr 65:432–438
Dewey KG, Heinig MJ, Nommsen LA (1993) Maternal weight-loss patterns during prolonged lactation. Am J Clin Nutr 58:162–166
Butte NF, Hopkinson JM (1998) Body composition changes during lactation are highly variable among women. J Nutr 128:381S–385S
Ulrich U, Miller PB, Eyre DR, Chesnut CH III, Schlebusch H, Soules MR (2003) Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316
Sowers M, Crutchfield M, Jannausch M, Updike S, Corton G (1991) A prospective evaluation of bone mineral change in pregnancy. Obstet Gynecol 77:841–845
Kaur M, Pearson D, Godber I, Lawson N, Baker P, Hosking D (2003) Longitudinal changes in bone mineral density during normal pregnancy. Bone 32:449–454
Cross NA, Hillman LS, Allen SH, Krause GF (1995) Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. J Bone Miner Res 10:1312–1320
Pearson D, Kaur M, San P, Lawson N, Baker P, Hosking D (2004) Recovery of pregnancy mediated bone loss during lactation. Bone 34:570–578
Holmberg-Marttila D, Sievanen H, Tuimala R (1999) Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos Int 10:41–46
Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15:129–137
Fiore CE, Pennisi P, DiStefano A, Riccobene S, Caschetto S (2003) Pregnancy-associated changes in bone density and bone turnover in the physiological state: prospective data on sixteen women. Horm Metab Res 35:313–318
More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12:732–737
Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci (Lond) 94:405–412
Hermann AP, Thomsen J, Vestergaard P, Mosekilde L, Charles P (1999) Assessment of kalcium intake. A quick method comparerd to a 7 days food diary. Calcif Tissue Int 64(S1):S82
Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33:661–670
Silverberg SJ, Shane E, de la Cruz L, Dempster DW, Feldman F, Seldin D, Jacobs TP, Siris ES, Cafferty M, Parisien MV (1989) Skeletal disease in primary hyperparathyroidism. J Bone Miner Res 4:283–291
Favus M (2006) Primer on the metabolic bone diseases and disorders of mineral metabolism, 6th edn. American Society for Bone and Mineral Research, Washington, DC, pp 50–132
Kovacs CS, Kronenberg HM (1997) Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev 18:832–872
Kalkwarf HJ, Specker BL (2002) Bone mineral changes during pregnancy and lactation. Endocr 17:49–53
Purdie DW, Aaron JE, Selby PL (1988) Bone histology and mineral homeostasis in human pregnancy. Br J Obstet Gynaecol 95:849–854
Shahtaheri SM, Aaron JE, Johnson DR, Purdie DW (1999) Changes in trabecular bone architecture in women during pregnancy. Br J Obstet Gynaecol 106:432–438
Phillips AJ, Ostlere SJ, Smith R (2000) Pregnancy-associated osteoporosis: does the skeleton recover? Osteoporos Int 11:449–454
Affinito P, Tommaselli GA, di Carlo C, Guida F, Nappi C (1996) Changes in bone mineral density and calcium metabolism in breastfeeding women: a one year follow-up study. J Clin Endocrinol Metab 81:2314–2318
Krebs NF, Reidinger CJ, Robertson AD, Brenner M (1997) Bone mineral density changes during lactation: maternal, dietary, and biochemical correlates. Am J Clin Nutr 65:1738–1746
Hopkinson JM, Butte NF, Ellis K, Smith EO (2000) Lactation delays postpartum bone mineral accretion and temporarily alters its regional distribution in women. J Nutr 130:777–783
Acknowledgements
We are grateful for the financial support provided to the project from: The Danish Agency for Science, Technology and Innovation; The Aarhus University Research Foundation; AP Moeller Foundation for the Advancement of Medical Science; Svend Fældings Humanitære Fond; The Lundbeck Foundation; Aarhus University Fellowship; Novo Nordic Foundation; and Helga and Peter Kornings Foundation.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Møller, U.K., við Streym, S., Mosekilde, L. et al. Changes in bone mineral density and body composition during pregnancy and postpartum. A controlled cohort study. Osteoporos Int 23, 1213–1223 (2012). https://doi.org/10.1007/s00198-011-1654-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-011-1654-6