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Hypoparathyroidism During Pregnancy, Lactation, and Fetal/Neonatal Development

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Abstract

Specific adaptations are invoked during pregnancy and lactation to enable women to supply calcium and other minerals needed to support rapid growth and mineralization of the fetal and neonatal skeletons. These adaptations alter the expected normal values for serum minerals and calciotropic hormones and can occasionally lead to maternal hypercalcemia or fractures. Moreover, the presentation, diagnosis, and management of hypoparathyroidism and pseudohypoparathyroidism can also be altered by these adaptations. Fetal mineral metabolism is characterized by low levels of parathyroid hormone and calcitriol as compared to adult values. The fetus can be adversely affected by maternal hypocalcemia or hypercalcemia and genetic parathyroid disorders. The blood calcium normally falls after birth, and this triggers an upregulation in parathyroid function and calcitriol synthesis. Neonatal mineral homeostasis can be impacted by genetic parathyroid disorders and by prior exposure in utero to abnormal mineral concentrations in the mother.

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References

  1. Kovacs CS, Kronenberg HM (1997) Maternal-fetal calcium and bone metabolism during pregnancy, puerperium and lactation. Endocr Rev 18:832–872

    CAS  PubMed  Google Scholar 

  2. Kovacs CS (2012) The role of vitamin D in pregnancy and lactation: insights from animal models and clinical studies. Ann Rev Nutr 32:9.1–9.27

    Google Scholar 

  3. Kovacs CS (2012) Control of skeletal homeostasis during pregnancy and lactation – lessons from physiological models. In: Thakker RV, Whyte MP, Eisman JA, Igarashi T (eds) Genetics of bone biology and skeletal disease. Academic Press/Elsevier, San Diego, pp 221–240

    Google Scholar 

  4. Kovacs CS (2012) Fetal control of calcium and phosphate homeostasis – lessons from mouse models. In: Thakker RV, Whyte MP, Eisman JA, Igarashi T (eds) Genetics of bone biology and skeletal disease. Academic Press/Elsevier, San Diego, pp 205–220

    Google Scholar 

  5. Kovacs CS (2011) Calcium and bone metabolism disorders during pregnancy and lactation. Endocrinol Metab Clin North Am 40:795–826

    CAS  PubMed  Google Scholar 

  6. Givens MH, Macy IC (1933) The chemical composition of the human fetus. J Biol Chem 102:7–17

    CAS  Google Scholar 

  7. Trotter M, Hixon BB (1974) Sequential changes in weight, density, and percentage ash weight of human skeletons from an early fetal period through old age. Anat Rec 179:1–18

    CAS  PubMed  Google Scholar 

  8. Widdowson EM, Dickerson JW (1964) Chemical composition of the body. In: Comar CL, Bronner F (eds) Mineral metabolism: an advanced treatise, volume II, the elements, part A. Academic Press, New York, pp 1–247

    Google Scholar 

  9. Dahlman T, Sjoberg HE, Bucht E (1994) Calcium homeostasis in normal pregnancy and puerperium. A longitudinal study. Acta Obstet Gynecol Scand 73:393–398

    CAS  PubMed  Google Scholar 

  10. 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

    CAS  PubMed  Google Scholar 

  11. 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

    CAS  PubMed  Google Scholar 

  12. Rasmussen N, Frolich A, Hornnes PJ, Hegedus L (1990) Serum ionized calcium and intact parathyroid hormone levels during pregnancy and postpartum. Br J Obstet Gynaecol 97:857–859

    CAS  PubMed  Google Scholar 

  13. Seki K, Makimura N, Mitsui C, Hirata J, Nagata I (1991) Calcium-regulating hormones and osteocalcin levels during pregnancy: a longitudinal study. Am J Obstet Gynecol 164:1248–1252

    CAS  PubMed  Google Scholar 

  14. Ardawi MS, Nasrat HA, BA’Aqueel HS (1997) Calcium-regulating hormones and parathyroid hormone-related peptide in normal human pregnancy and postpartum: a longitudinal study. Eur J Endocrinol 137:402–409

    CAS  PubMed  Google Scholar 

  15. Singh HJ, Mohammad NH, Nila A (1999) Serum calcium and parathormone during normal pregnancy in Malay women. J Matern Fetal Med 8:95–100

    CAS  PubMed  Google Scholar 

  16. Bikle DD, Gee E, Halloran B, Haddad JG (1984) Free 1,25-dihydroxyvitamin D levels in serum from normal subjects, pregnant subjects, and subjects with liver disease. J Clin Invest 74:1966–1971

    PubMed Central  CAS  PubMed  Google Scholar 

  17. Kirby BJ, Ma Y, Martin HM, Favaro KL, Karaplis AC, Kovacs CS (2013) Upregulation of calcitriol during pregnancy and skeletal recovery after lactation do not require parathyroid hormone. J Bone Miner Res 28(9):1987–2000

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  19. Sweeney LL, Malabanan AO, Rosen H (2010) Decreased calcitriol requirement during pregnancy and lactation with a window of increased requirement immediately post partum. Endocr Pract 16:459–462

    PubMed  Google Scholar 

  20. Eller-Vainicher C, Ossola MW, Beck-Peccoz P, Chiodini I (2012) PTHrP-associated hypercalcemia of pregnancy resolved after delivery: a case report. Eur J Endocrinol 166:753–756

    CAS  PubMed  Google Scholar 

  21. Sato K (2008) Hypercalcemia during pregnancy, puerperium, and lactation: review and a case report of hypercalcemic crisis after delivery due to excessive production of PTH-related protein (PTHrP) without malignancy (humoral hypercalcemia of pregnancy). Endocr J 55:959–966

    CAS  PubMed  Google Scholar 

  22. Marx SJ, Zusman RM, Umiker WO (1977) Benign breast dysplasia causing hypercalcemia. J Clin Endocrinol Metab 45:1049–1052

    CAS  PubMed  Google Scholar 

  23. Khosla S, van Heerden JA, Gharib H, Jackson IT, Danks J, Hayman JA, Martin TJ (1990) Parathyroid hormone-related protein and hypercalcemia secondary to massive mammary hyperplasia [letter]. N Engl J Med 322:1157

    CAS  PubMed  Google Scholar 

  24. Jackson IT, Saleh J, van Heerden JA (1989) Gigantic mammary hyperplasia in pregnancy associated with pseudohyperparathyroidism. Plast Reconstr Surg 84:806–810

    CAS  PubMed  Google Scholar 

  25. Horwitz MJ, Tedesco MB, Sereika SM, Hollis BW, Garcia-Ocana A, Stewart AF (2003) Direct comparison of sustained infusion of human parathyroid hormone-related protein-(1–36). J Clin Endocrinol Metab 88:1603–1609

    CAS  PubMed  Google Scholar 

  26. Horwitz MJ, Tedesco MB, Sereika SM, Syed MA, Garcia-Ocana A, Bisello A, Hollis BW, Rosen CJ, Wysolmerski JJ, Dann P, Gundberg C, Stewart AF (2005) Continuous PTH and PTHrP infusion causes suppression of bone formation and discordant effects on 1,25(OH)2 vitamin D. J Bone Miner Res 20:1792–1803

    CAS  PubMed  Google Scholar 

  27. Cornish J, Callon KE, Nicholson GC, Reid IR (1997) Parathyroid hormone-related protein-(107–139) inhibits bone resorption in vivo. Endocrinology 138:1299–1304

    CAS  PubMed  Google Scholar 

  28. Fenton AJ, Kemp BE, Hammonds RG Jr, Mitchelhill K, Moseley JM, Martin TJ, Nicholson GC (1991) A potent inhibitor of osteoclastic bone resorption within a highly conserved pentapeptide region of parathyroid hormone-related protein; PTHrP[107–111]. Endocrinology 129:3424–3426

    CAS  PubMed  Google Scholar 

  29. Fenton AJ, Kemp BE, Kent GN, Moseley JM, Zheng MH, Rowe DJ, Britto JM, Martin TJ, Nicholson GC (1991) A carboxyl-terminal peptide from the parathyroid hormone-related protein inhibits bone resorption by osteoclasts. Endocrinology 129:1762–1768

    CAS  PubMed  Google Scholar 

  30. Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33:661–670

    CAS  PubMed  Google Scholar 

  31. Halloran BP, DeLuca HF (1980) Calcium transport in small intestine during pregnancy and lactation. Am J Physiol 239:E64–E68

    CAS  PubMed  Google Scholar 

  32. Brommage R, Baxter DC, Gierke LW (1990) Vitamin D-independent intestinal calcium and phosphorus absorption during reproduction. Am J Physiol 259:G631–G638

    CAS  PubMed  Google Scholar 

  33. Fudge NJ, Kovacs CS (2010) Pregnancy up-regulates intestinal calcium absorption and skeletal mineralization independently of the vitamin D receptor. Endocrinology 151:886–895

    CAS  PubMed  Google Scholar 

  34. Wasserman RH, Comar CL, Nold MM, Lengemann FW (1957) Placental transfer of calcium and strontium in the rat and rabbit. Am J Physiol 189:91–97

    CAS  PubMed  Google Scholar 

  35. Purdie DW, Aaron JE, Selby PL (1988) Bone histology and mineral homeostasis in human pregnancy. Br J Obstet Gynaecol 95:849–854

    CAS  PubMed  Google Scholar 

  36. Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86:2344–2348

    CAS  PubMed  Google Scholar 

  37. 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

    CAS  PubMed  Google Scholar 

  38. 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

    CAS  PubMed  Google Scholar 

  39. 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

    CAS  PubMed  Google Scholar 

  40. Ulrich U, Miller PB, Eyre DR, Chesnut CH, Schlebusch H, Soules MR (2003) Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316

    CAS  PubMed  Google Scholar 

  41. 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

    CAS  PubMed  Google Scholar 

  42. Gambacciani M, Spinetti A, Gallo R, Cappagli B, Teti GC, Facchini V (1995) Ultrasonographic bone characteristics during normal pregnancy: longitudinal and cross-sectional evaluation. Am J Obstet Gynecol 173:890–893

    CAS  PubMed  Google Scholar 

  43. 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

    CAS  PubMed  Google Scholar 

  44. To WW, Wong MW (2011) Changes in bone mineral density of the os calcis as measured by quantitative ultrasound during pregnancy and 24 months after delivery. Aust N Z J Obstet Gynaecol 51:166–171

    PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  46. Paton LM, Alexander JL, Nowson CA, Margerison C, Frame MG, Kaymakci B, Wark JD (2003) Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 77:707–714

    CAS  PubMed  Google Scholar 

  47. Simmonds CS, Karsenty G, Karaplis AC, Kovacs CS (2010) Parathyroid hormone regulates fetal-placental mineral homeostasis. J Bone Miner Res 25:594–605

    CAS  PubMed  Google Scholar 

  48. Kovacs CS (2003) Fetal mineral homeostasis. In: Glorieux FH, Pettifor JM, Jüppner H (eds) Pediatric bone: biology and diseases. Academic Press, San Diego, pp 271–302

    Google Scholar 

  49. Kovacs CS (2011) Fetal mineral homeostasis. In: Glorieux FH, Pettifor JM, Jüppner H (eds) Pediatric bone: biology and diseases, 2nd edn. Elsevier/Academic Press, San Diego, pp 247–275

    Google Scholar 

  50. Kovacs CS, Chafe LL, Fudge NJ, Friel JK, Manley NR (2001) PTH regulates fetal blood calcium and skeletal mineralization independently of PTHrP. Endocrinology 142:4983–4993

    CAS  PubMed  Google Scholar 

  51. Kovacs CS, Manley NR, Moseley JM, Martin TJ, Kronenberg HM (2001) Fetal parathyroids are not required to maintain placental calcium transport. J Clin Invest 107:1007–1015

    PubMed Central  CAS  PubMed  Google Scholar 

  52. Suzuki Y, Kovacs CS, Takanaga H, Peng JB, Landowski CP, Hediger MA (2008) Calcium TRPV6 is involved in murine maternal-fetal calcium transport. J Bone Miner Res 23:1249–1256

    PubMed Central  CAS  PubMed  Google Scholar 

  53. Loughead JL, Mimouni F, Tsang RC (1988) Serum ionized calcium concentrations in normal neonates. Am J Dis Child 142:516–518

    CAS  PubMed  Google Scholar 

  54. David L, Anast CS (1974) Calcium metabolism in newborn infants. The interrelationship of parathyroid function and calcium, magnesium, and phosphorus metabolism in normal, sick, and hypocalcemic newborns. J Clin Invest 54:287–296

    PubMed Central  CAS  PubMed  Google Scholar 

  55. Schauberger CW, Pitkin RM (1979) Maternal-perinatal calcium relationships. Obstet Gynecol 53:74–76

    CAS  PubMed  Google Scholar 

  56. Garel JM, Barlet JP (1976) Calcium metabolism in newborn animals: the interrelationship of calcium, magnesium, and inorganic phosphorus in newborn rats, foals, lambs, and calves. Pediatr Res 10:749–754

    CAS  PubMed  Google Scholar 

  57. Krukowski M, Smith JJ (1976) pH and the level of calcium in the blood of fetal and neonatal albino rats. Biol Neonate 29:148–161

    PubMed  Google Scholar 

  58. Miao D, He B, Karaplis AC, Goltzman D (2002) Parathyroid hormone is essential for normal fetal bone formation. J Clin Invest 109:1173–1182

    PubMed Central  CAS  PubMed  Google Scholar 

  59. Haddad JG Jr, Boisseau V, Avioli LV (1971) Placental transfer of vitamin D3 and 25-hydroxycholecalciferol in the rat. J Lab Clin Med 77:908–915

    CAS  PubMed  Google Scholar 

  60. Noff D, Edelstein S (1978) Vitamin D and its hydroxylated metabolites in the rat. Placental and lacteal transport, subsequent metabolic pathways and tissue distribution. Horm Res 9:292–300

    CAS  PubMed  Google Scholar 

  61. Hillman LS, Haddad JG (1974) Human perinatal vitamin D metabolism. I. 25-Hydroxyvitamin D in maternal and cord blood. J Pediatr 84:742–749

    CAS  PubMed  Google Scholar 

  62. Wieland P, Fischer JA, Trechsel U, Roth HR, Vetter K, Schneider H, Huch A (1980) Perinatal parathyroid hormone, vitamin D metabolites, and calcitonin in man. Am J Physiol 239:E385–E390

    CAS  PubMed  Google Scholar 

  63. Fleischman AR, Rosen JF, Cole J, Smith CM, DeLuca HF (1980) Maternal and fetal serum 1,25-dihydroxyvitamin D levels at term. J Pediatr 97:640–642

    CAS  PubMed  Google Scholar 

  64. Seki K, Furuya K, Makimura N, Mitsui C, Hirata J, Nagata I (1994) Cord blood levels of calcium-regulating hormones and osteocalcin in premature infants. J Perinat Med 22:189–194

    CAS  PubMed  Google Scholar 

  65. Hollis BW, Pittard WB (1984) Evaluation of the total fetomaternal vitamin D relationships at term: evidence for racial differences. J Clin Endocrinol Metab 59:652–657

    CAS  PubMed  Google Scholar 

  66. Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Makitie O, Andersson S, Laitinen K, Lamberg-Allardt C (2010) Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab 95:1749–1757

    CAS  PubMed  Google Scholar 

  67. Ma Y, Samaraweera M, Cooke-Hubley S, Kirby BJ, Karaplis AC, Lanske B, Kovacs CS (2014) Neither absence nor excess of FGF23 disturbs murine fetal-placental phosphorus homeostasis or prenatal skeletal development and mineralization. Endocrinology 155:1596–1605

    PubMed  Google Scholar 

  68. Kovacs CS (2011) Fetus, neonate and infant. In: Feldman D, Pike WJ, Adams JS (eds) Vitamin D, 3rd edn. Academic Press, New York, pp 625–646

    Google Scholar 

  69. Karaplis AC, Luz A, Glowacki J, Bronson RT, Tybulewicz VL, Kronenberg HM, Mulligan RC (1994) Lethal skeletal dysplasia from targeted disruption of the parathyroid hormone-related peptide gene. Genes Dev 8:277–289

    CAS  PubMed  Google Scholar 

  70. Kovacs CS, Lanske B, Hunzelman JL, Guo J, Karaplis AC, Kronenberg HM (1996) Parathyroid hormone-related peptide (PTHrP) regulates fetal-placental calcium transport through a receptor distinct from the PTH/PTHrP receptor. Proc Natl Acad Sci U S A 93:15233–15238

    PubMed Central  CAS  PubMed  Google Scholar 

  71. Simmonds CS, Kovacs CS (2010) Role of parathyroid hormone (PTH) and PTH-related protein (PTHrP) in regulating mineral homeostasis during fetal development. Crit Rev Eukaryot Gene Expr 20:235–273

    CAS  PubMed  Google Scholar 

  72. Kovacs CS (2011) Bone development in the fetus and neonate: role of the calciotropic hormones. Curr Osteoporos Rep 9:274–283

    PubMed  Google Scholar 

  73. Care AD (1997) Fetal calcium homeostasis. Equine Vet J Suppl 24:59–61

    PubMed  Google Scholar 

  74. Barlet JP, Davicco MJ, Rouffet J, Coxam V, Lefaivre J (1994) Short communication: parathyroid hormone-related peptide does not stimulate phosphate placental transport. Placenta 15:441–444

    CAS  PubMed  Google Scholar 

  75. Stulc J, Stulcova B (1996) Placental transfer of phosphate in anaesthetized rats. Placenta 17:487–493

    CAS  PubMed  Google Scholar 

  76. Dobnig H, Kainer F, Stepan V, Winter R, Lipp R, Schaffer M, Kahr A, Nocnik S, Patterer G, Leb G (1995) Elevated parathyroid hormone-related peptide levels after human gestation: relationship to changes in bone and mineral metabolism. J Clin Endocrinol Metab 80:3699–3707

    CAS  PubMed  Google Scholar 

  77. Yamamoto M, Duong LT, Fisher JE, Thiede MA, Caulfield MP, Rosenblatt M (1991) Suckling-mediated increases in urinary phosphate and 3′,5′-cyclic adenosine monophosphate excretion in lactating rats: possible systemic effects of parathyroid hormone-related protein. Endocrinology 129:2614–2622

    CAS  PubMed  Google Scholar 

  78. Ratcliffe WA, Thompson GE, Care AD, Peaker M (1992) Production of parathyroid hormone-related protein by the mammary gland of the goat. J Endocrinol 133:87–93

    CAS  PubMed  Google Scholar 

  79. VanHouten JN, Dann P, Stewart AF, Watson CJ, Pollak M, Karaplis AC, Wysolmerski JJ (2003) Mammary-specific deletion of parathyroid hormone-related protein preserves bone mass during lactation. J Clin Invest 112:1429–1436

    PubMed Central  CAS  PubMed  Google Scholar 

  80. Sowers MF, Hollis BW, Shapiro B, Randolph J, Janney CA, Zhang D, Schork A, Crutchfield M, Stanczyk F, Russell-Aulet M (1996) Elevated parathyroid hormone-related peptide associated with lactation and bone density loss. JAMA 276:549–554

    CAS  PubMed  Google Scholar 

  81. Kovacs CS, Chik CL (1995) Hyperprolactinemia caused by lactation and pituitary adenomas is associated with altered serum calcium, phosphate, parathyroid hormone (PTH), and PTH-related peptide levels. J Clin Endocrinol Metab 80:3036–3042

    CAS  PubMed  Google Scholar 

  82. Woodrow JP, Sharpe CJ, Fudge NJ, Hoff AO, Gagel RF, Kovacs CS (2006) Calcitonin plays a critical role in regulating skeletal mineral metabolism during lactation. Endocrinology 147:4010–4021

    CAS  PubMed  Google Scholar 

  83. 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

    CAS  PubMed  Google Scholar 

  84. Kalkwarf HJ, Specker BL, Bianchi DC, Ranz J, Ho M (1997) The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med 337:523–528

    CAS  PubMed  Google Scholar 

  85. Polatti F, Capuzzo E, Viazzo F, Colleoni R, Klersy C (1999) Bone mineral changes during and after lactation. Obstet Gynecol 94:52–56

    CAS  PubMed  Google Scholar 

  86. Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci (Colch) 94:405–412

    CAS  Google Scholar 

  87. Hollis BW, Wagner CL (2004) Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 80:1752S–1758S

    CAS  PubMed  Google Scholar 

  88. Basile LA, Taylor SN, Wagner CL, Horst RL, Hollis BW (2006) The effect of high-dose vitamin D supplementation on serum vitamin D levels and milk calcium concentration in lactating women and their infants. Breastfeed Med 1:27–35

    PubMed  Google Scholar 

  89. Wagner CL, Hulsey TC, Fanning D, Ebeling M, Hollis BW (2006) High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeed Med 1:59–70

    PubMed  Google Scholar 

  90. Laskey MA, Prentice A (1997) Effect of pregnancy on recovery of lactational bone loss [letter]. Lancet 349:1518–1519

    CAS  PubMed  Google Scholar 

  91. Prentice A (2000) Calcium in pregnancy and lactation. Annu Rev Nutr 20:249–272

    CAS  PubMed  Google Scholar 

  92. Prentice A, Jarjou LM, Cole TJ, Stirling DM, Dibba B, Fairweather-Tait S (1995) Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. Am J Clin Nutr 62:58–67

    CAS  PubMed  Google Scholar 

  93. Prentice A, Jarjou LM, Stirling DM, Buffenstein R, Fairweather-Tait S (1998) Biochemical markers of calcium and bone metabolism during 18 months of lactation in Gambian women accustomed to a low calcium intake and in those consuming a calcium supplement. J Clin Endocrinol Metab 83:1059–1066

    CAS  PubMed  Google Scholar 

  94. Prentice A, Yan L, Jarjou LM, Dibba B, Laskey MA, Stirling DM, Fairweather-Tait S (1997) Vitamin D status does not influence the breast-milk calcium concentration of lactating mothers accustomed to a low calcium intake. Acta Paediatr 86:1006–1008

    CAS  PubMed  Google Scholar 

  95. Laskey MA, Prentice A, Hanratty LA, Jarjou LM, Dibba B, Beavan SR, Cole TJ (1998) Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype. Am J Clin Nutr 67:685–692

    CAS  PubMed  Google Scholar 

  96. Kovacs CS (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 10:105–118

    PubMed  Google Scholar 

  97. Kirby BJ, Ardeshirpour L, Woodrow JP, Wysolmerski JJ, Sims NA, Karaplis AC, Kovacs CS (2011) Skeletal recovery after weaning does not require PTHrP. J Bone Miner Res 26:1242–1251

    PubMed Central  CAS  PubMed  Google Scholar 

  98. Collins JN, Kirby BJ, Woodrow JP, Gagel RF, Rosen CJ, Sims NA, Kovacs CS (2013) Lactating Ctcgrp nulls lose twice the normal bone mineral content due to fewer osteoblasts and more osteoclasts, whereas bone mass is fully restored after weaning in association with up-regulation of Wnt signaling and other novel genes. Endocrinology 154:1400–1413

    PubMed Central  CAS  PubMed  Google Scholar 

  99. Liu XS, Ardeshirpour L, VanHouten JN, Shane E, Wysolmerski JJ (2012) Site-specific changes in bone microarchitecture, mineralization, and stiffness during lactation and after weaning in mice. J Bone Miner Res 27:865–875

    CAS  PubMed  Google Scholar 

  100. Bjørnerem A, Ghasem-Zadeh A, Vu T, Seeman E (2010) Bone microstructure during and after lactation [abstract]. J Bone Miner Res 25(Suppl 1):S121

    Google Scholar 

  101. Wiklund PK, Xu L, Wang Q, Mikkola T, Lyytikainen A, Volgyi E, Munukka E, Cheng SM, Alen M, Keinanen-Kiukaanniemi S, Cheng S (2012) Lactation is associated with greater maternal bone size and bone strength later in life. Osteoporos Int 23:1939–1945

    CAS  PubMed  Google Scholar 

  102. Bowman BM, Miller SC (2001) Skeletal adaptations during mammalian reproduction. J Musculoskelet Neuronal Interact 1:347–355

    CAS  PubMed  Google Scholar 

  103. Vajda EG, Bowman BM, Miller SC (2001) Cancellous and cortical bone mechanical properties and tissue dynamics during pregnancy, lactation, and postlactation in the rat. Biol Reprod 65:689–695

    CAS  PubMed  Google Scholar 

  104. Giles MM, Fenton MH, Shaw B, Elton RA, Clarke M, Lang M, Hume R (1987) Sequential calcium and phosphorus balance studies in preterm infants. J Pediatr 110:591–598

    CAS  PubMed  Google Scholar 

  105. Barltrop D, Oppe TE (1973) Calcium and fat absorption by low birthweight infants from a calcium-supplemented milk formula. Arch Dis Child 48:580–582

    PubMed Central  CAS  PubMed  Google Scholar 

  106. Kobayashi A, Kawai S, Obe Y, Nagashima Y (1975) Effects of dietary lactose and lactase preparation on the intestinal absorption of calcium and magnesium in normal infants. Am J Clin Nutr 28:681–683

    PubMed  Google Scholar 

  107. Kocian J, Skala I, Bakos K (1973) Calcium absorption from milk and lactose-free milk in healthy subjects and patients with lactose intolerance. Digestion 9:317–324

    CAS  PubMed  Google Scholar 

  108. Shaw JC (1976) Evidence for defective skeletal mineralization in low-birthweight infants: the absorption of calcium and fat. Pediatrics 57:16–25

    CAS  PubMed  Google Scholar 

  109. Senterre J, Salle B (1982) Calcium and phosphorus economy of the preterm infant and its interaction with vitamin D and its metabolites. Acta Paediatr Scand Suppl 296:85–92

    CAS  PubMed  Google Scholar 

  110. Buchowski MS, Miller DD (1991) Lactose, calcium source and age affect calcium bioavailability in rats. J Nutr 121:1746–1754

    CAS  PubMed  Google Scholar 

  111. Thomas AK, McVie R, Levine SN (1999) Disorders of maternal calcium metabolism implicated by abnormal calcium metabolism in the neonate. Am J Perinatol 16:515–520

    CAS  PubMed  Google Scholar 

  112. Demirel N, Aydin M, Zenciroglu A, Okumus N, Cetinkaya S, Yildiz YT, Ipek MS (2009) Hyperparathyroidism secondary to maternal hypoparathyroidism and vitamin D deficiency: an uncommon cause of neonatal respiratory distress. Ann Trop Paediatr 29:149–154

    CAS  PubMed  Google Scholar 

  113. Callies F, Arlt W, Scholz HJ, Reincke M, Allolio B (1998) Management of hypoparathyroidism during pregnancy–report of twelve cases. Eur J Endocrinol 139:284–289

    CAS  PubMed  Google Scholar 

  114. Krysiak R, Kobielusz-Gembala I, Okopien B (2011) Hypoparathyroidism in pregnancy. Gynecol Endocrinol 27:529–532

    PubMed  Google Scholar 

  115. Landing BH, Kamoshita S (1970) Congenital hyperparathyroidism secondary to maternal hypoparathyroidism. J Pediatr 77:842–847

    CAS  PubMed  Google Scholar 

  116. Kurzel RB, Hagen GA (1990) Use of thiazide diuretics to reduce the hypercalciuria of hypoparathyroidism during pregnancy. Am J Perinatol 7:333–336

    CAS  PubMed  Google Scholar 

  117. Taussig HB (1966) Possible injury to the cardiovascular system from vitamin D. Ann Intern Med 65:1195–1200

    CAS  PubMed  Google Scholar 

  118. Friedman WF, Mills LF (1969) The relationship between vitamin D and the craniofacial and dental anomalies of the supravalvular aortic stenosis syndrome. Pediatrics 43:12–18

    CAS  PubMed  Google Scholar 

  119. Breslau NA, Zerwekh JE (1986) Relationship of estrogen and pregnancy to calcium homeostasis in pseudohypoparathyroidism. J Clin Endocrinol Metab 62:45–51

    CAS  PubMed  Google Scholar 

  120. Saito H, Saito M, Saito K, Terauchi A, Kobayashi T, Tominaga T, Hosoi E, Senoo M, Saito T (1989) Subclinical pseudohypoparathyroidism type II: evidence for failure of physiologic adjustment in calcium metabolism during pregnancy. Am J Med Sci 297:247–250

    CAS  PubMed  Google Scholar 

  121. Seki K, Osada H, Yasuda T, Sekiya S (1999) Pseudohypoparathyroidism type 1b in pregnancy. Gynecol Obstet Invest 47:278–280

    CAS  PubMed  Google Scholar 

  122. Zerwekh JE, Breslau NA (1986) Human placental production of 1a,25-dihydroxyvitamin D3: biochemical characterization and production in normal subjects and patients with pseudohypoparathyroidism. J Clin Endocrinol Metab 62:192–196

    CAS  PubMed  Google Scholar 

  123. Salle BL, Berthezene F, Glorieux FH, Delvin EE, Berland M, David L, Varenne JP, Putet G (1981) Hypoparathyroidism during pregnancy: treatment with calcitriol. J Clin Endocrinol Metab 52:810–813

    CAS  PubMed  Google Scholar 

  124. Sadeghi-Nejad A, Wolfsdorf JI, Senior B (1980) Hypoparathyroidism and pregnancy. Treatment with calcitriol. JAMA 243:254–255

    CAS  PubMed  Google Scholar 

  125. Cathebras P, Cartry O, Sassolas G, Rousset H (1996) Hypercalcemia induced by lactation in 2 patients with treated hypoparathyroidism. Rev Med Interne 17:675–676

    CAS  PubMed  Google Scholar 

  126. Shomali ME, Ross DS (1999) Hypercalcemia in a woman with hypoparathyroidism associated with increased parathyroid hormone-related protein during lactation. Endocr Pract 5:198–200

    CAS  PubMed  Google Scholar 

  127. Caplan RH, Beguin EA (1990) Hypercalcemia in a calcitriol-treated hypoparathyroid woman during lactation. Obstet Gynecol 76:485–489

    CAS  PubMed  Google Scholar 

  128. Mather KJ, Chik CL, Corenblum B (1999) Maintenance of serum calcium by parathyroid hormone-related peptide during lactation in a hypoparathyroid patient. J Clin Endocrinol Metab 84:424–427

    CAS  PubMed  Google Scholar 

  129. Bronsky D, Kiamko RT, Moncada R, Rosenthal IM (1968) Intra-uterine hyperparathyroidism secondary to maternal hypoparathyroidism. Pediatrics 42:606–613

    CAS  PubMed  Google Scholar 

  130. Stuart C, Aceto T Jr, Kuhn JP, Terplan K (1979) Intrauterine hyperparathyroidism. Postmortem findings in two cases. Am J Dis Child 133:67–70

    CAS  PubMed  Google Scholar 

  131. Loughead JL, Mughal Z, Mimouni F, Tsang RC, Oestreich AE (1990) Spectrum and natural history of congenital hyperparathyroidism secondary to maternal hypocalcemia. Am J Perinatol 7:350–355

    CAS  PubMed  Google Scholar 

  132. Sann L, David L, Thomas A, Frederich A, Chapuy MC, Francois R (1976) Congenital hyperparathyroidism and vitamin D deficiency secondary to maternal hypoparathyroidism. Acta Paediatr Scand 65:381–385

    CAS  PubMed  Google Scholar 

  133. Aceto T Jr, Batt RE, Bruck E, Schultz RB, Perz YR (1966) Intrauterine hyperparathyroidism: a complication of untreated maternal hypoparathyroidism. J Clin Endocrinol Metab 26:487–492

    PubMed  Google Scholar 

  134. Eastell R, Edmonds CJ, de Chayal RC, McFadyen IR (1985) Prolonged hypoparathyroidism presenting eventually as second trimester abortion. Br Med J (Clin Res Ed) 291:955–956

    CAS  Google Scholar 

  135. Anderson GW, Musselman L (1942) The treatment of tetany in pregnancy. Am J Obstet Gynecol 43:547–567

    Google Scholar 

  136. Kehrer E (1913) Die geburtschilflich-gynäkologische bedeutung der tetanie. Arch Gynaek 99:372–447

    Google Scholar 

  137. Glass EJ, Barr DG (1981) Transient neonatal hyperparathyroidism secondary to maternal pseudohypoparathyroidism. Arch Dis Child 56:565–568

    PubMed Central  CAS  PubMed  Google Scholar 

  138. Vidailhet M, Monin P, Andre M, Suty Y, Marchal C, Vert P (1980) Neonatal hyperparathyroidism secondary to maternal hypoparathyroidism. Arch Fr Pediatr 37:305–312

    CAS  PubMed  Google Scholar 

  139. Schnatz PF, Curry SL (2002) Primary hyperparathyroidism in pregnancy: evidence-based management. Obstet Gynecol Surv 57:365–376

    PubMed  Google Scholar 

  140. Shangold MM, Dor N, Welt SI, Fleischman AR, Crenshaw MC Jr (1982) Hyperparathyroidism and pregnancy: a review. Obstet Gynecol Surv 37:217–228

    CAS  PubMed  Google Scholar 

  141. Norman J, Politz D, Politz L (2009) Hyperparathyroidism during pregnancy and the effect of rising calcium on pregnancy loss: a call for earlier intervention. Clin Endocrinol (Oxf) 71:104–109

    CAS  Google Scholar 

  142. Shani H, Sivan E, Cassif E, Simchen MJ (2008) Maternal hypercalcemia as a possible cause of unexplained fetal polyhydramnion: a case series. Am J Obstet Gynecol 199(410):e411–e415

    Google Scholar 

  143. Kelly TR (1991) Primary hyperparathyroidism during pregnancy. Surgery 110:1028–1033; discussion 1033–1034

    CAS  PubMed  Google Scholar 

  144. Wagner G, Transhol L, Melchior JC (1964) Hyperparathyroidism and pregnancy. Acta Endocrinol (Copenh) 47:549–564

    CAS  Google Scholar 

  145. Ludwig GD (1962) Hyperparathyroidism in relation to pregnancy. N Engl J Med 267:637–642

    CAS  PubMed  Google Scholar 

  146. Delmonico FL, Neer RM, Cosimi AB, Barnes AB, Russell PS (1976) Hyperparathyroidism during pregnancy. Am J Surg 131:328–337

    CAS  PubMed  Google Scholar 

  147. Bruce J, Strong JA (1955) Maternal hyperparathyroidism and parathyroid deficiency in the child, with account of effect of parathyroidectomy on renal function, and of attempt to transplant part of tumor. Q J Med 24:307–319

    CAS  PubMed  Google Scholar 

  148. Ip P (2003) Neonatal convulsion revealing maternal hyperparathyroidism: an unusual case of late neonatal hypoparathyroidism. Arch Gynecol Obstet 268:227–229

    PubMed  Google Scholar 

  149. Tseng UF, Shu SG, Chen CH, Chi CS (2001) Transient neonatal hypoparathyroidism: report of four cases. Acta Paediatr Taiwan 42:359–362

    CAS  PubMed  Google Scholar 

  150. Naru T, Khan RS, Khan MA (2011) Primary hyperparathyrodism in pregnancy and review of literature. J Pak Med Assoc 61:401–403

    PubMed  Google Scholar 

  151. Pieringer H, Hatzl-Griesenhofer M, Shebl O, Wiesinger-Eidenberger G, Maschek W, Biesenbach G (2007) Hypocalcemic tetany in the newborn as a manifestation of unrecognized maternal primary hyperparathyroidism. Wien Klin Wochenschr 119:129–131

    PubMed  Google Scholar 

  152. McDonnell CM, Zacharin MR (2006) Maternal primary hyperparathyroidism: discordant outcomes in a twin pregnancy. J Paediatr Child Health 42:70–71

    PubMed  Google Scholar 

  153. Powell BR, Buist NR (1990) Late presenting, prolonged hypocalcemia in an infant of a woman with hypocalciuric hypercalcemia. Clin Pediatr (Phila) 29:241–243

    CAS  Google Scholar 

  154. Thomas BR, Bennett JD (1995) Symptomatic hypocalcemia and hypoparathyroidism in two infants of mothers with hyperparathyroidism and familial benign hypercalcemia. J Perinatol 15:23–26

    CAS  PubMed  Google Scholar 

  155. Thomas BR, Bennett JD (1997) Late-onset neonatal hypocalcemia as an unusual presentation in an offspring of a mother with familial hypocalciuric hypercalcemia. Clin Pediatr (Phila) 36:547–550

    CAS  Google Scholar 

  156. Kovacs CS, Ho-Pao CL, Hunzelman JL, Lanske B, Fox J, Seidman JG, Seidman CE, Kronenberg HM (1998) Regulation of murine fetal-placental calcium metabolism by the calcium-sensing receptor. J Clin Invest 101:2812–2820

    PubMed Central  CAS  PubMed  Google Scholar 

  157. Donovan EF, Tsang RC, Steichen JJ, Strub RJ, Chen IW, Chen M (1980) Neonatal hypermagnesemia: effect on parathyroid hormone and calcium homeostasis. J Pediatr 96:305–310

    CAS  PubMed  Google Scholar 

  158. Cruikshank DP, Pitkin RM, Reynolds WA, Williams GA, Hargis GK (1979) Effects of magnesium sulfate treatment on perinatal calcium metabolism. I. Maternal and fetal responses. Am J Obstet Gynecol 134:243–249

    CAS  PubMed  Google Scholar 

  159. Lipsitz PJ, English IC (1967) Hypermagnesemia in the newborn infant. Pediatrics 40:856–862

    CAS  PubMed  Google Scholar 

  160. Lipsitz PJ (1971) The clinical and biochemical effects of excess magnesium in the newborn. Pediatrics 47:501–509

    CAS  PubMed  Google Scholar 

  161. Lamm CI, Norton KI, Murphy RJ, Wilkins IA, Rabinowitz JG (1988) Congenital rickets associated with magnesium sulfate infusion for tocolysis. J Pediatr 113:1078–1082

    CAS  PubMed  Google Scholar 

  162. Santi MD, Henry GW, Douglas GL (1994) Magnesium sulfate treatment of preterm labor as a cause of abnormal neonatal bone mineralization. J Pediatr Orthop 14:249–253

    CAS  PubMed  Google Scholar 

  163. Cumming WA, Thomas VJ (1989) Hypermagnesemia: a cause of abnormal metaphyses in the neonate. AJR Am J Roentgenol 152:1071–1072

    CAS  PubMed  Google Scholar 

  164. Malaeb SN, Rassi AI, Haddad MC, Seoud MA, Yunis KA (2004) Bone mineralization in newborns whose mothers received magnesium sulphate for tocolysis of premature labour. Pediatr Radiol 34:384–386

    PubMed  Google Scholar 

  165. Savory J, Monif GR (1971) Serum calcium levels in cord sera of the progeny of mothers treated with magnesium sulfate for toxemia of pregnancy. Am J Obstet Gynecol 110:556–559

    CAS  PubMed  Google Scholar 

  166. Culbert EC, Schfirin BS (2006) Malignant hypercalcemia in pregnancy: effect of pamidronate on uterine contractions. Obstet Gynecol 108:789–791

    PubMed  Google Scholar 

  167. Usta IM, Chammas M, Khalil AM (1998) Renal cell carcinoma with hypercalcemia complicating a pregnancy: case report and review of the literature. Eur J Gynaecol Oncol 19:584–587

    CAS  PubMed  Google Scholar 

  168. Illidge TM, Hussey M, Godden CW (1996) Malignant hypercalcaemia in pregnancy and antenatal administration of intravenous pamidronate. Clin Oncol (R Coll Radiol) 8:257–258

    CAS  Google Scholar 

  169. Montoro MN, Paler RJ, Goodwin TM, Mestman JH (2000) Parathyroid carcinoma during pregnancy. Obstet Gynecol 96:841

    CAS  PubMed  Google Scholar 

  170. Abraham P, Ralston SH, Hewison M, Fraser WD, Bevan JS (2002) Presentation of a PTHrP-secreting pancreatic neuroendocrine tumour, with hypercalcaemic crisis, pre-eclampsia, and renal failure. Postgrad Med J 78:752–753

    PubMed Central  CAS  PubMed  Google Scholar 

  171. Tsang RC, Chen I, Friedman MA, Gigger M, Steichen J, Koffler H, Fenton L, Brown D, Pramanik A, Keenan W, Strub R, Joyce T (1975) Parathyroid function in infants of diabetic mothers. J Pediatr 86:399–404

    CAS  PubMed  Google Scholar 

  172. Mehta KC, Kalkwarf HJ, Mimouni F, Khoury J, Tsang RC (1998) Randomized trial of magnesium administration to prevent hypocalcemia in infants of diabetic mothers. J Perinatol 18:352–356

    CAS  PubMed  Google Scholar 

  173. Brandi ML (2011) Genetics of hypoparathyroidism and pseudohypoparathyroidism. J Endocrinol Invest 34:27–34

    CAS  PubMed  Google Scholar 

  174. Ryan AK, Goodship JA, Wilson DI, Philip N, Levy A, Seidel H, Schuffenhauer S, Oechsler H, Belohradsky B, Prieur M, Aurias A, Raymond FL, Clayton-Smith J, Hatchwell E, McKeown C, Beemer FA, Dallapiccola B, Novelli G, Hurst JA, Ignatius J, Green AJ, Winter RM, Brueton L, Brondum-Nielsen K, Scambler PJ et al (1997) Spectrum of clinical features associated with interstitial chromosome 22q11 deletions: a European collaborative study. J Med Genet 34:798–804

    PubMed Central  CAS  PubMed  Google Scholar 

  175. Brauner R, Harivel L, de Gonneville A, Kindermans C, Le Bidois J, Prieur M, Lyonnet S, Souberbielle JC (2003) Parathyroid function and growth in 22q11.2 deletion syndrome. J Pediatr 142:504–508

    CAS  PubMed  Google Scholar 

  176. Adachi M, Tachibana K, Masuno M, Makita Y, Maesaka H, Okada T, Hizukuri K, Imaizumi K, Kuroki Y, Kurahashi H, Suwa S (1998) Clinical characteristics of children with hypoparathyroidism due to 22q11.2 microdeletion. Eur J Pediatr 157:34–38

    CAS  PubMed  Google Scholar 

  177. Mantovani G (2011) Clinical review: pseudohypoparathyroidism: diagnosis and treatment. J Clin Endocrinol Metab 96:3020–3030

    CAS  PubMed  Google Scholar 

  178. Ngai YF, Chijiwa C, Mercimek-Mahmutoglu S, Stewart L, Yong SL, Robinson WP, Gibson WT (2010) Pseudohypoparathyroidism type 1a and the GNAS p.R231H mutation: somatic mosaicism in a mother with two affected sons. Am J Med Genet A 152A:2784–2790

    CAS  PubMed  Google Scholar 

  179. Rubin LP, Kovacs CS, De Paepe ME, Tsai SW, Torday JS, Kronenberg HM (2004) Arrested pulmonary alveolar cytodifferentiation and defective surfactant synthesis in mice missing the gene for parathyroid hormone-related protein. Dev Dyn 230:278–289

    CAS  PubMed  Google Scholar 

  180. Klopocki E, Hennig BP, Dathe K, Koll R, de Ravel T, Baten E, Blom E, Gillerot Y, Weigel JF, Kruger G, Hiort O, Seemann P, Mundlos S (2010) Deletion and point mutations of PTHLH cause brachydactyly type E. Am J Hum Genet 86:434–439

    PubMed Central  CAS  PubMed  Google Scholar 

  181. Lanske B, Karaplis AC, Lee K, Luz A, Vortkamp A, Pirro A, Karperien M, Defize L, Ho C, Abou-Samra AB, Jüppner H, Segre GV, Kronenberg HM (1996) PTH/PTHrP receptor in early development and Indian hedgehog-regulated bone growth. Science 273:663–666

    CAS  PubMed  Google Scholar 

  182. Karaplis AC, He B, Nguyen MT, Young ID, Semeraro D, Ozawa H, Amizuka N (1998) Inactivating mutation in the human parathyroid hormone receptor type 1 gene in Blomstrand chondrodysplasia. Endocrinology 139:5255–5258

    CAS  PubMed  Google Scholar 

  183. Oostra RJ, van der Harten JJ, Rijnders WP, Scott RJ, Young MP, Trump D (2000) Blomstrand osteochondrodysplasia: three novel cases and histological evidence for heterogeneity. Virchows Arch 436:28–35

    CAS  PubMed  Google Scholar 

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  1. Faculty of Medicine – Endocrinology, Obstetrics and Gynecology, and BioMedical Sciences, Health Sciences Centre, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John’s, NL, A1B 3 V6, Canada

    Christopher S. Kovacs MD, FRCPC, FACP, FACE

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  1. Unit of Metabolic and Bone Diseases, University of Florence, Florence, Italy

    Maria Luisa Brandi

  2. Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts, USA

    Edward Meigs Brown

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Kovacs, C.S. (2015). Hypoparathyroidism During Pregnancy, Lactation, and Fetal/Neonatal Development. In: Brandi, M., Brown, E. (eds) Hypoparathyroidism. Springer, Milano. https://doi.org/10.1007/978-88-470-5376-2_23

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