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Bone resorption and dietary calcium in pregnancy—a window to future maternal bone health

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Abstract

Background

Pregnancy is characterized by increased bone turnover and reversible loss of bone mineral density (BMD) to meet fetal calcium demands. The long-term effect of bone turnover and maternal diet in pregnancy on maternal bone is not well established.

Objective

We aimed to determine if an association exists between [1] bone resorption, [2] dietary calcium, and [3] serum 25-hydroxyvitamin D in pregnancy with maternal BMD 5-year postpartum.

Design

This is a prospective, longitudinal study of 107 women recruited to the ROLO low glycemic index dietary intervention trial in pregnancy and followed-up at 13, 28, and 34 weeks’ gestation and 5 years’ postpartum. At 13 and 28 weeks’ gestation, a biomarker of bone resorption, urine cross-linked N-telopeptide of type I collagen (uNTX), was measured. At the 5-year follow-up BMD was measured using dual-energy X-ray absorptiometry. Anthropometry, dietary intakes, and serum 25-hydroxyvitamin D were measured in pregnancy and at 5 years. Multiple linear regression, controlling for confounders, was used for analysis.

Results

Mean BMD at 5 years was 1.208 g/cm2. In pregnancy, 24–34% reported dietary calcium intakes <800 mg/day. Vitamin D deficiency (< 30 nmol/L) was observed in 38–41% of women in pregnancy and in 29% of women at the 5-year follow-up. At 13 and 28 weeks’ gestation, uNTX levels greater than the median were associated with 0.060 and 0.050 g/cm2 lower BMD 5 years later, respectively. Dietary calcium <800 mg/day in trimester 3 was associated with 0.072 g/cm2 lower BMD 5 years later. Vitamin D deficiency at 5 years, but not in pregnancy, was associated with lower BMD.

Conclusion

Higher bone resorption and low dietary calcium in pregnancy were associated with lower BMD 5 years later. These findings could enable the identification of women at risk of declining of BMD in later life, but further research is needed. Adequate dietary calcium should be advised in the antenatal setting to promote lifelong maternal bone health.

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Abbreviations

BMD:

Bone mineral density

uNTX:

Urine Cross-Linked N-Telopeptides Of Type I Collagen

25OHD:

Serum 25-Hydroxyvitamin D

DXA:

Dual-energy X-ray absorptiometry

BMI:

Body mass index

ROLO:

Randomized control trial of a low glycemic index diet in pregnancy to prevent macrosomia

IPAQ:

International Physical Activity Questionnaire

MET:

Metabolic equivalent

IOM:

Institute of Medicine

EAR:

Estimated average requirements

RDA:

Recommended dietary allowances

SD:

Standard deviation

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Acknowledgments

ECOB designed research, conducted research, analyzed data, wrote paper; AAG conducted research, wrote paper; MTK conducted research, provided essential reagents, wrote paper; MJMcK provided essential reagents, wrote paper; FMcA designed research and had primary responsibility for final content.

Data sharing

Data described in the manuscript, code book, and analytic code will be made available upon request pending.

Funding

This study was supported by the Health Research Centre for Health and Diet Research (Health Research Board Ireland), The National Maternity Hospital Medical Fund and the European Union’s Seventh Framework Programme (FP7/2007–2013), project EarlyNutrition under grant agreement no. 289346. The funding sources had no involvement in the study.

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Authors and Affiliations

  1. UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland

    E.C. O’Brien, A.A. Geraghty, M.J. McKenna & F.M. McAuliffe

  2. Department of Clinical Chemistry, St Vincent’s University Hospital, Dublin, Ireland

    M.T. Kilbane

  3. Department of Endocrinology, St Vincent’s University Hospital, Dublin, Ireland

    M.J. McKenna

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  1. E.C. O’Brien
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  2. A.A. Geraghty
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  5. F.M. McAuliffe
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Correspondence to F.M. McAuliffe.

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O’Brien, E., Geraghty, A., Kilbane, M. et al. Bone resorption and dietary calcium in pregnancy—a window to future maternal bone health. Osteoporos Int 32, 1803–1814 (2021). https://doi.org/10.1007/s00198-021-05891-w

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