A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses

To clarify the role of the intestine, kidney, and bone in maintaining calcium homeostasis during pregnancy and lactation and after the resumption of menses, a longitudinal comparison was undertaken of 14 well-nourished women consuming approximate to 1200 mg Ca/d. Measurements were made before conception (prepregnancy), once during each trimester of pregnancy (T1, T2, and T3), early in lactation at 2 mo postpartum (EL), and 5 mo after resumption of menses. Intestinal calcium absorption was determined from the enrichment of the first 24-h urine sample collected after administration of stable calcium isotopes. Bone mineral of the total body and lumbar spine was measured by dual-energy X-ray absorptiometry and quantitative computerized tomography, respectively. Twenty-four-hour urine and fasting serum samples were analyzed for calcium, calcitropic hormones, and biochemical markers of bone turnover. Despite an increase in calcium intake during pregnancy, true percentage absorption of calcium increased from 32.9 +/- 9.1% at prepregnancy to 49.9 +/- 10.2% at T2 and 53.8 +/- 11.3% at T3 (P < 0.001). Urinary calcium increased from 4.32 +/- 2.20 mmol/d at prepreg nancy to 6.21 +/- 3.72 mmol/d at T3 (P < 0.001), but only minor changes in maternal bone mineral were detected. At EL, dietary calcium and calcium absorption were not significantly different from that at prepregnancy, but urinary calcium decreased to 1.87 +/- 1.22 mmol/d (P < 0.001) and trabecular bone mineral density of the spine decreased to 147.7 +/- 21.2 mg/cm(3) from 162.9 +/- 25.0 mg/cm(3) at prepregnancy (P < 0.001). Calcium absorption postmenses increased nonsignificantly to 36.0 +/- 8.1% whereas urinary calcium decreased to 2.72 +/- 1.52 mmol/d (P < 0.001). We concluded that fetal calcium demand was met by increased maternal intestinal absorption; early breast-milk calcium was provided by maternal renal calcium conservation and loss of spinal trabecular bone, a loss that was recovered postmenses.