Pregnancy‐related change in pQCT and bone biochemistry in a population with a habitually low calcium intake

Mícheál Ó Breasail*, Kate A. Ward, Simon M. Schoenbuchner, Mustapha Ceesay, Michael Mendy, Landing M Jarjou, Sophie E. Moore, Ann Prentice

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

In pregnancy, changes in maternal calcium (Ca) economy occur to satisfy fetal Ca demand. It is unclear whether maternal mineral reserves facilitate these requirements and no data exist from sub‐Saharan Africa. The aim was to determine skeletal changes with peripheral quantitative computed tomography (pQCT) and bone biochemistry between early second and third trimesters. Pregnant rural Gambians aged 18 to 45 years (n = 467) participating in a trial of antenatal nutritional supplements (ISRCTN49285450) had pQCT scans and blood collections at mean (SD) 14 (3) and 31 (1) weeks’ gestation. Outcomes were pQCT: radius/tibia 4% total volumetric bone mineral density (vBMD), trabecular vBMD, total cross‐sectional area (CSA), 33%/38% radius/tibia cortical vBMD, bone mineral content (BMC), total CSA; biochemistry: collagen type 1 cross‐linked β‐C‐telopeptide (β‐CTX), type 1 procollagen N‐terminal (P1NP), parathyroid hormone (PTH), and 1,25(OH)2D. Independent t tests tested whether pooled or within‐group changes differed from 0. Multiple regression was performed adjusting for age. Data for change are expressed as mean (confidence interval [CI] 2.5, 97.5%). Radius trabecular vBMD, cortical vBMD, and BMC increased by 1.15 (0.55, 1.75)%, 0.41 (0.24, 0.58)%, and 0.47 (0.25, 0.69)%. Tibia total and trabecular vBMD increased by 0.34 (0.15, 0.54)% and 0.46 (0.17, 0.74)%, while tibia cortical vBMD, BMC, and cortical CSA increased by 0.35 (0.26, 0.44)%, 0.55 (0.41, 0.68)% and 0.20 (0.09, 0.31)%, respectively. CTX, PTH, and 1,25(OH)2D increased by 23.0 (15.09, 29.29)%, 13.2 (8.44, 19.34)%, and 21.0 (17.67, 24.29)%, while P1NP decreased by 32.4 (−37.19, −28.17)%. No evidence of mobilization was observed in the peripheral skeleton. Resorption, although higher in late versus early gestation, was lower throughout pregnancy compared with non‐pregnant non‐lactating (NPNL) in the same community. Formation was lower in late pregnancy than in early, and below NPNL levels. This suggests a shift in the ratio of resorption to formation. Despite some evidence of change in bone metabolism, in this population, with habitually low Ca intakes, the peripheral skeleton was not mobilized as a Ca source for the fetus. © 2021 crown copyright . Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). The article published with the permission of the Controller of HMSO and the Queen's Printer of Scotland
Original languageEnglish
Pages (from-to)1269-1280
Number of pages12
JournalJournal of Bone and Mineral Research
Volume36
Issue number7
Early online date30 Mar 2021
DOIs
Publication statusPublished - 7 May 2021

Bibliographical note

Funding Information:
The authors acknowledge the contribution of the participants who took part in this study. We thank the women of West Kiang who patiently participated in the study. We acknowledge the enthusiastic work of the ENID study team, especially the fieldworkers, village assistants, midwives, clinical staff, and laboratory technicians who tirelessly collected the data and samples. We acknowledge the support of Mr Bakary Sonko and colleagues in the Keneba data office for the development and management of the ENID database. We thank Mr Darren Cole for assistance in processing pQCT output. We are grateful to Dr Shailja Nigdikar, Mrs Janet Bennett, and Mrs Ann Laidlaw of the MRC Elsie Widdowson Laboratory, Cambridge, UK, who processed and analyzed all biochemistry and bone turnover markers. This research was jointly funded by the MRC (program codes U105960371, U123261351, MCA760‐5QX00) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement.

Funding Information:
The authors acknowledge the contribution of the participants who took part in this study. We thank the women of West Kiang who patiently participated in the study. We acknowledge the enthusiastic work of the ENID study team, especially the fieldworkers, village assistants, midwives, clinical staff, and laboratory technicians who tirelessly collected the data and samples. We acknowledge the support of Mr Bakary Sonko and colleagues in the Keneba data office for the development and management of the ENID database. We thank Mr Darren Cole for assistance in processing pQCT output. We are grateful to Dr Shailja Nigdikar, Mrs Janet Bennett, and Mrs Ann Laidlaw of the MRC Elsie Widdowson Laboratory, Cambridge, UK, who processed and analyzed all biochemistry and bone turnover markers. This research was jointly funded by the MRC (program codes U105960371, U123261351, MCA760-5QX00) and the Department for International Development (DFID) under the MRC/DFID Concordat agreement. Authors? roles: Study design: M?B, KAW, SEM, and AP. Study conduct and data collection: KAW, MC MM, LJ, SEM, and AP. Data analysis and interpretation: M?B, KAW, SMS, and AP. Drafting manuscript and revising manuscript content: M?B, KAW, and AP. Approving final version of manuscript: MOB, KAW, SMS, MC, MM, LJ, SEM, and AP. M?B and AP take responsibility for the integrity of the data analysis.

Publisher Copyright:
© 2021 crown copyright. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). The article published with the permission of the Controller of HMSO and the Queen's Printer of Scotland.

Keywords

  • ANALYSIS/QUANTIFICATION OF BONE
  • BONE QCT/μCT
  • EPIDEMIOLOGY
  • GENERAL POPULATION STUDIES
  • AGING
  • BONE MODELING AND REMODELING
  • BIOCHEMICAL MARKERS OF BONE TURNOVER

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