Calcium needs increase during pregnancy and lactation to support fetal and infant development. During pregnancy, 200-300 mg of calcium is transferred daily via the placenta to the fetus or excreted in breastmilk. To meet these demands, women experience increased intestinal calcium absorption, decreased urinary calcium excretion, and increased bone calcium turnover. Calcium supplementation in pregnancy has been shown to reduce risks of preeclampsia and gestational hypertension by around 40%. Adequate calcium intake during pregnancy and lactation supports healthy bone development in both mother and child.

1. Presented by

2. INTRODUCTION
• During gestation the average foetus requires about 30 g of
calcium to mineralize its skeleton and maintain normal
physiological processes.
• The suckling neonate requires more than this amount in breast
milk during six months of exclusive lactation
• Although pregnant and lactating women face a comparable
demand in the amount of calcium

3. • During pregnancy and lactation, 200–300 mg Ca/d is eithertransferred via
the placenta to the foetus or excreted in breast milk.
• The provision of calcium during pregnancy and lactation requires
• Physiologic adaptation of calcium homeostatic mechanisms.
• Including
1. intestinal calcium absorption
2. urinary calcium excretion
3. maternal bone calcium turnover

4. Calcium
•Calcium is important for a number of functions in the body
•It is essential for
1. Growth
2. Maintenance of bones and teeth
3. Nerve transmission
4. Muscle contraction
5. Number of other cell processes

5. • The body has increased calcium needs during growth spurts,
pregnancy and lactation.
• An inadequate calcium intake can therefore cause a number of
problems
• In growing children and adolescents, this can lead to stunted
growth, and a reduced peak bone density increasing the risk of
osteoporosis later in life
• In pregnancy, the unborn child will draw on the mother’s
calcium stores to meet its needs, putting the condition of the
mother’s bones and teeth at risk

6. Recommended Daily Intake
Population Group RDI
Adults 800 mg/day
Pregnancy 1200 mg/day
Lactation 1400 mg/day
Elderly 1000 mg/day

7. Pregnancy
•The normal foetal skeleton has accreted about 30 g
calcium by the end of gestation.
•About 80% of the accretion occurs rapidly during the
third trimester.
•Daily accretion rate of about 250–300 mg calcium by
the foetal skeleton during the third trimester.

8. The mother could theoretically meet this demand by
Increasing the intestinal absorption.
Decreasing renal calcium losses.
Increasing the resorption of calcium from the
maternal skeleton.

9. Minerals and hormones
•Earliest apparent changes in calcium balance in
pregnancy is a fall in total serum calcium.
•Serum calcitonin levels are increased during
pregnancy.
•PTHrP levels have been increased during pregnancy.
•Other hormones are clearly in flux during pregnancy.

10. Intestinal calcium absorption
• Intestinal absorption of calcium is doubled during pregnancy
• The increase in intestinal calcium absorption is associated with
• Doubling of 1,25-dihydroxyvitamin D levels.
• Increased intestinal expression of the vitamin D-dependent calcium-
binding protein calbindin-D.

11. Renal calcium excretion
• The 24-h urine calcium excretion is typically increased as early
as the 12th week of gestation
• This increase is likely a consequence of
• Increased intestinal absorption of calcium
• Increased renal filtered load of calcium
• Increased glomerular filtration rate
• In the fasted state, the calcium excretion is normal or even low.

12. Lactation
•The typical daily loss of calcium in breast milk has been
estimated to range from 280–400 mg
•Although daily losses as great as 1000 mg
•A temporary demineralization of the skeleton seems to be
the main mechanism

13. CALCIUM PHYSIOLOGY DURING
PREGNANCY
• Calcium provided from the maternal decidua aids in fertilization
of the egg and implantation of the blastocyst.
• About 80% of the calcium present in the foetal skeleton at the
end of gestation crossed the placenta during the third trimester.
• Intestinal calcium absorption doubles during pregnancy.

14. Vitamin D Metabolites
• A common concern is that the placenta and fetus will deplete
maternal 25-D stores, but this does not appear to be the case.
• Even in severely vitamin D deficient women there was either
no change or at most a no significant decline in maternal 25-D
levels during pregnancy.

15. Calcitonin
• Serum calcitonin levels are increased during pregnancy and may
derive from
• Maternal Thyroid
• Breast
• Decidua
• Placenta
• Calcitonin plays an important role in the physiological responses
to the calcium demands of pregnancy

16. Consequences of bone loss during pregnancy
and Lactation
•Maternal bone loss during pregnancy or lactation might
lead to osteoporosis and fracture either
contemporaneously or, by reducing peak bone mass, in
later life.
•Severe bone loss leading to osteoporosis and fracture is a
well recognized but rare complication of pregnancy and
lactation.

17. Influence of calcium intakes on breast-milk
calcium secretion
•Breast-milk calcium secretion is known to be
independent of recent maternal calcium intake.
•No relationships between breast-milk calcium
concentrations and maternal calcium intakes.
•However, there have been no definitive investigations in
women with low calcium intakes.

18. Effect of maternal calcium intake on foetal
and infant growth
•Marginal calcium deficiency may be associated with
reduced bone mineral content.
•The influence of maternal calcium intakes during
pregnancy and lactation on the growth and bone
development of the foetus and breast-fed baby is not
known.

19. Calcium intakes and hypertensive disorders
of pregnancy
• A potential connection between low calcium intakes and
hypertensive disorders in pregnancy was suggested by the fact
that the incidence of eclampsia is highest in countries where
calcium intakes are low.
• Several well-conducted trials have studied the efficacy of calcium
supplements in preventing preeclampsia, gestational hypertension,
and premature delivery.

20. •Calcium supplementation prevents endothelial cell
activation induced by trophoblastic debris from pre-
eclamptic placentae.
•Calcium supplementation during pregnancy leads to a
reduction of 40 % in risk of pre-eclampsia, 35 % in
risk of development of gestational hypertension.

21. Study Name: Calcium Supplementation Commencing Before Or Early In
Pregnancy For Preventing Hypertensive Disorders Of
Pregnancy.
Study Period: 12 July 2011To 31 October 2017
StudyType: Interventional
Study Design: Double‐blind
Population : 651
Age Group: 18To 40Years pregnant women
• The findings revealed that calcium supplementation in pregnancy
significantly reduced the risk of pre-eclampsia and high blood
pressure in about 39% patients.
G Justus Hofmeyr, Sarah Manyame, Nancy Medley, Myfanwy J
Williams
https://doi.org/10.1002/14651858.CD011192.pub3

22. Calcium in GDM
Calcium induces rapid (within 5–10 sec),
synchronous, sinusoidal oscillations in pancreatic
beta-cells. This phenomenon in turns causes
release of insulin from beta-cell thus lowering the
blood glucose level.

24. Study Name: Calcium and vitamin D supplementation improves metabolic
profile of pregnant women with gestational diabetes.
Study Period: December 2011 to June, 2013
StudyType: Interventional
Study Design: Randomized placebo-controlled trial
Population : 56
Age Group: 18To 40Years pregnant women
• The findings revealed that following the administration of Calcium plus
vitamin D supplements, they observed significant reductions in fasting
plasma glucose as well as improvements in insulin sensitivity.
Calcium and vitamin D supplementation improves metabolic profile
of pregnant women with gestational diabetes.
https://medicalxpress.com/news/2014-06-calcium-vitamin-d-
supplementation-metabolic.html

25. During lactation
•Urinary calcium excretion is generally decreased.
•Increased calcium absorption may occur.
•No differences in fractional absorption have been found
during established lactation between breast-feeding
mothers and control subjects

26. Adverse effects of increases in calcium
intakes
•Very high calcium intakes are believed to increase the risk
of kidney stones.
•Renal calculi occur in 1/1500 pregnancies.
•The potential for urinary tract infection may be increased
when urinary calcium excretion rises as a result of calcium
supplementation.

27. Disorders of calcium and bone
metabolism during pregnancy &
lactation.

28. Osteoporosis in Pregnancy
• In such cases it is not possible to exclude the possibility that low
bone density or skeletal fragility preceded pregnancy
• Osteoporosis in pregnancy usually presents in a first pregnancy
at age 27-28 and there is no increased risk with higher parity
• Fractures tend not to recur in subsequent pregnancies

29. Other disorders
•Hypoparathyroidism
•Primary Hyperparathyroidism

30. Why you need calcium during pregnancy
• Baby needs calcium to build strong bones and teeth
• Grow a healthy heart, nerves, and muscles
• Develop a normal heart rhythm and blood-clotting abilities
• Reduce bone resorption

31. THANK YOU
FOR YOUR
KIND ATTENTION