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CALCIUM 250 - ADDITIONAL INFORMATION

Calcium & Pregnancy

There is evidence in the literature to support an association between maternal calcium intake during pregnancy and offspring blood pressure. However, more research is needed to confirm these finding given the small sample sizes and the methodological problems in many of the studies conducted so far. More studies on populations with calcium deficit are also needed. If confirmed, these findings could have important public health implications. Calcium supplementation during pregnancy is simple and inexpensive and may be a way to reduce the risk of hypertension and its sequels in the next generation.

Increased dietary calcium intake has been associated with lower blood pressure among children, adults and pregnant women. The effect seems to be more evident among individuals with low calcium intake.

Pregnancy and lactation are periods of high calcium requirement. The skeleton of a newborn baby contains approximately 20-30 g of calcium. The bulk of fetal skeletal growth takes place from mid-pregnancy onwards, with maximal calcium accretion occurring during the third trimester. The total calcium accretion rate of the fetus increases from approximately 50 mg/day at 20 weeks gestation to 330 mg/day at 35 weeks. For the third trimester of pregnancy, 200 mg/day is considered the average accretion rate. The potential negative consequences of a deficiency in calcium intake during pregnancy may affect bone metabolism, may cause hypertensive disorders or affect the fetal growth.

Bone metabolism Calcium absorption and urinary calcium excretion are higher during pregnancy than before conception or after delivery. The increase is evident in early-to-mid pregnancy and precedes the increased demand for calcium by the fetus for skeletal growth. Bone restoration is also increased, as indicated histologically (the study of microscopic structure of tissues) and biochemically by measurements of plasma markers such as tartrate-resistant acid phosphates and the urinary excretion of collagen cross-links, telopeptides or hydroxyproline. The increase in absorption rate is apparent by early gestation and rises further during pregnancy. Bone formation increases similarly as indicated by plasma markers such as bone alkaline phosphates and pro-collagen peptides. However, osteocalcin concentration, a commonly used plasma marker for bone formation, is lower throughout pregnancy than before conception, although concentrations in late gestation are higher than those earlier in pregnancy. This may be due to the uptake of osteocalcin by the placenta. The alterations in calcium and bone metabolism during pregnancy are accompanied by an increased concentration of the calciotropic hormone 1, 25-dihydroxyvitamin D (calcitriol) but with little alteration in parathyroid or calcitonin hormone concentrations. After delivery, calcium absorption and urinary calcium excretion return to pre-pregnancy values. No data shows that pregnancy causes a permanent negative effect on bone density. In fact, recent data shows that human pregnancy and lactation are accompanied by physiological changes in calcium and bone metabolism that are sufficient to make calcium available for fetal growth and breast milk production without a need to increase maternal calcium intake. Physiological hyper absorption of calcium occurs in pregnancy, preceding the demands of the fetus for calcium, whereas renal conservation of calcium and temporary liberation of calcium from skeleton occur during lactation period.

Maternal malnutrition has a major impact on fetal growth and birth weight, and hence on skeletal mass. Poor nutrition during pregnancy may reduce neonatal bone density as well as size. The question whether a low maternal intake of calcium can limit fetal growth or skeletal development in an otherwise healthy growing fetus has not been addressed. In an early study using radiographic densitometry, calcium supplementation of pregnant Indian women with a low calcium intake resulted in higher neonatal bone density compared to infants from mothers not receiving supplementation. There was no difference on birth weight or length between the groups. Maybe the traditional anthropometric assessment of the neonate is not suitable to measure these effects. The use of sensitive absorptiometric techniques for measuring bone mineral content of small infants could result in better outcomes. Additional evidence of a positive effect of prenatal calcium intake comes from the studies in mothers receiving calcium supplementation as a preventive strategy to reduce pre-eclampsia. In a systematic review of calcium supplementation for the prevention of hypertensive disorders published in the Cochrane Library, 6 out of 9 studies reported that birth weights were higher in the intervention group compared to the control group, and in 2 of these trials the difference was statistically significant.

Necessary Daily Intake for Pregnant Ladies:

[1.] Less than 18 years of age, 1,300 mg of Calcium per day.

[2.] From 19 to 50 years of age, 1,000 mg of Calcium per day.

Necessary Daily Intake for Lactating Ladies:

Less than 18 years of age, 1300 mg of Calcium per day.
Between 19 and 50 years of age, 1,000 mg of Calcium per day.

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