Skip to main content
SpringerLink
Log in

Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail

  • Materno-fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Calcium demand is increased during pregnancy. However, few randomized controlled trials examined the effects of calcium supplementation on bone mass during pregnancy. This study determined effects of calcium and milk supplementation on maternal bone mineral density (BMD) and bone turnover in pregnant Chinese women with habitual low calcium intake.

Methods

In this randomized controlled trial, 36 Chinese pregnant women (24–31 years, 18 gestational weeks) were randomly assigned to the following three arms (12 each): I, usual diet; II, “I” + 45 g milk powder (containing 350 mg calcium); or III, “II” + 600 mg calcium/day from gestational age of 20 weeks to 6 weeks post-partum (PP). BMD was measured post-treatment using dual-energy X-ray absorptiometry. Dietary intakes, 24-h urinary calcium, bone resorption (urinary hydroxyproline) and formation (serum osteocalcin) biomarkers were examined at the gestational age of 20 and 34 weeks, and 6 weeks PP.

Results

A dose-dependent relationship was observed between calcium intake and BMDs. The BMD values were significantly higher in subjects with calcium and milk supplementation than those in the controls at the whole body and spine (p < 0.05) but not at the hip sites. We found significant decreases in changes of urinary hydroxyproline, and significant increases in serum osteocalcin during the intervention period in the calcium/milk intervention groups than those in the control group (all p < 0.05).

Conclusion

Calcium/milk supplementation during pregnancy is associated with greater BMD at the spine and whole body and suppresses bone resorption in Chinese women with habitual low calcium intake.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Prentice A (2003) Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr 133:1693S–1699S

    CAS  PubMed  Google Scholar 

  2. Forbes GB (1976) Letter: calcium accumulation by the human fetus. Pediatrics 57:976–977

    CAS  PubMed  Google Scholar 

  3. Heaney RP, Skillman TG (1971) Calcium metabolism in normal human pregnancy. J Clin Endocrinol Metab 33:661–670

    Article  CAS  PubMed  Google Scholar 

  4. O’Brien KO, Donangelo CM, Zapata CL, Abrams SA, Spencer EM, King JC (2006) Bone calcium turnover during pregnancy and lactation in women with low calcium diets is associated with calcium intake and circulating insulin-like growth factor 1 concentrations. Am J Clin Nutr 83:317–323

    PubMed  Google Scholar 

  5. Kovacs CS (2001) Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 86:2344–2348

    Article  CAS  PubMed  Google Scholar 

  6. Sowers M (1996) Pregnancy and lactation as risk factors for subsequent bone loss and osteoporosis. J Bone Miner Res 11:1052–1060

    Article  CAS  PubMed  Google Scholar 

  7. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A (2007) Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370:657–666

    Article  CAS  PubMed  Google Scholar 

  8. Winzenberg T, Shaw K, Fryer J, Jones G (2006) Effects of calcium supplementation on bone density in healthy children: meta-analysis of randomised controlled trials. BMJ 333:775–781

    Article  CAS  PubMed  Google Scholar 

  9. Welten DC, Kemper HC, Post GB, Van Staveren WA (1995) A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J Nutr 125:2802–2813

    CAS  PubMed  Google Scholar 

  10. Zeni SN, Ortela Soler CR, Lazzari A, Lopez L, Suarez M, Di Gregorio S, Somoza JI, de Portela ML (2003) Interrelationship between bone turnover markers and dietary calcium intake in pregnant women: a longitudinal study. Bone 33:606–613

    Article  CAS  PubMed  Google Scholar 

  11. Olausson H, Laskey MA, Goldberg GR, Prentice A (2008) Changes in bone mineral status and bone size during pregnancy and the influences of body weight and calcium intake. Am J Clin Nutr 88:1032–1039

    CAS  PubMed  Google Scholar 

  12. Janakiraman V, Ettinger A, Mercado-Garcia A, Hu H, Hernandez-Avila M (2003) Calcium supplements and bone resorption in pregnancy: a randomized crossover trial. Am J Prev Med 24:260–264

    Article  PubMed  Google Scholar 

  13. Avendano-Badillo D, Hernandez-Avila M, Hernandez-Cadena L, Rueda-Hernandez G, Solano-Gonzalez M, Ibarra LG, Hu H, Tellez-Rojo MM (2009) High dietary calcium intake decreases bone mobilization during pregnancy in humans. Salud Publica Mex 51(Suppl 1):S100–S107

    PubMed  Google Scholar 

  14. Kolthoff N, Eiken P, Kristensen B, Nielsen SP (1998) Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci 94:405–412

    CAS  PubMed  Google Scholar 

  15. Krishnamachari KA, Iyengar L (1975) Effect of maternal malnutrition on the bone density of the neonates. Am J Clin Nutr 28:482–486

    CAS  PubMed  Google Scholar 

  16. Kent GN, Price RI, Gutteridge DH, Rosman KJ, Smith M, Allen JR, Hickling CJ, Blakeman SL (1991) The efficiency of intestinal calcium absorption is increased in late pregnancy but not in established lactation. Calcif Tissue Int 48:293–295

    Article  CAS  PubMed  Google Scholar 

  17. Holmberg-Marttila D, Sievanen H, Tuimala R (1999) Changes in bone mineral density during pregnancy and postpartum: prospective data on five women. Osteoporos Int 10:41–46

    Article  CAS  PubMed  Google Scholar 

  18. More C, Bettembuk P, Bhattoa HP, Balogh A (2001) The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 12:732–737

    Article  CAS  PubMed  Google Scholar 

  19. Pearson D, Kaur M, San P, Lawson N, Baker P, Hosking D (2004) Recovery of pregnancy mediated bone loss during lactation. Bone 34:570–578

    Article  CAS  PubMed  Google Scholar 

  20. Kaur M, Pearson D, Godber I, Lawson N, Baker P, Hosking D (2003) Longitudinal changes in bone mineral density during normal pregnancy. Bone 32:449–454

    Article  CAS  PubMed  Google Scholar 

  21. Naylor KE, Iqbal P, Fledelius C, Fraser RB, Eastell R (2000) The effect of pregnancy on bone density and bone turnover. J Bone Miner Res 15:129–137

    Article  CAS  PubMed  Google Scholar 

  22. Ulrich U, Miller PB, Eyre DR, Chesnut CH 3rd, Schlebusch H, Soules MR (2003) Bone remodeling and bone mineral density during pregnancy. Arch Gynecol Obstet 268:309–316

    Article  CAS  PubMed  Google Scholar 

  23. Drinkwater BL, Chesnut CH 3rd (1991) Bone density changes during pregnancy and lactation in active women: a longitudinal study. J Bone Miner Metab 14:153–160

    CAS  Google Scholar 

  24. Yamaga A, Taga M, Minaguchi H, Sato K (1996) Changes in bone mass as determined by ultrasound and biochemical markers of bone turnover during pregnancy and puerperium: a longitudinal study. J Clin Endocrinol Metab 81:752–756

    Article  CAS  PubMed  Google Scholar 

  25. Walker GL, Danielson DM, Peo ER Jr, Mumm RF (1993) Effect of calcium source, dietary calcium concentration, and gestation phase on various bone characteristics in gestating gilts. J Anim Sci 71:3003–3010

    CAS  PubMed  Google Scholar 

  26. Glade MJ (1993) Effects of gestation, lactation, and maternal calcium intake on mechanical strength of equine bone. J Am Coll Nutr 12:372–377

    CAS  PubMed  Google Scholar 

  27. Chan GM, McElligott K, McNaught T, Gill G (2006) Effects of dietary calcium intervention on adolescent mothers and newborns: a randomized controlled trial. Obstet Gynecol 108:565–571

    Article  CAS  PubMed  Google Scholar 

  28. Ganpule A, Yajnik CS, Fall CH, Rao S, Fisher DJ, Kanade A, Cooper C, Naik S, Joshi N, Lubree H, Deshpande V, Joglekar C (2006) Bone mass in Indian children—relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study. J Clin Endocrinol Metab 91:2994–3001

    Article  CAS  PubMed  Google Scholar 

  29. Koo WW, Walters JC, Esterlitz J, Levine RJ, Bush AJ, Sibai B (1999) Maternal calcium supplementation and fetal bone mineralization. Obstet Gynecol 94:577–582

    Article  CAS  PubMed  Google Scholar 

  30. O’Brien KO, Nathanson MS, Mancini J, Witter FR (2003) Calcium absorption is significantly higher in adolescents during pregnancy than in the early postpartum period. Am J Clin Nutr 78:1188–1193

    PubMed  Google Scholar 

  31. Duan Y, Beck TJ, Wang XF, Seeman E (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774

    Article  PubMed  Google Scholar 

  32. Black AJ, Topping J, Durham B, Farquharson RG, Fraser WD (2000) A detailed assessment of alterations in bone turnover, calcium homeostasis, and bone density in normal pregnancy. J Bone Miner Res 15:557–563

    Article  CAS  PubMed  Google Scholar 

  33. Sowers M, Crutchfield M, Jannausch M, Updike S, Corton G (1991) A prospective evaluation of bone mineral change in pregnancy. Obstet Gynecol 77:841–845

    CAS  PubMed  Google Scholar 

  34. Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporos Int 5:252–261

    Article  CAS  PubMed  Google Scholar 

  35. Oden ZM, Selvitelli DM, Bouxsein ML (1999) Effect of local density changes on the failure load of the proximal femur. J Orthop Res 17:661–667

    Article  CAS  PubMed  Google Scholar 

  36. Yoon BK, Lee JW, Choi DS, Roh CR, Lee JH (2000) Changes in biochemical bone markers during pregnancy and puerperium. J Kor Med Sci 15:189–193

    CAS  Google Scholar 

  37. Delmas PD, Eastell R, Garnero P, Seibel MJ, Stepan J (2000) The use of biochemical markers of bone turnover in osteoporosis. Committee of Scientific Advisors of the International Osteoporosis Foundation. Osteoporos Int 11(Suppl 6):S2–S17

    Article  PubMed  Google Scholar 

  38. Christenson RH (1997) Biochemical markers of bone metabolism: an overview. Clin Biochem 30:573–593

    Article  CAS  PubMed  Google Scholar 

  39. Kusumi T, Kusumi A (2004) Osteocalcin/bone Gla protein(BGP). Nippon Rinsho 62(Suppl 2):136–140

    PubMed  Google Scholar 

  40. Vermeer C, Jie KS, Knapen MH (1995) Role of vitamin K in bone metabolism. Annu Rev Nutr 15:1–22

    Article  CAS  PubMed  Google Scholar 

  41. Calvo MS, Eyre DR, Gundberg CM (1996) Molecular basis and clinical application of biological markers of bone turnover. Endocr Rev 17:333–368

    CAS  PubMed  Google Scholar 

  42. Weaver CM, Peacock M, Martin BR, Plawecki KL, McCabe GP (1996) Calcium retention estimated from indicators of skeletal status in adolescent girls and young women. Am J Clin Nutr 64:67–70

    CAS  PubMed  Google Scholar 

  43. Paton LM, Alexander JL, Nowson CA, Margerison C, Frame MG, Kaymakci B, Wark JD (2003) Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 77:707–714

    CAS  PubMed  Google Scholar 

  44. Petersen HC, Jeune B, Vaupel JW, Christensen K (2002) Reproduction life history and hip fractures. Ann Epidemiol 12:257–263

    Article  PubMed  Google Scholar 

  45. Paganini-Hill A, Atchison KA, Gornbein JA, Nattiv A, Service SK, White SC (2005) Menstrual and reproductive factors and fracture risk: the Leisure World Cohort Study. J Women’s Health 14:808–819

    Article  Google Scholar 

Download references

Acknowledgments

The study was supported by 11th Five Years Key Programs for Science and Technology Development of China (No. 2008BAI58B02).

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Zhen Liu & Yi-xiang Su

  2. Department of Rehabilitation, Nanfang Hospital, Guangzhou, China

    Ling Qiu

  3. Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China

    Yu-ming Chen

Authors
  1. Zhen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ling Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-ming Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi-xiang Su
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yu-ming Chen or Yi-xiang Su.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Liu, Z., Qiu, L., Chen, Ym. et al. Effect of milk and calcium supplementation on bone density and bone turnover in pregnant Chinese women: a randomized controlled trail. Arch Gynecol Obstet 283, 205–211 (2011). https://doi.org/10.1007/s00404-009-1345-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-009-1345-0

Keywords

Search

Navigation