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[Perinatal calcium metabolism. Physiology and pathophysiology]
1Klinik für Pädiatrie, Medizinische Universität Lübeck.
Summary
During pregnancy, calcium transfer to the fetus is regulated by hormones like parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25(OH)2D). Post-birth, PTH and 1,25(OH)2D are key for newborn calcium metabolism, with preterm infants needing careful monitoring.
Area of Science:
- Endocrinology and Metabolism
- Maternal-Fetal Medicine
- Neonatology
Context:
- Pregnancy involves continuous calcium transfer from mother to fetus, primarily regulated by parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (1,25(OH)2D), and calcitonin.
- Parathyroid hormone-related protein (PTHrP) acts as the fetal equivalent of PTH, crucial for maintaining the maternal-fetal calcium gradient.
- Post-delivery, abrupt cessation of placental calcium supply necessitates increased PTH and 1,25(OH)2D for neonatal calcium homeostasis.
Purpose:
- To elucidate the hormonal regulation of calcium transfer during pregnancy and its transition to neonatal metabolism.
- To highlight the role of PTHrP in fetal calcium homeostasis and the impact of its placental and parathyroid sources.
- To identify risk factors and preventative strategies for neonatal calcium and phosphate disorders, particularly in preterm infants.
Summary:
- Calcium transfer during pregnancy is hormonally regulated by PTH, 1,25(OH)2D, and calcitonin, with PTHrP playing a key fetal role.
- Postnatal calcium metabolism relies on PTH and 1,25(OH)2D, and abrupt supply changes can lead to transient neonatal disorders.
- Preterm infants are highly susceptible to hypocalcemia and osteopathy due to high mineral demands and abrupt cessation of supply, requiring adequate calcium and phosphate intake monitored via laboratory tests.
Impact:
- Understanding these hormonal mechanisms is crucial for managing maternal and fetal calcium balance.
- Identifies PTHrP as a critical factor in fetal development and calcium regulation.
- Emphasizes the importance of monitoring calcium and phosphate levels in newborns, especially preterm infants, to prevent bone disease and metabolic disturbances.