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Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Puerperium, and Lactation¹

Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114

I. Introduction

II. Maternal Physiology and Pathophysiology During Pregnancy

A. Maternal adaptive goals during pregnancy

B. Mineral ions and calcitropic hormones

C. Intestinal absorption of calcium

D. Renal handling of calcium

E. Skeletal calcium metabolism

F. Primary hyperparathyroidism

G. Hypoparathyroidism and pseudohypopara- thyroidism

H. Summary

III. Fetal-Placental Physiology and Pathophysiology

A. Fetal adaptive goals

B. Mineral ions and calcitropic hormones

C. Fetal-placental calcium transport

D. Renal handling of calcium and the amniotic fluid

E. Skeletal calcium metabolism

F. Fetal response to maternal hyper- or hypoparathy-roidism

G. Integrated fetal calcium homeostasis

H. Summary

IV. Maternal Physiology and Pathophysiology During Lactation

A. Maternal adaptive goals during lactation

B. Mineral ions and calcitropic hormones

C. Intestinal absorption of calcium

D. Renal handling of calcium

E. Skeletal calcium metabolism

F. Hypoparathyroidism and pseudohypoparathy- roidism

G. Summary

V. Neonatal Physiology and Pathophysiology

A. Neonatal adaptive goals

B. Mineral ions and calcitropic hormones

C. Intestinal absorption of calcium

D. Renal handling of calcium

E. Skeletal calcium metabolism

F. Neonatal response to maternal hyper- or hypopara-thyroidism

G. Neonatal hypocalcemia

H. Summary

VI. Discussion and Conclusions

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