Maternal-Fetal Calcium and Bone Metabolism During Pregnancy, Puerperium, and Lactation1
Christopher S. Kovacs2 and
Henry M. Kronenberg
Endocrine Unit, Massachusetts General Hospital and Harvard Medical
School, Boston, Massachusetts 02114
I. Introduction
II. Maternal Physiology and PathophysiologyDuring Pregnancy
A. Maternal adaptive goals during pregnancy
B. Mineral ions and calcitropic hormones
C. Intestinal absorptionof calcium
D. Renal handling of calcium
E. Skeletal calciummetabolism
F. Primary hyperparathyroidism
G. Hypoparathyroidismand pseudohypopara- thyroidism
H. Summary
III. Fetal-PlacentalPhysiology and Pathophysiology
A. Fetal adaptive goals
B.Mineral ions and calcitropic hormones
C. Fetal-placental calciumtransport
D. Renal handling of calcium and the amniotic fluid
E. Skeletal calcium metabolism
F. Fetal response to maternalhyper- or hypoparathy-roidism
G. Integrated fetal calciumhomeostasis
H. Summary
IV. Maternal Physiology and PathophysiologyDuring Lactation
A. Maternal adaptive goals during lactation
B. Mineral ions and calcitropic hormones
C. Intestinal absorptionof calcium
D. Renal handling of calcium
E. Skeletal calciummetabolism
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 ofcalcium
E. Skeletal calcium metabolism
F. Neonatal responseto maternal hyper- or hypopara-thyroidism
G. Neonatal hypocalcemia
H. Summary
VI. Discussion and Conclusions
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