Human Reproduction, Vol. 15, No. 8, 1834-1837,
August 2000
© 2000 European Society of Human Reproduction and Embryology
The feto–placental unit stimulates the pregnancy-associated increase in maternal bone metabolism
1 Section of Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, 2 The Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, SE5 8RX and 3 Department of Chemical Pathology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London, UK
The aim of the study was to investigate role of the feto–placental unit in the pregnancy-induced increase in maternal bone metabolism. To achieve this, circulating concentrations of carboxy terminal pro-peptide of type I pro-collagen (PICP, a marker of bone formation) and cross-linked carboxy terminal telopeptide of type I collagen (ICTP, a marker of bone resorption) were measured in three groups of pregnant women. Group 1 comprised 12 women with singleton pregnancies; group 2, nine women with twin pregnancies; and group 3, 19 women with multifetal pregnancies (
3 fetuses) before and after selective fetal reduction to twin pregnancies. Blood samples were obtained at 10–12 weeks gestation (groups 1–3, pre-fetal reduction in group 3) and 4 weeks and 8 weeks later (groups 2 and 3). Before fetal reduction there was a significant correlation between the number of fetuses and the concentrations of both PICP and ICTP (r = 0.503 and P = 0.001 and r = 0.573 and P < 0.001 respectively). The circulating concentrations of PICP and ICTP were significantly higher in the pre-reduction multifetal pregnancies than in the twin pregnancies (P < 0.001 and P = 0.0013 respectively). The circulating concentrations of ICTP in multifetal pregnancies fell by 4 weeks after fetal reduction to those observed in control twins. Concentrations of PICP were unaltered after fetal reduction. Higher order multiple pregnancies had the greatest decline in ICTP concentrations. These data suggest that the increased bone turnover observed in the multifetal pregnancies is due to a factor derived from the feto–placental unit and that this factor acts primarily to stimulate bone resorption.
Key words: bone metabolism/feto-placental unit/maternal/pregnancy
4 To whom correspondence should be addressed at: Department of Maternal & Fetal Medicine, Division of Paediatrics, Obstetrics and Gynaecology, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. E-mail: mark.johnson{at}ic.ac.uk
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