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During pregnancy, there is a high demand on the mother to provide sufficient calcium (along with other minerals and nutrients) to the foetus. The majority of foetal skeletal growth takes place from mid-pregnancy onwards, with maximum calcium accretion taking place in the last trimester. Calcium and bone metabolism during pregnancy has to cater for about 30grams of calcium for the average foetus to mineralize its skeleton and maintain normal physiological processes.

Although this extra demand of calcium on the mother could interfere in her own bone mineralisation, pregnancy generally does not cause any adverse long-term consequence to the maternal skeleton. Bone metabolism increases significantly to provide for the skeleton of the foetus. For this reason, the expecting mother is advised to increase her intake of calcium.

Calcium and Bone Metabolism during Pregnancy

• About 80% of the calcium of the foetus comes from the mother during the last trimester. Intestinal calcium absorption increases during pregnancy to meet this increased demand.
• Maternal bone loss may occur during this time. Daily about 250-300 milligrams of calcium is built-up in this trimester.
• Intestinal calcium absorption doubles during pregnancy and is driven by 1,25-dihydroxyvitaminD (calcitriol) and other factors.
• The foetus and the placenta get calcium from the circulation in the mother’s body.
• Though the daily loss of calcium in a pregnant woman in her third trimester is similar to the lactating mother, the adjustments made in both these periods differ. Though significant calcium loss occurs during lactation as well, the calcium needed for milk production is met through renal calcium conservation and also by mobilization of calcium from the mother’s skeleton.
• During pregnancy, bone metabolism, calcium absorption and urinary calcium excretion are higher than before conception or after delivery.

If there is a deficiency in calcium intake during pregnancy, it may effect bone metabolism, cause hypertensive disorders or affect the foetal growth. It may also have a long-term effect on the maternal skeleton. The birth weight and the skeletal mass of the mother may also be affected. Therefore, nutrition rich in essential minerals like calcium is very important during pregnancy as lack of calcium may reduce neonatal bone density as well as size.

Pregnant women must have a daily intake of:

• 1,300 mg calcium per day for women less than 18 years of age
• 1,000 mg calcium per day for women from19-50 years of age.

Calcium and bone metabolism during pregnancy must adapt to the demand created by the foetus and the placenta. These together draw calcium and other minerals from the mother to enable the mineralisation of the foetal skeleton.

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