Parathyroid Hormone in Sri Lankan Pregnant Women: Vitamin D and Other Determinants

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Oct 8

PMID 34624060

Authors

Anusha Kaneshapillai

Usha Hettiaratchi

Shamini Prathapan

Guwani Liyanage

Affiliations

Soon will be listed here.

Abstract

Introduction: Determinants of parathyroid hormone level during pregnancy have been less frequently studied. We aimed to describe the serum parathyroid hormone (PTH) and its determinants in Sri Lankan pregnant women in a community setting.

Materials And Methods: In this cross-sectional analysis, 390 pregnant mothers in their third trimester were enrolled from primary care centers of 15 health divisions in the Colombo District in Sri Lanka. Venous blood was analyzed for a total 25-hydroxyvitamin-D [25(OH)D], serum parathyroid hormone (PTH), serum calcium, and alkaline phosphatase. The bone quality was assessed in terms of speed of sound (SOS) using the quantitative ultrasound scan (QUS). Univariate and multivariate regression analysis was used to examine the determinants of PTH concentration in blood.

Results: Median serum 25(OH)D was 17.5ng/mL. Most (61.6%) were vitamin D deficient (<20ng/mL). Median PTH was 23.7pg/mL. Only 0.8% had hyperparathyroidism (PTH >65pg/mL). The correlation between 25(OH)D and PTH was weak but significant (r = -0.197; p<0.001). SOS Z-score was below the cut-off (≤-2) in fifty-six women (14.7%), and SOS did not relate significantly to PTH. In regression analysis, serum 25(OH)D, serum calcium, body mass index, educational level, and weeks of pregnancy were significant independent variables when adjusted. The model explained 16% of the variation in the PTH level.

Conclusions: A high prevalence of vitamin D deficiency was observed among Sri Lankan pregnant women in the present study. Serum 25(OH)D, calcium, weeks of pregnancy, and educational level were determinants of serum PTH.

References

Cormick G, Betran A, Romero I, Lombardo C, Gulmezoglu A, Ciapponi A . Global inequities in dietary calcium intake during pregnancy: a systematic review and meta-analysis. BJOG. 2018; 126(4):444-456. PMC: 6518872. DOI: 10.1111/1471-0528.15512. View

Jayawardena R, Byrne N, Soares M, Katulanda P, Hills A . Validity of a food frequency questionnaire to assess nutritional intake among Sri Lankan adults. Springerplus. 2016; 5:162. PMC: 4766149. DOI: 10.1186/s40064-016-1837-x. View

Anusha K, Hettiaratchi U, Gunasekera D, Prathapan S, Liyanage G . Maternal Vitamin D Status and Its Effect on Vitamin D Levels in Early Infancy in a Tertiary Care Centre in Sri Lanka. Int J Endocrinol. 2019; 2019:9017951. PMC: 6652042. DOI: 10.1155/2019/9017951. View

Kramer C, Ye C, Hanley A, Connelly P, Sermer M, Zinman B . The Relationship Between Parathyroid Hormone and 25-Hydroxyvitamin D During and After Pregnancy. J Clin Endocrinol Metab. 2016; 101(4):1729-36. DOI: 10.1210/jc.2015-4060. View

Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R . Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96(7):1911-30. DOI: 10.1210/jc.2011-0385. View

Drewnowski A . Obesity, diets, and social inequalities. Nutr Rev. 2009; 67 Suppl 1:S36-9. DOI: 10.1111/j.1753-4887.2009.00157.x. View

Han S, Kim M, Lee S, Lee J, Kim S, Joo K . Association between body fat and vitamin D status in Korean adults. Asia Pac J Clin Nutr. 2014; 23(1):65-75. DOI: 10.6133/apjcn.2014.23.1.10. View

Hysaj O, Marques-Gallego P, Richard A, Elgizouli M, Nieters A, Quack Lotscher K . Parathyroid Hormone in Pregnancy: Vitamin D and Other Determinants. Nutrients. 2021; 13(2). PMC: 7911996. DOI: 10.3390/nu13020360. View

Mukhopadhyay P, Ghosh S, Bhattacharjee K, Chowdhury S . Inverse Relationship Between 25 Hydroxy Vitamin D and Parathormone: Are there Two Inflection Points?. Indian J Endocrinol Metab. 2019; 23(4):422-427. PMC: 6844158. DOI: 10.4103/ijem.IJEM_322_19. View

10.

Thomas S, Need A, Nordin B . Suppression of C-terminal telopeptide in hypovitaminosis D requires calcium as well as vitamin D. Calcif Tissue Int. 2010; 86(5):367-74. DOI: 10.1007/s00223-010-9354-3. View

11.

Almaghamsi A, H Almalki M, Mahmood Buhary B . Hypocalcemia in Pregnancy: A Clinical Review Update. Oman Med J. 2018; 33(6):453-462. PMC: 6206424. DOI: 10.5001/omj.2018.85. View

12.

Marwaha R, Garg M, Mahalle N, Bhadra K, Tandon N . Role of Parathyroid Hormone in Determination of Fat Mass in Patients with Vitamin D Deficiency. Indian J Endocrinol Metab. 2017; 21(6):848-853. PMC: 5729672. DOI: 10.4103/ijem.IJEM_42_17. View

13.

Lian I, Asberg A . Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway. BMJ Open. 2018; 8(4):e017703. PMC: 5892769. DOI: 10.1136/bmjopen-2017-017703. View

14.

Sai A, Walters R, Fang X, Gallagher J . Relationship between vitamin D, parathyroid hormone, and bone health. J Clin Endocrinol Metab. 2010; 96(3):E436-46. PMC: 3047227. DOI: 10.1210/jc.2010-1886. View

15.

Xu Y, Guo B, Gong J, Xu H, Bai Z . The correlation between calcaneus stiffness index calculated by QUS and total body BMD assessed by DXA in Chinese children and adolescents. J Bone Miner Metab. 2013; 32(2):159-66. DOI: 10.1007/s00774-013-0474-5. View

16.

Garg M, Kharb S . Dual energy X-ray absorptiometry: Pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab. 2013; 17(2):203-10. PMC: 3683192. DOI: 10.4103/2230-8210.109659. View

17.

Brandao K, Mottola M, Gratton R, Maloni J . Bone status in activity-restricted pregnant women assessed using calcaneal quantitative ultrasound. Biol Res Nurs. 2011; 15(2):205-12. DOI: 10.1177/1099800411423807. View

18.

Hellmeyer L, Hahn B, Fischer C, Hars O, Boekhoff J, Maier J . Quantitative ultrasonometry during pregnancy and lactation: a longitudinal study. Osteoporos Int. 2014; 26(3):1147-54. DOI: 10.1007/s00198-014-2984-y. View

19.

Schraders K, Zatta G, Kruger M, Coad J, Weber J, Brough L . Quantitative Ultrasound and Dual X-Ray Absorptiometry as Indicators of Bone Mineral Density in Young Women and Nutritional Factors Affecting It. Nutrients. 2019; 11(10). PMC: 6836084. DOI: 10.3390/nu11102336. View

20.

Briot K, Roux C . What is the role of DXA, QUS and bone markers in fracture prediction, treatment allocation and monitoring?. Best Pract Res Clin Rheumatol. 2005; 19(6):951-64. DOI: 10.1016/j.berh.2005.06.004. View