title: Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers: a randomized, placebo-controlled trial.
abstract: BACKGROUND
  Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass.
  
  
  OBJECTIVE
  We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets (∼600 mg/d).
  
  
  METHODS
  Pregnant adolescents (14-19 y) randomly received daily calcium (600 mg) plus vitamin D3 (200 IU) (n = 30) or a placebo (n = 26) from 26 wk of pregnancy (baseline) until parturition. The bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the total body, lumbar spine, and hip (total and femoral neck) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum. Serum hormones and 25-hydroxyvitamin D [25(OH)D] were measured. Group comparisons were adjusted for significant covariates.
  
  
  RESULTS
  The mean serum 25(OH)D concentration was 59 nmol/L at baseline. In comparison with the placebo, 25(OH)D tended to be 14-15 nmol/L higher postpartum in the supplemented group (P = 0.08). Total body and hip BMC and BMD decreased over time (P ≤ 0.005) in both groups with a group × time interaction at the femoral neck (P < 0.04). Supplemented mothers had higher lumbar spine BA (6.7%; P = 0.002) and lumbar spine BMC (7.9%, P = 0.08) than did mothers who consumed the placebo at 5 wk postpartum. At 20 wk postpartum, differences between groups were more evident, with higher lumbar spine BMC (13.9%), lumbar spine BA (6.2%), and lumbar spine BMD (10.6%) in the supplemented group (P ≤ 0.008).
  
  
  CONCLUSIONS
  Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation. Additional studies are required to determine whether bone effects are temporary or long-lasting. This trial was registered at clinicaltrials.gov as NCT01732328.
authors.affiliation: Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química and the Maternidade Escola, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Maria Eduarda L
authors.initials: ME
authors.lastname: Diogenes
authors.forename: Flávia F
authors.initials: FF
authors.lastname: Bezerra
authors.forename: Elaine P
authors.initials: EP
authors.lastname: Rezende
authors.forename: Marcia Fernanda
authors.initials: MF
authors.lastname: Taveira
authors.forename: Isabel
authors.initials: I
authors.lastname: Pinhal
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Donangelo
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density / Q000187:drug effects*; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism; D001938:Brazil; D002136:Calcium, Dietary / Q000008:administration & dosage*; D002762:Cholecalciferol / Q000008:administration & dosage*; D019587:Dietary Supplements; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007774:Lactation / Q000187:drug effects; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000378:metabolism; D009035:Mothers; D011247:Pregnancy / Q000502:physiology*; D016037:Single-Blind Method; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D055815:Young Adult
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D