Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Postpartum vitamin D insufficiency and secondary hyperparathyroidism in healthy Danish women

European Journal of Clinical Nutrition volume 60, pages 1214–1221 (2006)Cite this article

Abstract

Objective:

To examine vitamin D status and parathyroid function in normal Danish women postpartum.

Design:

Three cross-sectional measures during follow-up of 89 women postpartum.

Subjects and intervention:

We assessed vitamin D status by measuring plasma 25-hydroxyvitamin D (P-25OHD) and the degree of secondary hyperparathyroidism by measuring plasma parathyroid hormone (P-PTH) in 89 Caucasian women at three consecutive visits: (mean (range)) 23 (10–37) days (spring), 117 (95–140) days (late summer) and 274 (254–323) days (winter) postpartum.

Results:

P-25OHD showed seasonal variations with higher values in late summer than in the other periods (P<0.001). At the first visit, 65% received vitamin D supplements. At the following visits, almost 50% were supplemented. Vitamin D insufficiency (P-25OHD<50 nmol/l) occurred more often during winter (28%) than in spring (14%) (Fisher's exact test, P=0.02) or late summer (7%) (P=0.0001). Irrespective of season, vitamin D insufficiency occurred most frequent in women who did not take vitamin D supplements (Fisher's exact test, P<0.02). Frank vitamin D deficiency (P-25OHD<25 nmol/l) was observed during winter in 6%. At all three periods, P-25OHD correlated inversely with P-PTH indicating secondary hyperparathyroidism at deficient vitamin D status. During spring, late summer and winter three, one and four females, respectively, had elevated plasma PTH.

Conclusion:

Vitamin D insufficiency with secondary hyperparathyroidism is a frequent finding in healthy Danish women postpartum and especially during winter. Vitamin D supplements reduced the risk of vitamin D insufficiency, especially during winter. Our results support the importance of increased alertness regarding information of pregnant and lactating women about vitamin D supplements. Furthermore, it has to be studied whether the present recommendations of an intake of 5–10 μg vitamin D/day are sufficient, especially during winter months.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  • Affinito P, Tommaselli GA, di Carlo C, Guida F, Nappi C (1996). Changes in bone mineral density and calcium metabolism in breastfeeding women: a one year follow-up study. J Clin Endocrinol Metab 81, 2314–2318.

    CAS  PubMed  Google Scholar 

  • Arbejdsgruppe under Fagligt Forum for Amtssundhedsplejersker FffA (2003). Ammeundersøgelse år 2000–2002.

  • Brot C, Vestergaard P, Kolthoff N, Gram J, Hermann AP, Sorensen OH (2001). Vitamin D status and its adequacy in healthy Danish perimenopausal women: relationships to dietary intake, sun exposure and serum parathyroid hormone. Br J Nutr 86, S97–S103.

    Article  CAS  PubMed  Google Scholar 

  • Cantorna MT (2000). Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc Soc Exp Biol Med 223, 230–233.

    Article  CAS  PubMed  Google Scholar 

  • Cross NA, Hillman LS, Allen SH, Krause GF (1995). Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. J Bone Miner Res 10, 1312–1320.

    Article  CAS  PubMed  Google Scholar 

  • Dawson-Hughes B, Dallal GE, Krall EA, Harris S, Sokoll LJ, Falconer G (1991). Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Ann Intern Med 115, 505–512.

    Article  CAS  PubMed  Google Scholar 

  • Dobnig H, Kainer F, Stepan V, Winter R, Lipp R, Schaffer M et al. (1995). Elevated parathyroid hormone-related peptide levels after human gestation: relationship to changes in bone and mineral metabolism. J Clin Endocrinol Metab 80, 3699–3707.

    Article  CAS  PubMed  Google Scholar 

  • Glerup H, Rytter L, Mortensen L, Nathan E (2004). Vitamin D deficiency among immigrant children in Denmark. Eur J Pediatr 163, 272–273.

    Article  PubMed  Google Scholar 

  • Greer FR, Searcy JE, Levin RS, Steichen JJ, Steichen-Asche PS, Tsang RC (1982). Bone mineral content and serum 25-hydroxyvitamin D concentrations in breast-fed infants with and without supplemental vitamin D: one-year follow-up. J Pediatr 100, 919–922.

    Article  CAS  PubMed  Google Scholar 

  • Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ (2003). Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77, 204–210.

    Article  CAS  PubMed  Google Scholar 

  • Hegaard HK, Kjaergaard H, Moller LF, Wachmann H, Ottesen BS (2004). The prevalence of passive smoking among pregnant women in Denmark on their first visit to the midwife. Ugeskr Laeger 166, 3706–3711.

    PubMed  Google Scholar 

  • Hermann AP, Thomsen J, Vestergaard P, Mosekilde L, Charles P (1999). Assessment of calcium intake. A quick method comparerd to a 7 days food diary. Calcif Tissue Int 64, S82.

    Google Scholar 

  • Holick M (1999). Vitamin D: photobiology, metabolism; mechanism of action, and clinical applications. In: Favus MJ, Christakos S, Goldring SR, Holick MF (eds). Primer on the metabolic bone diseases and disorders of mineral metabolism. An official publication of the American Society for Bone and Mineral Research, Kelseyville, CA: Lippincott Williams and Wilkins, 4, 92–98.

    Google Scholar 

  • Hollis BW, Wagner CL (2004a). Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 79, 717–726.

    CAS  PubMed  Google Scholar 

  • Hollis BW, Wagner CL (2004b). Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Am J Clin Nutr 80, 1752S–1758S.

    Article  CAS  PubMed  Google Scholar 

  • Jesudason D, Need AG, Horowitz M, O’Loughlin PD, Morris HA, Nordin BE (2002). Relationship between serum 25-hydroxyvitamin D and bone resorption markers in vitamin D insufficiency. Bone 31, 626–630.

    Article  CAS  PubMed  Google Scholar 

  • Kalkwarf HJ, Specker BL, Bianchi DC, Ranz J, Ho M (1997). The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med 337, 523–528.

    Article  CAS  PubMed  Google Scholar 

  • Lips P (2001). Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22, 477–501.

    Article  CAS  PubMed  Google Scholar 

  • Mosekilde L (2005). Vitamin D and the elderly. Clin Endocrinol 62, 265–281.

    Article  CAS  Google Scholar 

  • Mosekilde L, Nielsen LR, Larsen ER, Moosgaard B, Heickendorff L (2005). Vitamin D deficiency. Definition and prevalence in Denmark. Ugeskr Laeger 167, 29–33.

    PubMed  Google Scholar 

  • Nordic Council of Minister C (2005). Nordic Nutrition Recommendations Integrating Nutrition and Physical Activity 4th edn. The Nordic Council of Minister. Copenhagen.

  • Paoletti AM, Orru M, Floris L, Guerriero S, Ajossa S, Romagnino S et al. (2003). Pattern of bone markers during pregnancy and their changes after delivery. Horm Res 59, 21–29.

    CAS  PubMed  Google Scholar 

  • Pawley N, Bishop NJ (2004). Prenatal and infant predictors of bone health: the influence of vitamin D. Am J Clin Nutr 80, 1748S–1751S.

    Article  CAS  PubMed  Google Scholar 

  • Prentice A (2003). Micronutrients and the bone mineral content of the mother, fetus and newborn. J Nutr 133, 1693S–1699S.

    Article  CAS  PubMed  Google Scholar 

  • Ramlau-Hansen C (2004). Et follow-up studie om amnings indflydelse på plasma-homocystein. Master Thesis, Aarhus University.

  • Rasmussen L, Hansen GL, Hansen E, Koch B, Mosekilde L, Mølgård C et al. (1998). Vitamin D: bør forsyningen i den danske befolkning bedres? 236. The Danish Veterinary and Food Administration. Publication number 246 (December 1998). Copenhagen.

  • Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE et al. (1998). A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr 67, 693–701.

    Article  CAS  PubMed  Google Scholar 

  • Sowers M, Eyre D, Hollis BW, Randolph JF, Shapiro B, Jannausch ML et al. (1995). Biochemical markers of bone turnover in lactating and nonlactating postpartum women. J Clin Endocrinol Metab 80, 2210–2216.

    CAS  PubMed  Google Scholar 

  • Sowers M, Zhang D, Hollis BW, Shapiro B, Janney CA, Crutchfield M et al. (1998). Role of calciotrophic hormones in calcium mobilization of lactation. Am J Clin Nutr 67, 284–291.

    Article  CAS  PubMed  Google Scholar 

  • Sowers MF, Hollis BW, Shapiro B, Randolph J, Janney CA, Zhang D et al. (1996). Elevated parathyroid hormone-related peptide associated with lactation and bone density loss. JAMA 276, 549–554.

    Article  CAS  PubMed  Google Scholar 

  • Specker B (2004). Vitamin D requirements during pregnancy. Am J Clin Nutr 80, 1740S–1747S.

    Article  CAS  PubMed  Google Scholar 

  • Vieth R, Chan PC, MacFarlane GD (2001). Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 73, 288–294.

    Article  CAS  PubMed  Google Scholar 

  • Vieth R, Ladak Y, Walfish PG (2003). Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D. J Clin Endocrinol Metab 88, 185–191.

    Article  CAS  PubMed  Google Scholar 

  • Zamora SA, Rizzoli R, Belli DC (2000). Long-term effect of early vitamin-D supplementation on bone mineral status in prematurely born infants. J Pediatr Gastroenterol Nutr 31, 94.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We appreciate the technical assistance of Lisbeth Flyvbjerg, Charlotte Beck Gylling, Tove Stenum and Helle Thøgersen. This study was supported by grants from The memorial award of Market gardener Ove William Buhl Olesen and spouse Mrs Edith Buhl Olesen; The Foundation of Managing director Jacob Madsen and wife Olga Madsen; The Foundation of Miss Carla Cornelia Storch Moeller to promote medical research and The Faculty of Health Sciences, University of Aarhus, BSc. Bjarke Moosgaard is thanked for supplying information on the average index of sun hours and UV exposure per month in Denmark.

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism C, Aarhus University Hospital, Aarhus, Denmark

    U K Møller, L Rejnmark & L Mosekilde

  2. Department of Occupational Medicine, Institute of Public Health, Aarhus University Hospital, Aarhus, Denmark

    C H Ramlau-Hansen

  3. Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark

    L Heickendorff

  4. Department of Obstetrics and Paediatrics, Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark

    T B Henriksen

Authors
  1. U K Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C H Ramlau-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Rejnmark
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L Heickendorff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T B Henriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L Mosekilde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U K Møller.

Additional information

Guarantor: UK Møller.

Contributors: UKM, CHR, LR, TBH and LM designed the study. UKM and CHR carried out the study. UKM performed the statistical calculations and analyses, wrote the original manuscript and edited all subsequent versions. LR, LM and TBH contributed to the interpretation of data and commented on the manuscript. All authors approved the final version of the manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Møller, U., Ramlau-Hansen, C., Rejnmark, L. et al. Postpartum vitamin D insufficiency and secondary hyperparathyroidism in healthy Danish women. Eur J Clin Nutr 60, 1214–1221 (2006). https://doi.org/10.1038/sj.ejcn.1602440

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602440

Keywords

This article is cited by

Search

Advanced search

Quick links