Maternal-fetal calcium relationships in man

Development of endocrine pathways in the regulation of calcium homeostasis

The mammalian fetus is maintained hypercalcaemic relative to its mother by the action of a calcium pump believed to be located at the basement membranes of the epithelial cells of the fetal chorion. It has recently been demonstrated that the activity of this putative pump is stimulated by a new fetal hormone, parathyroid hormone-related protein, described originally as the product of a human BEN cell line which was derived from a lung tumour associated with hypercalcaemia of malignancy. Whereas the circulating level of immunoreactive parathyroid hormone in the fetus is very low, in keeping with the hypercalcaemia, the plasma concentrations of bioactive parathyroid hormone and parathyroid hormone-related protein can be measured using a sensitive cytochemical bioassay and the separate concentrations assessed by pre-incubation with appropriate antisera. The total plasma concentration of both hormones is inversely related to the prevailing calcium ion concentration but the set point of parathyroid hormone-related protein is probably higher than that for parathyroid hormone. Probably as a result of the hypercalcaemia, the circulating concentration of calcitonin is also higher than in maternal plasma and may serve to limit bone resorption to favour net bone accretion as part of the overall growth of the fetus. Vitamin D and its most active metabolite, 1,25(OH)2D, can pass across the placenta in either direction, in contrast to most peptide hormones. In addition to the supply of some 1,25(OH)2D by the mother to her fetus, the fetal placenta and fetal kidneys can all synthesize 1,25(OH)2D. The relative concentrations circulating in maternal and fetal plasma pools vary with the species, presumably as a result of differing importance of the three sources of supply to the fetus and the relative concentrations of vitamin D-binding protein circulating in mother and fetus. The importance of parathyroid hormone-related protein derived from fetal parathyroid glands has been clearly demonstrated in the fetal sheep. Such animals develop rickets following the removal of their parathyroid glands, despite the demonstration of this substance in fetal placental membranes. However, the relative importance of the parathyroid glands versus the placenta and its membranes as the principal source of parathyroid hormone-related protein remains to be elucidated and may vary with species.

Calcium homeostasis in second trimester fetuses

The concentrations of ionised calcium ions (Ca++), total calcium, parathyroid hormone, pH, total protein, albumin, sodium, and potassium were measured in paired fetal and maternal blood from pregnancies at 15 to 24 weeks' gestation. Pure fetal blood samples were obtained fetoscopically. The concentrations of fetal ionised calcium ions (n = 26); mean (SD) 1.33 (0.12) mmol/l (5.32 (0.48) mg/100 ml) and those of parathyroid hormone (n = 9); 68 (19) pmol/l (58 (16) micrograms/100 ml) were significantly higher than those of the mothers: 1.18 (0.09) mmol/l (4.7 (0.4) mg/100 ml), and 40 pmol/l (less than 34 micrograms/100 ml), respectively. There was no difference between measured fetal and maternal total calcium, pH, and electrolytes. The fetal total protein and albumin concentrations increased with gestation but were always lower than the equivalent maternal values. The calculated total calcium was 0.23-0.45 mmol/l (0.9-1.8 mg/100 ml) higher in the fetal than in maternal blood from the same pregnancy. There were no fetal arteriovenous differences in ionised calcium ions despite higher venous pH.

Identification and characterization of a calcium-binding protein in the mouse chorioallantoic placenta

Mouse chorioallantoic placenta contains a specific calcium-binding protein (MCaBP). A procedure involving gel filtration and ion-exchange chromatography was developed to purify the MCaBP. The MCaBP activity increased as a function of embryonic gestation and was highly specific for Ca2+. The MCaBP is a monomeric protein of Mr 57000, with pI 4.7. Specific antibodies were prepared against the MCaBP and were used to localize the MCaBP to syncytiotrophoblasts of the chorionic villi of mouse chorioallantoic placenta. These properties suggest that the MCaBP may be involved in transplacental calcium transport.

Ca2+-binding protein of the human placenta. Characterization, immunohistochemical localization and functional involvement in Ca2+ transport

The Ca2+-binding protein (HCaBP) of the human placenta was studied with respect to its biochemical properties, tissue and cellular distribution, and possible involvement in placental Ca2+ transport. Optimal Ca2+ binding by the HCaBP occurs at pH 7-8 and in 100 mM-Na+ and 3 mM-Ca2+. The HCaBP possesses at least 10 Ca2+-binding sites with a Kd of 5 X 10(-6) M ([Ca2+]). Highly specific rabbit-derived anti-HCaBP antibodies were used for HCaBP immunoquantification and immunohistochemistry, which revealed that the HCaBP is localized in the chorionic villi and is primarily associated with the trophoblastic cells of the placenta. In addition, an 'in vitro' cell-free assay system for Ca2+ uptake was constructed with microsomal membranes isolated from term placental tissues. Ca2+ uptake by the placental microsomal fraction exhibited characteristics indicative of active Ca2+ transport such as temperature-dependence, saturability and energetic requirement. In this system, preincubation of microsomal membranes with anti-HCaBP antibodies inhibited Ca2+ uptake, suggesting that the HCaBP is functionally involved in placental membrane Ca2+ uptake.

Cytochemical bioassay of parathyroid hormone in maternal and cord blood

Parathyroid hormone and calcium were measured in plasma taken from pregnant women at term and from the umbilical veins of their infants at birth. Three assays were used to measure parathyroid hormone, a cytochemical bioassay of bioactivity and two immunoradiometric assays, one specific for the amino terminus, the other specific for the carboxy terminus of the parathyroid hormone molecule. Plasma calcium was significantly higher in the infants than in the mothers. Maternal parathyroid hormone bioactivity and the amino terminus were both slightly raised, but the carboxy terminus value was normal; these findings supported the view that late pregnancy is a time of mild physiological hyperparathyroidism. In the infants, the amino terminus was undetectable and the carboxy terminus was either undetectable or towards the lower end of the normal range: bioactivity of parathyroid hormone was considerably raised and was related to the gradient of calcium across the placenta. This suggests that the parathyroid glands are not suppressed during fetal life and that they may play an important part in the maintenance of high fetal plasma calcium concentrations.

Identification and characterization of a calcium-binding protein from human placenta

The human placenta has been found to contain a specific calcium-binding protein (HCaBP) which increases in amount as a function of gestation. A procedure is described for the purification of the HCaBP to chromatographic and electrophoretic homogeneity. The HCaBP is (a) a high molecular weight protein with a native Mr of 150 000 and appears to be a dimer of subunits of Mr = 70 000; and (b) an acidic protein with a pI of 4.6. Amino acid analysis of the HCaBP revealed an abundance of acidic amino acid residues (27 per cent = Asp and Glu). A specific antiserum has been prepared against purified HCaBP. With Ouchterlony double immunodiffusion, the HCaBP appears to be specific for the human placenta, and is not cross-immunoreactive with the CaBP of the chick embryonic chorio-allantoic membrane.

Fetal and maternal mineral concentrations in dairy cattle during late pregnancy

Concentrations of ionic and total calcium, magnesium, and inorganic phosphorus in plasma were determined in bovine fetuses and their mothers within the last month before delivery. Mean fetal concentrations were higher than corresponding maternal contents during the 22 days before delivery. Ionic and total calcium in plasma fell towards term in mother and fetus. Fetal phosphorus was elevated before parturition while maternal phosphorus fell. Maternal magnesium was elevated slightly at parturition.

Calcium metabolism in pregnancy: a review

Calcium metabolism in pregnancy is a complex process involving calcium, phosphorus, vitamin D, parathyroid hormone (PTH), and calcitonin (CT). Calcium absorption is enhanced in pregnancy, and increased storage in the maternal skeleton probably occurs as well. Adequate amounts are provided by the current Recommended Dietary Allowance of 1,200 mg. daily which can be met readily by natural foods, specifically milk. If supplemental calcium is given, a nonphosphate salt is probably advisable, since some evidence suggests that excessive phosphate intake may be related to leg cramps in pregnancy. Vitamin D is necessary for optimal calcium utilization in pregnancy, although the possibility of fetal toxicity with overdosage has been suggested. From a review of available information with respect to maternal-perinatal calcium interrelationships, I propose the following hypothesis: While total maternal serum calcium declines during pregnancy because of the physiologic hypoalbuminemia, the level of ionic calcium remains constant, in part, at least, because of increasing maternal PTH output. The placenta plays a primary role in fetal calcium metabolism by transporting calcium ions from the mother to the fetus against a concentration gradient. Relatively high fetal ionic calcium levels cause suppression of PTH and stimulation of CT in the fetus, facilitating growth of the fetal skeleton. With sudden loss of the placental source of calcium at birth, the newborn infant becomes functionally hypoparathyroid and/or hypercalcitonemic, and the serum calcium level declines until 3 to 4 days of life when PTH rises and CT falls with a resultant slight rise in calcium.