Introduction
Due to the physiological changes in calcium homeostasis and the underlying etiology of hypercalcemia, hypercalcemia during pregnancy can be difficult to manage. The mother's calcium is mobilized more frequently throughout pregnancy and lactation to meet the fetus' calcium needs. Uncommonly, hypercalcemia in pregnancy can result in significant morbidity and mortality for the mother and the fetus or newborn. Clinicians find it difficult to manage this condition, particularly regarding prenatal tests, surgery, and cinacalcet and bisphosphonates.
An adequate calcium supply from maternal sources is necessary for normal fetal and neonatal calcium homeostasis. Both maternal hyper- and hypocalcemia can result in metabolic bone disease or problems with calcium homeostasis in newborns. The fetal parathyroid function can be inhibited by maternal hypercalcemia, which results in neonatal hypocalcemia. In contrast, maternal hypocalcemia can activate fetal parathyroid tissue, demineralizing bone.
What Is Hypercalcemia?
Hypercalcemia is a rare condition during pregnancy, and it is crucial to recognize it to lower fetal and neonatal morbidity and mortality. Hypercalcemia's vague appearance brings on the challenge. The symptoms could be mistaken for nausea and other common pregnancy discomforts, and reduced albumin values can affect total calcium levels. Furthermore, doctors who manage pregnancies frequently hesitate to conduct investigations using radiological imaging, and there are few effective treatment alternatives.
What Is Hypercalcemia in Pregnancy?
Pregnancy rarely involves hypercalcemia. Hyperparathyroidism is the most typical cause of hypercalcemia during pregnancy. More than two-thirds of the time, it results in substantial morbidity for both the mother and the fetus. Negative fetal consequences include increased abortion rates, severe intrauterine growth retardation, and stillbirth. Parathyroid hormone levels are low to mid-normal during pregnancy, and greater than normal values against excessive calcium may indicate the diagnosis of primary hyperparathyroidism.
The condition known as hypercalciuria, which usually develops during pregnancy due to increased intestinal absorption and GFR, is evident when a woman's urine excretion of calcium exceeds 250 mg daily. Renal insufficiency (GFR 60 mL/min 114), calcification of the vascular and soft tissues, and nephrolithiasis can all be brought on by hypercalcemia and hypercalciuria. Pregnant women are at a greater risk of developing kidney stones because of the hypercalciuria that typically occurs during pregnancy.
What Is the Necessity of Calcium During Pregnancy?
The important markers of the burden of any disease are the health and nutrition of the mother and the newborn. The most prevalent mineral in the body, calcium, is crucial for many different processes and reactions, including the contraction of muscles, the development of bones, and the activity of enzymes and hormones.
Maternal calcium consumption has a direct impact on the rise in calcium absorption. The parathyroid hormone (PTH) is one of several calcitropic hormones influencing maternal calcium metabolism. Parathyroid hormone (PTH) levels rise to the higher end of normal during the third trimester in women who consume adequate amounts of calcium during the first trimester, reflecting an increase in the transfer of calcium from the mother to the fetus. In women with low calcium intakes, calcium supplements are useful in lowering the risk of premature delivery.
What Is the Etiology of Neonatal Hypercalcemia?
Neonatal hypercalcemia's most typical root causes are:
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Iatrogenic.
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Iatrogenic reasons typically entail excessive amounts of calcium or vitamin D and phosphate depletion, which can be brought on by the extended use of improperly produced formulas.
These are some more reasons for newborn hypercalcemia:
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Hypoparathyroidism in the mother.
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Necrosis of subcutaneous fat.
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Hyperthyroidism in the thyroid.
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Irregular renal function.
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Wilson syndrome.
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Idiopathic.
Secondary fetal hyperparathyroidism with alterations in fetal mineralization, such as osteopenia, may result from maternal hypoparathyroidism or maternal hypocalcemia.
What Are the Symptoms and Signs of Neonatal Hypercalcemia?
When total blood calcium exceeds 12 mg/dL (more than 3 mmol/L), newborn hypercalcemia symptoms and signs may be present.
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Anorexia.
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Gastric reflux disease.
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Nausea.
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Lethargy.
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Seizures.
Other indications and symptoms include:
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Failure to thrive.
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Dehydration.
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Feeding intolerance.
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Constipation.
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Stomach pain.
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Neonatal infants might be feeble.
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In subcutaneous fat necrosis, firm purple nodules may be seen on the torso, buttocks, or legs.
What Is the Line of Treatment of Neonatal Hypercalcemia?
1. Furosemide in addition to intravenous saline.
2. Occasionally, bisphosphonates, calcitonin, and corticosteroids.
3. Treatment options for a marked spike in serum calcium levels include normal saline (20 mL/kg IV), Furosemide (2 mg/kg IV), corticosteroids, and Calcitonin if the condition persists. Bisphosphonates, such as Etidronate or Pamidronate, are utilized more frequently in this setting. Treatment for subcutaneous fat necrosis involves using a low-calcium formula; fluids, Furosemide, Calcitonin, and corticosteroids are utilized depending on the degree of hypercalcemia.
4. Given that it typically resolves on its own within a few weeks, fetal hypercalcemia brought on by maternal hypoparathyroidism can be treated optimistically.
5. A formula lacking in calcium and vitamin D is used to treat chronic illnesses.
Conclusion
An adequate calcium supply from maternal sources is necessary for normal fetal and neonatal calcium homeostasis. Both maternal hyper- and hypocalcemia can result in metabolic bone disease or problems with calcium homeostasis in newborns. Significant physiological changes occur in the mother during pregnancy to preserve calcium hemostasis. Increased intestinal calcium absorption meets the majority of the mineral needs of the growing fetus. Pregnant women's daily calcium intake has been reported to be inadequate.
Calcium supplementation during pregnancy for women who do not get enough calcium from their diet has a minor benefit of reducing preeclampsia and preterm births and enhancing maternal and newborn bone health. Maternal hyperparathyroidism can cause fetal growth limitation, severe newborn hypocalcemia, tetany, and mortality in the fetus. Depending on the genotype of the fetus, probable fetal problems include mild hypercalcemia, severe hypocalcemia, or severe neonatal hyperparathyroidism in maternal familial hypocalciuric hypercalcemia. To know more about the condition, consult the doctor online.
