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A Cross-Sectional Study of Postpartum Changes in Bone Status in Indian Mothers

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The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Background

Bone turnover is high during lactation. However, studies on bone status of Indian urban mothers are scarce. Hence, the objective was to conduct a cross-sectional study on the lactation-related changes in bone health status of Indian mothers postpartum using Dual X-ray Absorptiometry (DXA) at 3 time points: within a week of delivery, at 1- and 3-years postpartum. We also explored the association of dietary calcium intake, physical activity, serum vitamin D status, and dietary traditional food supplements (Dietary Food supplements) with bone health.

Methods

A cross-sectional study was conducted; 300 full-term, healthy primiparous women (28.6 ± 3.4 year) were randomly selected and categorized into 3 groups: 128 mothers within 7 days of delivery (Group A), 88 with 1-year-old children (B), and 84 with 3-year-old children (C). Anthropometry, lactation history, physical activity, diet, biochemical tests (vitamin D, parathyroid hormone), body composition, areal bone mineral density (a-BMD) at total body (TB), AP spine (APS), and dual neck femur (DF) were assessed by DXA (GE-Lunar DPX).

Results

Significantly higher APS-BMD (mean ± SD) was observed in Group C (1.107 ± 0.098 g/cm2) than that in A (1.045 ± 0.131 g/cm2) (p < 0.05). When adjusted for breastfeeding practices, mean (±standard error) APS-BMD was lowest in women in Group A (1.024 ± 0.013 g/cm2), but was higher at 1-year (1.079 ± 0.02 g/cm2) and at 3-years postpartum (1.111 ± 0.019 g/cm2), though differences were significant only between groups A and C (p < 0.05). Most mothers from all 3 groups consumed inadequate amount of nutrients except dietary fat and showed low physical activity. Multiple regression analysis indicated that dietary calcium, moderate physical activity, serum vitamin D, and consumption of dietary food supplements were not significant predictors of APS-BMD (p > 0.1).

Conclusion

Prevalence of nutrient and vitamin D deficiencies, low physical activity, and poor sunlight exposure were major concerns in Indian lactating mothers; improvement in bone mass at APS was observed at 3-years which was most likely due to physiologic changes.

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Abbreviations

a-BMD:

Areal bone mineral density

BMC:

Bone mineral content

TB:

Total body

APS:

Anterior–posterior spine

DF:

Dual femur

DXA:

Dual-energy X-ray absorptiometry

LBM:

Lean body mass

DFS:

Dietary food supplement

NDS:

No dietary food supplement

RDA:

Recommended dietary allowances

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Acknowledgments

Authors gratefully acknowledge the financial support provided by Mr. Pancharatnam, Panchasheel Filters, Pune. We thank to Director, HCJMRI, Dr. Uma Divate for giving permission for carrying out this study. Also, we would like to express gratitude to all the mothers for their participation and cooperation during the study.

Author information

Authors and Affiliations

  1. Growth and Endocrine Unit, Jehangir Hospital, Hirabai Cowasji Jehangir Medical Research Institute, 32, Sasoon Road, Pune, 411001, India

    Neha Kajale, Anuradha Khadilkar, Shashi Chiplonkar, Vaman Khadilkar & Nina Mansukhani

  2. Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, M13 9WL, UK

    Zulf Mughal

Authors
  1. Neha Kajale
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  2. Anuradha Khadilkar
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  3. Shashi Chiplonkar
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  4. Zulf Mughal
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  5. Vaman Khadilkar
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  6. Nina Mansukhani
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Corresponding author

Correspondence to Anuradha Khadilkar.

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Conflict of interest

All authors have no conflict of interest.

Ethical approval

Research protocol was approved by the institutional ethics committee and all participants gave written informed consent.

Additional information

Neha Kajale is a Research Scholar at Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune.

Appendix

Appendix

See Table 3.

Table 3 Commonly consumed Dietary food supplements with ingredient list and method of preparation
Full size table

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Kajale, N., Khadilkar, A., Chiplonkar, S. et al. A Cross-Sectional Study of Postpartum Changes in Bone Status in Indian Mothers. J Obstet Gynecol India 66, 218–225 (2016). https://doi.org/10.1007/s13224-015-0746-1

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  • DOI: https://doi.org/10.1007/s13224-015-0746-1

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