Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
School of Kinesiology and Department of Anatomy & Cell Biology, Western University, London, Ontario, Canada.
Am J Clin Nutr. 2022 Oct 6;116(4):887-896. doi: 10.1093/ajcn/nqac182.
Pregnancy induces bone mineral mobilization, which may be further compromised if diet and physical activity are suboptimal.
We aimed to determine the effects of a Nutrition + Exercise intervention during pregnancy on maternal calciotropic and bone biomarker profiles throughout pregnancy and the postpartum.
In the Be Healthy in Pregnancy (BHIP) randomized controlled trial, 203 of 225 participants who consented to the bone health substudy were, randomly assigned at 12-17 weeks gestation to receive either usual care (control) or a structured and monitored Nutrition + Exercise plan (intervention) providing an individualized high dairy protein diet and a walking program throughout pregnancy. Maternal serum total procollagen type 1 N-terminal propeptide (P1NP; bone formation), C-terminal telopeptide of type I collagen (CTX; bone resorption), and insulin-like growth factor-1 (IGF-1) were measured by ELISA, and vitamin D metabolites by ultra-performance LC tandem MS at early and late pregnancy, 6 mo postpartum, and in cord blood.
In 187 participants completing all measures, significantly higher intakes were observed in the intervention than in the control group for total protein (P < 0.0001), protein intake from dairy foods (P < 0.0001), and calcium (P < 0.0001), whereas vitamin D intake was similar between treatment groups in both the second and third trimesters. The intervention group had significantly lower serum CTX at end of pregnancy (mean ± SD: 0.78 ± 0.31 ng/mL; n = 91 compared with 0.89 ± 0.33 ng/mL; n = 96, P = 0.034) and in cord serum (0.58 ± 0.13 ng/mL; n = 31 compared with 0.69 ± 0.18 ng/mL; n = 22, P < 0.025). Serum concentrations of P1NP rose significantly (P < 0.02) from early pregnancy to 6 mo postpartum for the intervention group only. Serum 25-hydroxyvitamin D status was >50 nmol/L for 97% of all participants.
Higher maternal dietary protein and calcium intakes than usual care in concert with normal vitamin D status minimized bone resorption and maintained bone formation and may protect bone health during pregnancy.This trial was registered at clinicaltrials.gov as NCT01689961.
妊娠会引起骨矿物质动员，如果饮食和身体活动不达标，这种情况可能会进一步恶化。
我们旨在确定妊娠期间营养+运动干预对孕妇钙调节和骨生物标志物谱在整个妊娠和产后的影响。
在 Be Healthy in Pregnancy（BHIP）随机对照试验中，225 名同意进行骨健康子研究的参与者中有 203 名在 12-17 周妊娠时被随机分配接受常规护理（对照组）或结构化和监测的营养+运动计划（干预组），该计划在整个妊娠期间提供个体化的高乳蛋白饮食和步行计划。通过 ELISA 测量母体血清总前胶原 1 N 端前肽（P1NP；骨形成）、I 型胶原 C 端肽（CTX；骨吸收）和胰岛素样生长因子 1（IGF-1），通过超高效 LC 串联 MS 测量维生素 D 代谢物，在妊娠早期和晚期、产后 6 个月和脐带血中进行测量。
在完成所有测量的 187 名参与者中，干预组的总蛋白（P < 0.0001）、乳制食品中的蛋白质摄入（P < 0.0001）和钙摄入（P < 0.0001）明显高于对照组，而维生素 D 摄入在第二和第三孕期两组之间相似。与对照组相比，干预组在妊娠期末期（平均±SD：0.78±0.31 ng/mL；n=91 与 0.89±0.33 ng/mL；n=96，P=0.034）和脐带血中（0.58±0.13 ng/mL；n=31 与 0.69±0.18 ng/mL；n=22，P < 0.025）的血清 CTX 浓度显著降低。干预组的 P1NP 血清浓度从妊娠早期显著升高（P < 0.02），仅在产后 6 个月时升高。所有参与者的血清 25-羟维生素 D 状态均>50 nmol/L，占 97%。
与常规护理相比，较高的母体膳食蛋白质和钙摄入量，同时保持正常的维生素 D 状态，最大限度地减少了骨吸收，维持了骨形成，并可能在妊娠期间保护骨骼健康。本试验在 clinicaltrials.gov 上注册为 NCT01689961。
