Caird L E, Reid-Thomas V, Hannan W J, Gow S, Glasier A F
Department of Obstetrics and Gynaecology, University of Edinburgh, UK.
Clin Endocrinol (Oxf). 1994 Dec;41(6):739-45. doi: 10.1111/j.1365-2265.1994.tb02788.x.
A worldwide trend towards increasing life expectancy has meant that osteoporosis is emerging as an important public health problem. The loss of bone mineral density and its restoration in association with a premenopausal but physiological hypo-oestrogenic state may serve as an important model for research into the pathogenesis and prevention of osteoporosis. With this in mind we have undertaken a longitudinal study of changes in bone mineral density over one year in women after childbirth.
Observational study of 31 women in the first year following childbirth; 11 intending to breast-feed and use barrier methods of contraception, 9 intending to breastfeed and to use the progestogen-only pill and 10 intending to artificially feed and to use barrier methods.
Recruitment was from the antenatal clinics of the Simpson Memorial Maternity Pavilion. Only non-smokers who had regular menstrual cycles prior to conception were included.
Bone mineral density was measured at the lumbar spine within 3 weeks of childbirth and repeated at 6 and 12 months post partum. Plasma oestradiol, prolactin and osteocalcin concentrations were measured at each visit.
Breast-feeding women using barrier methods lost a mean +/- SE of 4.9 +/- 1.5% of bone mineral density in the first 6 months following delivery. This was however reversible since by one year the bone mineral density was no different from that measured immediately post partum. Breast-feeding women using the progestogen-only pill lost a significantly smaller percentage of bone mineral density in 6 months and by one year bone mineral density was 2.95 +/- 0.75% higher than post partum. Artificially feeding women had a steady increase in bone mineral density in the first year and bone mineral density was on average 4.3 +/- 1.2% higher.
Breast-feeding results in a reversible reduction in spinal bone mineral density. The small amounts of gestagen in the progesterone-only pill would appear to protect against this loss. The mechanism of this loss in bone mineral density and the potentially bone protective effects of gestagens require further study.
全球预期寿命不断增加的趋势意味着骨质疏松正成为一个重要的公共卫生问题。骨矿物质密度的丢失及其与绝经前但生理性低雌激素状态相关的恢复情况，可能成为研究骨质疏松发病机制和预防的重要模型。考虑到这一点，我们对产后女性一年内骨矿物质密度的变化进行了一项纵向研究。
对31名产后第一年的女性进行观察性研究；11名打算母乳喂养并采用屏障避孕法，9名打算母乳喂养并使用仅含孕激素的避孕药，10名打算人工喂养并采用屏障避孕法。
从辛普森纪念妇产医院的产前诊所招募。仅纳入孕前月经周期规律的非吸烟者。
在产后3周内测量腰椎的骨矿物质密度，并在产后6个月和12个月重复测量。每次就诊时测量血浆雌二醇、催乳素和骨钙素浓度。
采用屏障避孕法的母乳喂养女性在分娩后的前6个月骨矿物质密度平均降低了4.9±1.5%（均值±标准误）。然而这是可逆的，因为到一年时骨矿物质密度与产后立即测量时并无差异。使用仅含孕激素避孕药的母乳喂养女性在6个月时骨矿物质密度降低的百分比显著较小，到一年时骨矿物质密度比产后高2.95±0.75%。人工喂养的女性在第一年骨矿物质密度稳步增加，平均比产后高4.3±1.2%。
母乳喂养导致脊柱骨矿物质密度可逆性降低。仅含孕激素的避孕药中的少量孕激素似乎可预防这种丢失。这种骨矿物质密度丢失的机制以及孕激素潜在的骨保护作用需要进一步研究。
