Bone turnover and maternal 25(OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women?

OBJECTIVE: To investigate the relationship between 25(OH) vitamin D3 levels and maternal bone turnover during pregnancy and lactation. STUDY DESIGN: Thirty pregnant women and 30 healthy non-pregnant controls were included the study. The pregnant women were examined in the 12th, 25th and 32nd gestational weeks and 6 weeks after delivery. The controls were examined once. Serum concentrations of 25(OH) vitamin D3, parathyroid hormone (PTH), cross-linked C-terminal telopeptide of type I collagen (CTX), calcium, and phosphate were measured. RESULTS: In the 32nd week and the postpartum period, 25(OH) vitamin D3 deficiency rates were 13.3% and 33.3%, respectively. Serum 25(OH) vitamin D3 levels were below the detection limit in 10% and 33%, respectively, of the same subjects. In the control group, rates of 25(OH) vitamin D3 deficiency and "below detection limit" were 30% and 23%, respectively. While 25(OH) vitamin D3 and CTX levels were not correlated to each other in the first trimester, a negative correlation was found in the 2nd and 3rd trimesters and the postpartum period between 25(OH) vitamin D3 and CTX levels (r=-0.472, p=0.048; r=-0.893, p<0.0001, r=-0.881, p<0.001, respectively). No correlation between 25(OH) vitamin D3 and CTX levels was found in controls. CONCLUSION: We consider that 25(OH) vitamin D3 supplementation of women could both decrease maternal bone resorption and lead to enhanced bone mass in offspring during later life. Since women are prone to 25(OH) vitamin D3 insufficiency, we suggest higher doses of 25(OH) vitamin D3 should be given to pregnant subjects.

Surgical experiences in acute spontaneous dissection of the infrarenal abdominal aorta.

OBJECTIVE: Spontaneous dissection of the abdominal aorta should be considered as a vascular surgical emergency. We report here our experience with this rare pathology. METHODS: At our hospital, we operated on 200 patients for abdominal aortic aneurysm over a 4-year period, and aortic dissection was the underlying pathology in eight of them. Diagnosis was based on history, imaging study findings and visualization at surgery. RESULTS: The mean size of the aorta at the time of diagnosis was 5.5 +/- 0.4 cm. Aortic dissection was complicated by acute ischemia of lower limb and paraplegia in 1 patient and four patients were admitted to hospital with severe abdominal and back pain. Two patients with contained rupture were admitted with hemodynamic collapse and shock. One of the patients who presented with abdominal pain experienced also sudden onset paraplegia. The diagnosis of dissecting abdominal aortic aneurysm was established incidentally in the remaining 2 patients. All patients were treated using open techniques with paramedian transperitoneal incision. We performed aorto-bifemoral bypass operation procedure in all patients; there was no post-operative mortality in our series. One patient had to be reoperated because of bleeding during early postoperative period. One patient required transient dialysis at early postoperative period because of transient rise of serum creatinine level. CONCLUSION: The surgical treatment of spontaneous abdominal aortic dissection is usually associated with low morbidity and mortality rates. However, the clinical form of presentation of acute abdominal aortic dissection is usually nonspecific, and diagnosis requires a high index of suspicion.