Schoorlemmer, M. (Marijke) (2016) Zwangerschap & Osteogenesis Imperfecta : Een retrospectieve cohortstudie naar het effect van eenzwangerschap en het geven van borstvoeding op de botdichtheid bij vrouwen met Osteogenesis Imperfecta. thesis, Medicine.
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Abstract
Introduction: Osteogenesis Imperfecta (OI) is a hereditary disorder in most instances caused by a genetic defect in either the COL1A1 or the COL1A2 gene. Dominant mutations in these genes lead to a reduced or abnormal collagen type 1 production. The disease is clinically characterized by brittle bones, increased fracture rates and low bone density. Many female OI patients of reproductive age have questions about the possibility of pregnancy and breastfeeding. In healthy women a transient decrease in bone density during the 3rd trimester of pregnancy and during the lactation period is a physiological phenomenon due to the mobilization of calcium from the bones for the production of breast milk and the strengthening of the fetal skeleton. Nowadays, breastfeeding is usually not recommended in hospital because of uncertainty with regard to the effect on bone density and fracture rate of women with OI. Until now, the effect of breastfeeding on bone density and fracture rate has not been studied extensively since no large groups of women with this condition were available. However, at the center of expertise for adults with OI in Zwolle a larger group of women with OI type 1 is available and clinical details are registered in a database with consent from all patients. Consequently, a pilot study was performed to measure the effects of pregnancy and lactation on bone density and fracture rate. Method: This retrospective cohort study encompasses the largest national OI database containing clinical data of adult with OI. For this study, 65 women (type 1 (n=54), type 3 (n=1) and type 4 (n=10)) have been included. We obtained data about the women’s first pregnancies through file research for performed bone densitometry results. A survey was conducted by telephone, concerning the postpartum period including breastfeeding, the occurrence of back pain and fracture rates. The effect of lactation on bone density, the occurrence of back pain and fracture rate were investigated, both for the total group as for the types of OI separately. The case of a patient with OI type 3 (n=1) has been described in a supplementary appendix. Results: No significant lower bone density after pregnancy, compared with the bone density before, of women with OI was found (-2,5 vs. -2,1, p=0,22). In contrast with our hypothesis, the average amount of fractures a year after pregnancy was significantly lower compared with the average before (0,22 vs. 0,55, p<0,01). However, the number of women with back pain after pregnancy was significantly increased (37 vs. 23, p<0,01). In addition, the percentage of OI patients with complaints of back pain postpartum was much higher in our study compared to the current literature (43,1% vs. 13,1%). Lactation had no significant effect on bone density, nor on the occurrence of back pain or the fracture rate. The examining of each separate type of OI did not give any significant results either. However, it is important to mention that these groups were small. Conclusion: There seems no adverse effects of pregnancy on bone density and fracture rate, but it causes more back pain in women with OI. No significant effects of lactation on these outcomes have been found. According to this study, there seems no reason for the negative counseling of women with OI with regards to lactation. However, before a final recommendation can be given, the results of larger studies will have to be awaited.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | 1e facultair begeleider and Janus, AJM and orthopedisch chirurg and 2e facultair begeleider and Joostens, AM and gynaecoloog and Isala, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2722 |
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