{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:51:18Z","timestamp":1788522678458,"version":"build-2803163510"},"reference-count":37,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008816","name":"University of Sri Jayewardenepura","doi-asserted-by":"publisher","award":["ASP\/01\/RE\/MED\/2018\/59"],"award-info":[{"award-number":["ASP\/01\/RE\/MED\/2018\/59"]}],"id":[{"id":"10.13039\/501100008816","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Determinants of parathyroid hormone level during pregnancy have been less frequently studied. We aimed to describe the serum parathyroid hormone (PTH) and its determinants in Sri Lankan pregnant women in a community setting.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>In this cross-sectional analysis, 390 pregnant mothers in their third trimester were enrolled from primary care centers of 15 health divisions in the Colombo District in Sri Lanka. Venous blood was analyzed for a total 25-hydroxyvitamin-D [25(OH)D], serum parathyroid hormone (PTH), serum calcium, and alkaline phosphatase. The bone quality was assessed in terms of speed of sound (SOS) using the quantitative ultrasound scan (QUS). Univariate and multivariate regression analysis was used to examine the determinants of PTH concentration in blood.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Median serum 25(OH)D was 17.5ng\/mL. Most (61.6%) were vitamin D deficient (&lt;20ng\/mL). Median PTH was 23.7pg\/mL. Only 0.8% had hyperparathyroidism (PTH &gt;65pg\/mL). The correlation between 25(OH)D and PTH was weak but significant (r = -0.197; p&lt;0.001). SOS Z-score was below the cut-off (\u2264\u22122) in fifty-six women (14.7%), and SOS did not relate significantly to PTH. In regression analysis, serum 25(OH)D, serum calcium, body mass index, educational level, and weeks of pregnancy were significant independent variables when adjusted. The model explained 16% of the variation in the PTH level.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A high prevalence of vitamin D deficiency was observed among Sri Lankan pregnant women in the present study. Serum 25(OH)D, calcium, weeks of pregnancy, and educational level were determinants of serum PTH.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0258381","type":"journal-article","created":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T23:25:56Z","timestamp":1633821956000},"page":"e0258381","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Parathyroid hormone in Sri Lankan pregnant women: Vitamin D and other determinants"],"prefix":"10.1371","volume":"16","author":[{"given":"Anusha","family":"Kaneshapillai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usha","family":"Hettiaratchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6503-0396","authenticated-orcid":true,"given":"Shamini","family":"Prathapan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-3295","authenticated-orcid":true,"given":"Guwani","family":"Liyanage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"issue":"6","key":"pone.0258381.ref001","doi-asserted-by":"crossref","first-page":"453","DOI":"10.5001\/omj.2018.85","article-title":"Hypocalcemia in Pregnancy: A Clinical Review Update","volume":"33","author":"A Almaghamsi","year":"2018","journal-title":"Oman Med J."},{"issue":"1","key":"pone.0258381.ref002","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ecl.2005.09.004","article-title":"Calcium and bone disorders during pregnancy and lactation","volume":"35","author":"CS Kovacs","year":"2006","journal-title":"Endocrinol Metab Clin North Am"},{"key":"pone.0258381.ref003","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1146\/annurev.nutr.20.1.249","article-title":"Calcium in pregnancy and lactation","volume":"20","author":"A. 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Climate of Sri Lanka. 2020; Available from: http:\/\/www.meteo.gov.lk\/index.php?option=com_content&view=article&id=94&Itemid=310&lang=en1."},{"key":"pone.0258381.ref015","unstructured":"Family Health Bureau Ministry of Health. Maternal Care Package A Guide to Field Healthcare Workers. 2011. https:\/\/medicine.kln.ac.lk\/depts\/publichealth\/Fixed_Learning\/clearkship\/3.PHM\/maternal_care_package_a_guide_to_field_healthcare_workers_english.pdf"},{"key":"pone.0258381.ref016","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/9017951","article-title":"Maternal Vitamin D Status and Its Effect on Vitamin D Levels in Early Infancy in a Tertiary Care Centre in Sri Lanka","volume":"2019","author":"K Anusha","year":"2019","journal-title":"International journal of endocrinology"},{"key":"pone.0258381.ref017","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1186\/s40064-016-1837-x","article-title":"Validity of a food frequency questionnaire to assess nutritional intake among Sri Lankan adults","volume":"5","author":"R Jayawardena","year":"2016","journal-title":"Springerplus"},{"key":"pone.0258381.ref018","volume-title":"Indian Food Composition Tables","author":"T Longvah","year":"2017"},{"issue":"6","key":"pone.0258381.ref019","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/j.berh.2005.06.004","article-title":"What is the role of DXA, QUS and bone markers in fracture prediction, treatment allocation and monitoring?","volume":"19","author":"K Briot","year":"2005","journal-title":"Best Pract Res Clin Rheumatol"},{"issue":"7","key":"pone.0258381.ref020","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline","volume":"96","author":"MF Holick","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"pone.0258381.ref021","doi-asserted-by":"crossref","first-page":"e017703","DOI":"10.1136\/bmjopen-2017-017703","article-title":"Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway","volume":"8","author":"IA Lian","year":"2018","journal-title":"BMJ Open"},{"issue":"2","key":"pone.0258381.ref022","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1080\/13102818.2007.10817444","article-title":"Causes of high bone alkaline phosphatase","volume":"21","author":"F Sara\u00e7","year":"2007","journal-title":"Biotechnology & Biotechnological Equipment"},{"key":"pone.0258381.ref023","volume-title":"Clinical Methods: The History, Physical, and Laboratory Examinations","author":"VK Bansal","year":"1990","edition":"3"},{"issue":"1","key":"pone.0258381.ref024","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1210\/jc.2010-2704","article-title":"The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know","volume":"96","author":"AC Ross","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"3","key":"pone.0258381.ref025","doi-asserted-by":"crossref","first-page":"E436","DOI":"10.1210\/jc.2010-1886","article-title":"Relationship between Vitamin D, Parathyroid Hormone, and Bone Health","volume":"96","author":"J Sai","year":"2011","journal-title":"The Journal of Clinical Endocrinology & Metabolism"},{"issue":"4","key":"pone.0258381.ref026","doi-asserted-by":"crossref","first-page":"422","DOI":"10.4103\/ijem.IJEM_322_19","article-title":"Inverse Relationship Between 25 Hydroxy Vitamin D and Parathormone: Are there Two Inflection Points?","volume":"23","author":"P Mukhopadhyay","year":"2019","journal-title":"Indian J Endocrinol Metab"},{"issue":"6","key":"pone.0258381.ref027","doi-asserted-by":"crossref","first-page":"3215","DOI":"10.1210\/jc.2004-2364","article-title":"Prevalence of Vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy","volume":"90","author":"MF Holick","year":"2005","journal-title":"J Clin Endocrinol 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