This paper explores the burden of osteomalacia on pregnancy and childbirth through two cases from early medieval urban Milan. Two skeletons of female individuals with skeletal deformities and associated with 25–36 gestational weeks fetuses, excavated from the Ad Martyres and San Vittore al Corpo urban cemeteries and dated to the Early Middle Ages, were examined. Paleopathological and historical analyses were performed in a biocultural approach to investigate the impact of clinical complications and skeletal deformities on their daily life, the course of their pregnancy, and childbirth. The women showed severe skeletal deformities attributable to osteomalacia including scoliosis, reduced rib-neck angle, coxavara, severe bending of the pelvic bones, protrusio acetabuli, and narrowed pelvic outlet. The condition and its biomechanical complications impacted the health of both mothers and fetuses, the quality of life of the women (i.e., gait alteration, difficult and limited mobility, compression of internal organs), as well as pregnancy outcomes. It is possible that both the mothers and fetuses died due to childbirth complications. Bioarchaeological cases of osteomalacia, pregnancy, and death during childbirth are excessively rare. This paper also provides insight into how maternal experiences and biocultural environments in early medieval Milan impacted childbirth outcome. The study of the Ad Martyres and San Vittore al Corpo necropolises is still ongoing and could provide further insight. Isotopic and paleogenomic analyses may shed more light into the factors that led to vitamin D deficiency in these women.

中文翻译：

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中世纪早期米兰的维生素 D 缺乏症、怀孕和分娩


本文通过中世纪早期米兰城市的两个案例探讨了骨软化症对怀孕和分娩的负担。检查了从 Ad Martyres 和 San Vittore al Corpo 城市墓地出土的两具骨骼畸形并与 25-36 孕周胎儿相关的女性个体骨骼，其历史可追溯到中世纪早期。以生物培养方法进行古病理学和历史分析，以调查临床并发症和骨骼畸形对他们日常生活、怀孕和分娩过程的影响。这些女性表现出由骨软化症引起的严重骨骼畸形，包括脊柱侧弯、肋颈角度减小、髋骨严重弯曲、髋臼突出和骨盆出口狭窄。这种情况及其生物力学并发症影响了母亲和胎儿的健康、女性的生活质量（即步态改变、行动困难和受限、内脏受压）以及妊娠结局。母亲和胎儿都可能死于分娩并发症。骨软化症、妊娠和分娩时死亡的生物考古病例极为罕见。本文还深入了解了中世纪早期米兰的产妇经历和生物文化环境如何影响分娩结果。对 Ad Martyres 和 San Vittore al Corpo 墓地的研究仍在进行中，可能会提供进一步的见解。同位素和古基因组学分析可能会更清楚地了解导致这些女性维生素 D 缺乏的因素。