




































 Agricultural Science; Vol. 3, No. 4; 2021 
ISSN 2690-5396   E-ISSN 2690-4799 

https://doi.org/10.30560/as.v3n4p1 

1                             Published by IDEAS SPREAD 
 

The Association of Calcium Profiles at Calving with Health and 
Performance of Holstein Cows and Their Calves 

Constantin Găvan1 & Mihaela Riza1 
1Agriculture Research and Development Station Simnic – Craiova, Dolj, Romania 
Correspondence: Constantin Găvan, Agriculture Research and Development Station Simnic – Craiova, Șoseaua 
Bălcești, 54, Dolj, Romania. Tel: 40-025-141-7534. E-mail: scda_simnic@yahoo.com 
 
Received: October 5, 2021   Accepted: October 20, 2021    Online Published: November 1, 2021 
 
The research is financed by Agriculture Research and Development Station Simnic – Craiova.  
 
Abstract 
The aim of this study was to assess the association of hypocalcemia at calving with health and performance of 
Holstein cows and their calves. Data were collected January 1st 2017 to December 31st 2020. A total of 431 
lactating Holstein Friesian cows (118 primiparous and 313 multiparous) from a research of hypocalcemia was 2 
groups (hypo and non-hypo). The overall prevalence of hypocalcemia was 3.4% for first-lactation cows and 18% 
for multiparous cows. Lactating dairy cows with hypocalcemia had greater proportion of cows with Retained Fetal 
Membranes (RFM) metritis and culling within 60 days in milk (DIM), compared with non-hypocalcemia 
respectively. For the first 2 official milk tests milk yield and components (% fat, % protein on SCC) did not differ 
between hypo and non-hypo cows. The days in milk at first service, mastitis, dystocia and pregnancy at first service 
were not different between hypo and non-hypo groups. The proportion of stillbirth, survival at 60 days of age in 
calves did not differ between calves born from hypo or non-hypo cows. Calves born from Hypo cows had greater 
incidence of diarrhea (38.3%) than calves born (22.3%) from non-hypo cows. The results of this study show that 
hypocalcemia in calving has significant health implications for both dams and their calves. 
Keywords: hypocalcemia, retained fetal membranes, metritis, diarrhea 
1. Introduction 
The dairy cow undergoes a transition from non-lactating to lactating at calving. The animal is tremendously 
challenged to maintain calcium homeostasis. Those that fail can develop hypocalcemia, a common metabolic 
disorder in dairy cows that leads to an increased risk of detrimental health. Physiologically, serum calcium 
concentration in adult cow is maintained above 2.0 mmol/L (Martin-Tereso and Verstegen, 2011). Before calving, 
the cow has a calcium requirement for maintenance and an added requirement for fetal growth. After calving, the 
condition for pregnancy is exchanged for an addition for the colostrum and milk production. This increases the 
total need of calcium by approximately 100% (Ferneberg, 2010). Due to the start of colostrum production and 
consequently increasing calcium demand the nadir of serum concentration occurs 12 to 24 hours after parturition 
(Goff, 2008). 
Calcium ions play a very important role in many fundamental biological processes in the cow body, such as muscle 
concentration, blood coagulation and hormone release, and are structural components of the skeleton. Most of the 
calcium (99%) in the body is stored in bone, and a minor part (0.1%) is present in the extracellular fluid. The 
remainder is in plasma membrane and in the endoplasmic reticulum. In cow’s colostrum the concentration of total 
calcium is approximately 42-58 mmol/l (Goff et al. 2000), and milk is lower, approximately 30 mmol/l (Sjaostad 
et al., 2003). The total concentration of calcium in blood plasma is maintained between 2.1 and 2.5 mmol/l (Goff, 
2008) in the adult cows. 
To maintain calcium homeostasis after calving at the start of lactation, the cow will increase reabsorption in the 
kidneys, increase absorption in the intestine and withdraw calcium from bone (Goff, 2008). Bone calcium 
mobilization and renal reabsorption are induced by secretion of parathyroid hormone (PTH). The increased 
intestinal absorption is induced by 1.25-dihydroxyvitamin D, which is produced in the kidneys in response to 
increase PTH levels.   



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Practical animal nutrition often considers nutrient absorption to be a constant competence; however, Ca absorption 
is constantly changing due to endogenous signals and external from the diet. Ramberg et al., 1970, described Ca 
homeostasis as a system with „controlled signals, disturbing signals and controlling signals‟. This approach 
suggests that the cause of hypocalcemia could be delay in adaptive mechanisms („controlling signals‟) that cannot 
provide timely responses to the sudden changes in Ca clearance from the blood (Martin-Tereso and Verstegen, 
2011). The adaptive mechanisms involve renal reabsorption, gastrointestinal absorption and bone turnover. Renal 
reabsorption and intestinal absorption are both regulated processes of transepithelial Ca transport. Bone turnover 
is a tissue modification process that is regulated in such a way that it can respond anabolically or catabolically to 
sustain Ca homeostasis while maintaining the structural function of bone (Martin-Tereson and Verstegen, 2011). 
Ca reabsorption in the kidney and active gastro epithelial absorption are transcellular processes that coordinated 
by the hormonal Ca homeostatic system and that transports Ca into the blood. This transcellular transport of Ca 
consists of three steps: entry into epithelial cells, intracellular diffusion mediated by binding protein and active 
transport from the cell into the next extracellular compartment (Hoenderop et al., 2005). Ca enters the epithelial 
cells through two transient receptor potential vanillaid (TRPV) channels (TRPV5 and TRPV6), and this Ca entry 
represents the limiting key regulatory step of the process, and is strongly regulated by calcitriol (Boulin et al., 2003) 
and extracellular Ca concentration (Nilius et al., 2002). Inside the epithelial cell, Ca diffuses through the cytoplasm 
mediated by two cytosolic Ca-binding proteins, calbindin – D9K and calbindin – 28k (Hoenderop et al., 2005). 
This second step can limit transport across the cell because the lack of calbindin proteins impedes Ca transport 
(Bronner, 2003). 
The third step in transcellular transport is Ca export out of the cell into the bloodstream, and this process is 
mediated by ATP via Ca2+ - ATPase protein, and the Na+/Ca2+ exchanger. This step is also regulated by calcitriol. 
Calcitriol is the active form of vitamin D, also known as 1.25-dihydroxycholecalciferol. There are molecular 
differences between renal and intestinal transcellular Ca transport. The Ca entry channel in the intestine is TRPV6 
(Suzuki; et al., 2008) Whereas TRPV5 is in the kidney (Khanal and Nemere, 2008). The predominant intracellular 
Ca-binding protein in the kidney is calbindin-D28K and calbindin-D9K in the intestine (Bouillon et al., 2003). 
A characteristic of TRPV5 is its pH sensitivity. During metabolic acidosis TRPV5 has approximately half of its 
normal activity (Suzuki et al., 2008). This inhibition result in hypercalciuria, a condition in cows fed low-dietary 
cation-anion differences diets (Schonewille et al. 1994; Roche et al., 2003). 
Bone remodeling is an important adaptive mechanism of Ca homeostatic control. Bone Ca represents a 
quantitatively large source that sustain blood Ca levels in periods of Ca deficit in early cow lactation. The hormone 
affecting bone remodeling is PTH and its action is coordinated with calcitriol (Parfitt, 1976). The PTH initiates 
bone resorption to compensate for decreases in blood Ca, and in the same time, it induces the synthesis of calcitriol, 
which activates intestinal Ca absorption. If blood Ca is normalized by intestinal input, PTH ceases and 
consequently induces renal excretion of the surplus. 
In conclusion intestinal absorption and bone resorption present a delay of approximately 1 or 2 days when adapting 
to an increased Ca clearance from the blood. This time coincides with the period at calving when cows suffer from 
hypocalcemia. 
For many years, dairy nutritionists have searched for a dietary strategy to prevent hypocalcemia. Dietary preventive 
strategies and nutritional risk factors have been reviewed (Bauman and Bruce Currie, 1980). Implementation of 
low-Ca diets as a specific strategy for hypocalcemia has practical difficulties (is a difficult to formulate a dry cow 
ration below 1.5 g Ca per kg DM). Supplying anionic salts is a preventive dietary intervention. The effect of the 
DCAD (Dietary Cation-Anion Differences) levels on hypocalcemia has been evaluated (Lean et al., 2006). The 
objectives of feeding prepartum cows acidogenic diets is to induce a compensated metabolic acidosis.  
The transient hypocalcemia at calving is associated with increased risk of uterine and metabolic disorders 
(Martinez et al., 2012). 
Subclinical hypocalcemia affected reproductive performance such as estrus cyclicity (Ribeiro et al., Caixeta et al., 
2017) and pregnancy rate to first AI (Chapinal et al. 2012). 
Calves born from hypocalcemia cows have been reported to be at greater risk of developing diarrhea and 
respiratory events during neonatal period, compared with calves born from non-hypo calcemic cows (Planski and 
Abrashev, 1987). 
Wilhelm et al. (2017) reported that calves born from hypo calcemic cows had greater incidence of diarrhea (49%) 
than calves born (33.3%) from non-hypo calcemic cow under certified organic management.  



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The objective of this study was to assess the association of hypocalcemia (Hypo) of cows at calving with survival, 
health and performance of lactating dairy cows and their calves in a research dairy herd. 
2. Method 
2.1 Animals Feeding and Facilities in the Research Farm 
Dairy cows and heifers are housed in barns with access to dry-lot, prepartum and postpartum. All cows are milked 
twice daily in approximately 12 h interval. Cows and heifers were fed in the morning and afternoon with diets 
formulated to meet or to exceed nutritional requirements for dry and lactating dairy cows. Additionally, all cows 
and heifers have access to pasture (alfalfa or ryegrass). Prepartum and postpartum diets were presented in table 1. 
 
Table 1. Prepartum and postpartum dairy cow diets (DM basis). 

Item Prepartum 
% 

Postpartum 
% 

A. Ingredient: 
Alfalfa hay 26 29 
Grass hay 45 5.5 
Corn silage 10 16 
Grain mix 16 47 
Mineral mix 3 2.5 
TOTAL 100 100 
Nutrient profile: 
Net energy lactation 1.28 1.60 
Crude protein 12 19 
Neutral detergent fiber 46 28 
Acid detergent fiber 40 20 
Starch 14 27 
Calcium 1.4 1.3 
Phosphorus 0.3 0.4 
Magnesium  0.4 0.4 
Kalium 1.5 1.3 
Natrium  0.3 0.4 
Chloride 1.1 0.4 
Sulfa  0.4 0.2 
DCAD mEq/100g of DM* -5 26.9 

* Calculated as DCAD = (mEq of Na + mEq of K) – (mEq of S + mEq of Cl). 
 
Pregnant cows were dried-off 60 ± 10 days before the expected calving date and were moved in a dry pen after 
last milking. At 21 ± 3 days before the expected calving date the pregnant cows were moved to prepartum pens. 
In the prepartum pens all cows closely monitored by on farm personnel for signs of parturition every 1 hour. 
Calving ease of cows is recorded using a 4–point scale (1= no assistance; 2 = assistance by 1 person without the 
use of mechanical traction; 3 = mechanical extraction; and 4 = sever dystocia – surgery or fetology needed). 
Calving date and time and stillbirth are recorded. After calving all cows has their BCS assessed using a 5–point 
scale by a person from research team. Stillbirth is defined as a calf born dead or died within 24 hours after birth. 
Fresh colostrum is harvested within 2 hours after calving, and all calves receive 4 L of quality colostrum ≥ 50 mg 
of 1gG/dl from their dams or not from their dams, within 3 hours after birth. Two days after colostrum 
administration, blood samples are collected from jugular vein of female calves to assess failure of passive immune 
transfer (Brix refractometer; Brix value ≥ 22% for colostrum quality and Brix value ≥ 8.4% for adequate immune 
transfer). 
In the first day calves are moved to the calf raising facility and are housed individually. The calves are fed 8 L of 
milk twice daily in the morning (4 L) and afternoon (4L). 
2.2 Assessment of Urine PH in Cows 
Testing urine pH gives a strong indication of the effectiveness of DCAD balancing in the ration. All the cows in 
the prepartum transition group that have been consuming the transition diet for at least 3 days and are more than 3 



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days away from expected calving are selected once per week for urine pH test. Urine samples are collected between 
2 and 4 hours after feeding the diet, by perineal stimulation and free catch of the urine (not at start urinating, 
because alkaline components in the vagina can cause erroneous results). A portable pH meter is used that is cleaned, 
calibrated correctly and rinsed between measurements. Target urine pH levels in Holstein cows are between 6.0 
and 6.8. If 80% of the samples are within target, the diet is not adjusting for DCAD. The outlying 20% is likely 
caused by improper sampling or one or more of the following factors: eating behavior; feed preferences; adequate 
amount of feed; forage variability in K and Cl, overcrowding. Usually a DCAD of – 5 to – 15 milliequivalents per 
100 g dry matter is used. If the DCAD is not within this range, calcium sulfate or ammonium sulfate is added until 
sulfur is 0.4-0.5% of DM or calcium chloride and/or ammonium chloride until DCAD is -5 to -15 mEq/100 g of 
DM (Ammonium salts should always be checked for non protein nitrogen levels to avoid ammonia toxicity). 
2.3 Assessment of Calcium Status of Cows 
Blood samples (8 ml) for determination of serum calcium concentration is collected monthly from 4-5 cows within 
2 hours after parturition by jugular venipuncture (vacutainer system). After collection blood samples are 
centrifuged for 20 minutes. Serum sample are stored at -20° C until analyzed, for a longer storage or at 2-8°C for 
10 days storage. 
Total serum concentration of calcium is determined in duplicates, using Calorimetric Method (Calcium OCC – 
Linear Chemicals, S.L.U. Spain). 
This method is based on the specific binding of cresolftalein complexone (OCC), a metalochromic indicator and 
calcium at alkaline pH with the resulting shift in the absorption wavelength of the complex. The intensity of the 
chromophore formed is proportional to the concentration of total calcium in the sample. 
2.4 Health Events and Milk Production 
All postpartum cows were screened for retained fetal membranes (RFM), metritis, and mastitis. Retained fetal 
membranes is defined as a failure to expel the fetal membranes by 24 hours after parturition (LeBlanc et al., 2002). 
Metritis is defined as a foul-smelling, brown red, watery vaginal discharge within the first 20 days in milk (DIM) 
with or without fever (≥ 39.5°C). Clinical mastitis was defined as an inflammation of the udder with visible 
changes of milk within 20 DIM. Milk production and Somatic Cell Count (SCC), for the first 2 postpartum official 
milk test were collected from farm records. Survival of lactating dairy cows (died are culled within 60 DIM) was 
assessed by calcium status at calving. 
The incidence of diarrhea in calves was associated with calcium status of the dams of calving. Diarrhea is defined 
as the presence of fluid or bloody feces (score 2-3 on a 0-3 scale and either >5%) dehydration (score 3, on a 1-3 
scale) or fever (≥ 39.5°C). Within 10 days of age (Goodell et al., 2012). Also survival at 60 days of age was 
assessed. 
2.5 Breeding Practices 
For all lactating dairy cows the voluntary waiting period (VWP) is 50 to 60 days. The breeding program is based 
on estrus detection and artificial insemination (AI). Estrus detection is made by daily visual observation and using 
tail chalk. All cows presenting signs of standing estrus behavior receive AI. The cows that did not display estrus 
behavior or are not pregnant after 5 consecutive AI are enrolled in a program of induction of estrus and 
inseminations at an appointed time. Pregnancy diagnosis is performed at 40 ± 3 days, post AI via trans rectal 
palpation. The days in milk at first service and the proportion of pregnancy per AI at first service are recorded.  
2.6 Statistical Analyses 
Data were collected from January 1st 2017 to December 31st 2020. For this retrospective longitudinal study, data 
from individual lactating dairy cows were analyzed using Microsoft Office Excel. 
The association of cows with hypocalcemia at calving with dystocia, RFM, metritis, culling within 60 DIM and 
pregnancy at first A, were analyzed using statistical procedures of SAS (SAS Institute, 2009). Also, association of 
cows with hypocalcemia at calving with days in milk at first service, milk weights (kg) components (SCC and 
percent fat and protein were analyzed using MIXED procedure of SAS). The effect of parity BCS at calving were 
also included. Association of cows with hypocalcemia status at calving with stillbirth, diarrhea within 10 days of 
age and adequate immune transfer in calves were analyzed. 
3. Results 
In total 431 lactating Holstein Friesian cows (118 primiparous and 313 multiparous) from Research Farm of ARDS 
Simnic-Craiova were included in the analyses (Table 2). All 431 cows were divided in two groups: Hypo group 
and non-hypo group (table 2). 



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Table 2. Calving calcium profiles and cows health and reproductive parameters performance of dairy cows in hypo 
and non-hypo groups 

Item Hypo  
n=60 

Non-hypo
n=371 

p – value  

Calving related events and survival (%): 
Dystocia (%) 8.3 6 0.51 
RFM (%) 12.8 5.8 0.03 
Metritis (%) 21.6 14 0.02 
Mastitis (%) 11.6 8.2 0.10 
Culled within 60 DIM (%) 16.6 10.2 0.04 
Reproductive performances:    
Days in milk at First service (d) 86.6 ± 3.41 82.2 ± 2.53 0.62 
Pregnancy at First service (%) 51.6 53 0.18 

 
In total 60 cows (13.92%) had hypocalcemia, using a cut-off value for serum total calcium of 2 mmol/l (< 8.0 
mg/dl; Reinhardt et al. 2011). 
The overall prevalence of hypocalcemia was 3.4% for first lactation cows and 18% for multiparous cows. 
3.1 Health, Culling and Performances of Lactating Cows 
Lactating dairy cows with hypocalcemia had greater proportion of cows with RFM (p = 0.03), metritis (p = 0.02) 
and culling within 60 DIM (p = 0.04; table 2). The proportion of cows with dystocia (p = 0.51), and mastitis (p = 
0.10) was not different between hypo and non-hypo groups of cows (table 2). Also days in milk at first service (P 
= 0.62) and pregnancy at first service (p = 0.18) were not different between hypo and non-hypo cows (table 2). 
Milk yield (p = 0.40), percent milk fat (p = 0.57), percent milk protein (p = 0.43), and SCC (p = 0.62) were not 
different between hypo and non-hypo cows for the first 2 milk control tests relative to calving (table 3). 
 
Table 3. Association of calcium status at calving with milk yield and percent fat and protein, and SCC of Holstein 
Friesian dairy cows in the first 3 milk control tests relative to calving 1. 

Item Hypo (n = 60) Non-hypo (n = 371) P – value 
Control 1 Control 2 Control 1 Control 2 

D.I.M. at control test 28.2 ± 1 56.6 ± 2 28.5 ± 0.9 56.3 ± 0.4 0.40 
Milk yield (kg) 28.4 ± 3.1 31.2 ± 2.8 28.9 ± 1.2 33.6 ± 1.0 0.40 
Fat (%) 3.4 ± 0.2 3.5 ± 0.3 3.3 ± 0.2 3.5 ± 0.3 0.57 
Protein (%) 3.0 ± 0.1 3.1 ± 0.1 3.1 ± 0.1 3.2 ± 0.1 0.43 
SCC x 103 cells/ml of milk 249 ± 110 200 ± 98 256 ± 108 188 ± 90 0.62 

1 Least squares means are presented ± SEM; 
Hypo: cows with ≤ 8.0 mg Ca/dl; non-hypo: cows ≥ 8.1 mg Ca/dl. 
 
3.2 Calf Diarrhea within 10 Days of Age and Survival within 60 Days of Age in Calves 
The proportion of stillborn calves (P = 0.38) and survival within 60 days of age (P = 0.41), did not differ between 
hypo and non-hypo cows (table 4). 
Calves born by hypo cows had a significantly greater (P = 0.04) incidence of diarrhea compared with non-hypo 
cows (table 4). 
 
Table 4. Association of calcium status at calving with stillbirth, diarrhea 10 days of age and survival within 60 
days of age in calves. 

Item1 Hypo (n = 60) Non-hypo (n = 371) P – value  
Stillbirth2 (%) 3.3 2.6 0.38 
Diarrhea (%) 38.3 22.3 0.04 
Survival (%) 92 95 0.41 

 



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In the present study the overall prevalence of hypocalcemia clinical and subclinical combined was 3.4% for 
primiparous and 18% for multiparous cows. 
For vital bodily functions is necessary ionized calcium. Kimura et al., 2006 reported that the extracellular calcium 
status is the primary determinant of intracellular calcium status. The immunosuppression observed in postpartum 
dairy cows is likely due to the decreased storage of intracellular ionized Ca (Martinez et al., 2012). 
The depletion of intracellular calcium stores starts several days before parturition and development of 
hypocalcemia in early postpartum dairy cows. 
Calcium concentrations are reported to reach a nadir within 12 to 24 hours after parturition (Goff, 2008) thus, the 
prevalence of hypocalcemia in cows by 24 hours after calving may be higher than reported in this study. Martinez 
et al., 2012, reported that cows with subclinical hypocalcemia (total serum calcium ≤ 8.59 mg/dl) for at least one 
day, between 0 and 3 DIM had less neutrophils in their blood with reduced functions, and increased risk for metritis. 
In the present study, hypo cows had significantly increased risk for RFM, metritis and culling within 60 DIM as 
compared to non-hypo cows.  
Jawor et al., 2012, reported that cows with hypo (< 7.2 mg/dl) produced 5.7 kg/day more milk. Martinez et al., 
2012, reported that milk production did not differ between hypo (≤ 8.59 mg/dl) and non-hypo cows.  
In this study milk yield and components as well as SCC for the first 2 official milk control tests were not different 
in hypo and non-hypo cows. 
An interesting finding was that calves born from hypo cows had a greater proportion of diarrhea within 10 days of 
age compared to those born from non-hypo cows. The most efficient and effective management of the newborn 
health is achieved by feeding adequate quantity (4 l) of quality colostrum (≥ 50 g/L IgG) and minimal bacterial 
contamination within first 3 hours after birth (Mee, 2008). Immediately after birth calf require proper navel 
disinfection, removal from the dam and movement to a clean and dry environment. In this study hypo cows tended 
to yield colostrum of inferior concentration of IgG compared with non-hypo cows which in turn could compromise, 
in past, neonatal calf health within 10 days of age. Further studies are needed to assess the association between 
calcium and energy status at calving of dam and neonatal calf health, accounting for effect of colostrum 
components (IgG, vitamins and nutrients). 
4. Conclusions 
Overall the present study indicates that hypocalcemia is a metabolic disorder in the dairy farm analyzed, as 3.4% 
of first lactation cows and 18% of multiparous cows suffered from this metabolic disorder. 
Findings from this study show that hypocalcemia of dairy cows at calving has significant health implications for 
both dams and their calves. 
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as.ideasspread.org   Agricultural Science Vol. 3, No. 4; 2021 

 8       Published by IDEAS SPREAD 
 

Jawor, P. E., Huzzey, J. M., LeBlanc, S. J., & Keyserlingk, M. A. (2012). Association of subclinical hypocalcemia 
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https://doi.org/10.1016/j.tvjl.2007.12.032 

 
Copyrights 
Copyright for this article is retained by the author(s), with first publication rights granted to the journal. 
This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution 
license (http://creativecommons.org/licenses/by/4.0/). 
 
 
 
 
















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    /NLD (Gebruik deze instellingen om Adobe PDF-documenten te maken die zijn geoptimaliseerd voor prepress-afdrukken van hoge kwaliteit. De gemaakte PDF-documenten kunnen worden geopend met Acrobat en Adobe Reader 5.0 en hoger.)
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    /ENU (Use these settings to create Adobe PDF documents best suited for high-quality prepress printing.  Created PDF documents can be opened with Acrobat and Adobe Reader 5.0 and later.)
  >>
  /Namespace [
    (Adobe)
    (Common)
    (1.0)
  ]
  /OtherNamespaces [
    <<
      /AsReaderSpreads false
      /CropImagesToFrames true
      /ErrorControl /WarnAndContinue
      /FlattenerIgnoreSpreadOverrides false
      /IncludeGuidesGrids false
      /IncludeNonPrinting false
      /IncludeSlug false
      /Namespace [
        (Adobe)
        (InDesign)
        (4.0)
      ]
      /OmitPlacedBitmaps false
      /OmitPlacedEPS false
      /OmitPlacedPDF false
      /SimulateOverprint /Legacy
    >>
    <<
      /AddBleedMarks false
      /AddColorBars false
      /AddCropMarks false
      /AddPageInfo false
      /AddRegMarks false
      /ConvertColors /ConvertToCMYK
      /DestinationProfileName ()
      /DestinationProfileSelector /DocumentCMYK
      /Downsample16BitImages true
      /FlattenerPreset <<
        /PresetSelector /MediumResolution
      >>
      /FormElements false
      /GenerateStructure false
      /IncludeBookmarks false
      /IncludeHyperlinks false
      /IncludeInteractive false
      /IncludeLayers false
      /IncludeProfiles false
      /MultimediaHandling /UseObjectSettings
      /Namespace [
        (Adobe)
        (CreativeSuite)
        (2.0)
      ]
      /PDFXOutputIntentProfileSelector /DocumentCMYK
      /PreserveEditing true
      /UntaggedCMYKHandling /LeaveUntagged
      /UntaggedRGBHandling /UseDocumentProfile
      /UseDocumentBleed false
    >>
  ]
>> setdistillerparams
<<
  /HWResolution [2400 2400]
  /PageSize [612.000 792.000]
>> setpagedevice

