Low Bioactive Vitamin D Is Associated with Pregnancy-Induced Hypertension in a Cohort of Pregnant HIV-Infected Women Sampled Over a 23-Year Period

Overview

Journal Am J Perinatol

Specialty Gynecology & Obstetrics

Date 2019 Aug 1

PMID 31365935

Citations 5

Authors

Kristi R Van Winden

Allison Bearden

Naoko Kono

Toni Frederick

Eva Operskalski

Alice Stek

Raj Pandian

Lorayne Barton

Andrea Kovacs

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the association of vitamin D insufficiency and risk of pregnancy-induced hypertension (PIH) among human immunodeficiency virus (HIV)-infected pregnant women.

Study Design: This is a retrospective cohort study evaluating the impact of low maternal vitamin D levels on PIH and perinatal outcomes among HIV-infected pregnant women receiving care at an urban HIV center from 1991 to 2014.

Results: A total of 366 pregnant women were included, of which 11% developed PIH. Lower levels of 25-hydroxyvitamin D (25(OH)D) and bioactive 1,25-dihydroxyvitamin D (1,25(OH)D) were associated with increased HIV disease activity. 25(OH)D levels were not significantly associated with the incidence of PIH. Higher 1,25(OH)D levels were associated with reduced incidence of PIH in univariate (odds ratio, OR: 0.87 [95% confidence interval, CI: 0.79-0.95], = 0.004) and multivariate (OR: 0.88 [95% CI: 0.80-0.97], = 0.010) analyses. No association was found between 25(OH)D levels and other obstetric outcomes. Lower 1,25(OH)D levels were associated with group B colonization (OR: 0.92 [95% CI: 0.86-0.99]) and low birth weight (LBW) (OR: 0.90 [95% CI: 0.83-0.98]) on multivariate analysis. Mean 1,25(OH)D levels were significantly lower in women with preterm delivery and LBW infants.

Conclusion: Lower bioactive vitamin D levels are related to PIH in HIV-infected women. This association may be related to the coexistence of abnormal placental vitamin D metabolism and abnormal placental implantation.

Citing Articles

Effects of information-knowledge-attitude-practice health education combined with cluster-based care in patients with gestational hypertension.

Wen J, Liu X Medicine (Baltimore). 2023; 102(41):e35346.

PMID: 37832047 PMC: 10578767. DOI: 10.1097/MD.0000000000035346.

Clinical Effect of Nimodipine Combined with Magnesium Sulfate on Pregnancy-Induced Hypertension Syndrome.

Chang R, Miao H, Cui A, Jiang L, Yang L, Miao C J Healthc Eng. 2022; 2022:7217543.

PMID: 35368954 PMC: 8975643. DOI: 10.1155/2022/7217543.

Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications.

Olmos-Ortiz A, Olivares-Huerta A, Garcia-Quiroz J, Avila E, Halhali A, Quesada-Reyna B Nutrients. 2021; 13(9).

PMID: 34578991 PMC: 8467737. DOI: 10.3390/nu13093114.

Vitamin D and Streptococci: The Interface of Nutrition, Host Immune Response, and Antimicrobial Activity in Response to Infection.

Guevara M, Lu J, Moore R, Chambers S, Eastman A, Francis J ACS Infect Dis. 2020; 6(12):3131-3140.

PMID: 33170652 PMC: 7852033. DOI: 10.1021/acsinfecdis.0c00666.

Low maternal vitamin D is associated with increased risk of congenital and peri/postnatal transmission of Cytomegalovirus in women with HIV.

Bearden A, Van Winden K, Frederick T, Kono N, Operskalski E, Pandian R PLoS One. 2020; 15(2):e0228900.

PMID: 32053638 PMC: 7018030. DOI: 10.1371/journal.pone.0228900.

References

Yun C, Chen J, Yang C, Li Y, Piao J, Yang X . Comparison of two 25-hydroxyvitamin D immunoassays to liquid chromatography-tandem mass spectrometry in assessing samples from the Chinese population. Clin Chim Acta. 2015; 448:22-6. DOI: 10.1016/j.cca.2015.06.007. View

Behjat Sasan S, Zandvakili F, Soufizadeh N, Baybordi E . The Effects of Vitamin D Supplement on Prevention of Recurrence of Preeclampsia in Pregnant Women with a History of Preeclampsia. Obstet Gynecol Int. 2017; 2017:8249264. PMC: 5585545. DOI: 10.1155/2017/8249264. View

Mueller N, Fux C, Ledergerber B, Elzi L, Schmid P, Dang T . High prevalence of severe vitamin D deficiency in combined antiretroviral therapy-naive and successfully treated Swiss HIV patients. AIDS. 2010; 24(8):1127-34. DOI: 10.1097/QAD.0b013e328337b161. View

Browne J, Schrier V, Grobbee D, Peters S, Klipstein-Grobusch K . HIV, Antiretroviral Therapy, and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-analysis. J Acquir Immune Defic Syndr. 2015; 70(1):91-8. DOI: 10.1097/QAI.0000000000000686. View

Dekker G, Sibai B . Etiology and pathogenesis of preeclampsia: current concepts. Am J Obstet Gynecol. 1998; 179(5):1359-75. DOI: 10.1016/s0002-9378(98)70160-7. View

Wallis A, Saftlas A, Hsia J, Atrash H . Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987-2004. Am J Hypertens. 2008; 21(5):521-6. DOI: 10.1038/ajh.2008.20. View

Purswani J, Gala P, Dwarkanath P, Larkin H, Kurpad A, Mehta S . The role of vitamin D in pre-eclampsia: a systematic review. BMC Pregnancy Childbirth. 2017; 17(1):231. PMC: 5513133. DOI: 10.1186/s12884-017-1408-3. View

Powe C, Seely E, Rana S, Bhan I, Ecker J, Karumanchi S . First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension. 2010; 56(4):758-63. PMC: 3775612. DOI: 10.1161/HYPERTENSIONAHA.110.158238. View

Finkelstein J, Mehta S, Duggan C, Manji K, Mugusi F, Aboud S . Maternal vitamin D status and child morbidity, anemia, and growth in human immunodeficiency virus-exposed children in Tanzania. Pediatr Infect Dis J. 2012; 31(2):171-5. PMC: 3813463. DOI: 10.1097/INF.0b013e318245636b. View

10.

Reitter A, Stucker A, Linde R, Konigs C, Knecht G, Herrmann E . Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med. 2014; 15(9):525-36. DOI: 10.1111/hiv.12142. View

11.

Haug C, Aukrust P, Haug E, Morkrid L, Muller F, Froland S . Severe deficiency of 1,25-dihydroxyvitamin D3 in human immunodeficiency virus infection: association with immunological hyperactivity and only minor changes in calcium homeostasis. J Clin Endocrinol Metab. 1998; 83(11):3832-8. DOI: 10.1210/jcem.83.11.5270. View

12.

Wagner C, McNeil R, Hamilton S, Winkler J, Rodriguez Cook C, Warner G . A randomized trial of vitamin D supplementation in 2 community health center networks in South Carolina. Am J Obstet Gynecol. 2012; 208(2):137.e1-13. PMC: 4365423. DOI: 10.1016/j.ajog.2012.10.888. View

13.

Ewing A, Datwani H, Flowers L, Ellington S, Jamieson D, Kourtis A . Trends in hospitalizations of pregnant HIV-infected women in the United States: 2004 through 2011. Am J Obstet Gynecol. 2016; 215(4):499.e1-8. DOI: 10.1016/j.ajog.2016.05.048. View

14.

Kiely M, Zhang J, Kinsella M, Khashan A, Kenny L . Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small-for-gestational-age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. Am J Clin Nutr. 2016; 104(2):354-61. DOI: 10.3945/ajcn.116.130419. View

15.

Stoner M, Vwalika B, Smid M, George S, Chi B, Stringer E . A retrospective study of HIV, antiretroviral therapy, and pregnancy-associated hypertension among women in Lusaka, Zambia. Int J Gynaecol Obstet. 2016; 134(3):299-303. PMC: 4987258. DOI: 10.1016/j.ijgo.2016.03.014. View

16.

Mirzakhani H, Litonjua A, McElrath T, OConnor G, Lee-Parritz A, Iverson R . Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest. 2016; 126(12):4702-4715. PMC: 5127689. DOI: 10.1172/JCI89031. View

17.

Mehta S, Hunter D, Mugusi F, Spiegelman D, Manji K, Giovannucci E . Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis. 2009; 200(7):1022-30. PMC: 2758703. DOI: 10.1086/605699. View

18.

De-Regil L, Palacios C, Lombardo L, Pena-Rosas J . Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016; (1):CD008873. DOI: 10.1002/14651858.CD008873.pub3. View

19.

Mehta S, Giovannucci E, Mugusi F, Spiegelman D, Aboud S, Hertzmark E . Vitamin D status of HIV-infected women and its association with HIV disease progression, anemia, and mortality. PLoS One. 2010; 5(1):e8770. PMC: 2808247. DOI: 10.1371/journal.pone.0008770. View

20.

Brannon P, Picciano M . Vitamin D in pregnancy and lactation in humans. Annu Rev Nutr. 2011; 31:89-115. DOI: 10.1146/annurev.nutr.012809.104807. View