OBJECTIVE-We sought to examine the association between maternal serum 25-hydroxyvitamin D (25[OH]D) concentration in early pregnancy and the subsequent diagnosis of preeclampsia (PE).STUDY DESIGN-This was a nested case-control study from 2 prospective Canadian cohorts conducted in Quebec City, Quebec, and Halifax, Nova Scotia, from 2002 through 2010. Participants were pregnant women (n=169 cases with PE and 1975 controls). Maternal serum was drawn <20 weeks of gestation, and 25(OH)D measurement was performed. Cases were ascertained from medical records. Logistic regression analysis was used to estimate adjusted odds ratios with 95% confidence intervals.RESULTS-Women who developed PE had a significantly lower 25(OH)D concentration at a mean gestational age of 14 weeks compared with women in the control group (mean ± SD 25[OH]D 47.2 ± 17.7 vs 52.3 ± 17.2 nmol/L, P < .0001). Women with 25(OH)D <30 nmol/L compared to those with at least 50 nmol/L had a greater risk of developing PE (adjusted odds ratio, 2.23; 95% confidence interval, 1.29-3.83) after adjustment for prepregnancy body mass index, maternal age, smoking, parity, season and year of blood collection, gestational week at blood collection, and cohort site. Exploratory analysis with cubic splines demonstrated a dose-response relationship between maternal 25(OH)D and risk of PE, up to levels around 50 nmol/L, where the association appeared to plateau. Canada, Feb. 12-15, 2014; and
CONCLUSION-Maternal
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CIHR Author ManuscriptCIHR Author Manuscript women of child-bearing age should be explored as a strategy for reducing PE and for promoting a healthier pregnancy.
Keywords
25-hydroxyvitamin D; preeclampsia; vitamin DOne of the United Nations' Millennium Development Goals for maternal health is to reduce maternal mortality by three-quarters by 2015. 1 Hypertensive disorders of pregnancy, including preeclampsia (PE), are among the leading causes of maternal morbidity and mortality. 2 The clinical manifestations of PE are well described as elevated blood pressure and protein-uria, 3 yet the etiology and prevention of the syndrome remain unclear.Strategies to prevent PE include anti-platelet action of low-dose aspirin 4 Several epidemiologic studies have explored the association between vitamin D status and PE. In 2 of these studies, serum concentrations of 25(OH)D and 1,25-hydroxyvitamin D in early pregnancy were lower in women who subsequently developed PE. 13,16 Overall, however, the epidemiological evidence is conflicting and previous studies are limited by small sample sizes or the absence of adjustment for relevant confounders, such as season, smoking, or parity. 13,[16][17][18][19][20][21][22] Moreover, there is a lack of consensus about the threshold of 25(OH)D at which the risk of PE is decreased. Given a strong biological rationale for a link between vitamin D metabolism and the physiopathology of PE through immunomodulation 16 and angiogenesis, 23 stronger epidemiologic evidence from studies with larger sample sizes and ...