Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania.
BACKGROUND
Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes, mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV), and child mortality.


METHODS
A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality. The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis.


RESULTS
No association was observed between maternal vitamin D status and adverse pregnancy outcomes, including low birth weight and preterm birth. In multivariate models, a low maternal vitamin D level (<32 ng/mL) was associated with a 50% higher risk (95% confidence interval [CI], 2%-120%) of MTCT of HIV at 6 weeks, a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks (95% CI, 1.08-3.82), and a 46% higher overall risk of HIV infection (95% CI, 11%-91%). Children born to women with a low vitamin D level had a 61% higher risk of dying during follow-up (95% CI, 25%-107%).


CONCLUSIONS
If found to be efficacious in randomized trials, vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children, particularly in resource-limited settings.
Mehta
Saurabh
S
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA. smehta@hsph.harvard.edu
Hunter
David J
DJ
Mugusi
Ferdinand M
FM
Spiegelman
Donna
D
Manji
Karim P
KP
Giovannucci
Edward L
EL
Hertzmark
Ellen
E
Msamanga
Gernard I
GI
Fawzi
Wafaie W
WW
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D011256:Pregnancy Outcome; D013636:Tanzania / Q000453:epidemiology; D014801:Vitamin A / Q000008:administration & dosage; D014808:Vitamin D Deficiency / Q000150:complications* / Q000453:epidemiology; D014815:Vitamins / Q000008:administration & dosage / Q000494:pharmacology*
D019380:Anti-HIV Agents; D014815:Vitamins; D014801:Vitamin A