title: Vitamin D insufficiency in HIV-infected pregnant women receiving antiretroviral therapy is not associated with morbidity, mortality or growth impairment in their uninfected infants in Botswana.
abstract: BACKGROUND
  Low maternal 25(OH)D (vitamin D) values have been associated with higher mortality and impaired growth among HIV-exposed uninfected (HEU) infants of antiretroviral (ART)-naive women. These associations have not been studied among HEU infants of women receiving ART.
  
  
  METHODS
  We performed a nested case-control study in the Botswana Mma Bana Study, a study providing ART to women during pregnancy and breastfeeding. Median maternal vitamin D values, and the proportion with maternal vitamin D insufficiency, were compared between women whose HEU infants experienced morbidity/mortality during 24 months of follow-up and women with nonhospitalized HEU infants. Growth faltering was assessed for never hospitalized infants attending the 24-month-of-life visit. Multivariate logistic regression models determined associations between maternal vitamin D insufficiency and infant morbidity/mortality and growth faltering.
  
  
  RESULTS
  Delivery plasma was available and vitamin D levels assayable from 119 (86%) of 139 cases and 233 (84%) of 278 controls, and did not differ significantly between cases and controls [median: 36.7 ng/mL, interquartile range (IQR): 29.1-44.7 vs. 37.1 ng/mL, IQR: 30.0-47.2, P = 0.32]. Vitamin D insufficiency (<32 ng/mL) was recorded among 112 (31.8%) of 352 women at delivery and occurred most frequently among women delivering in winter. Multivariate logistic regression models adjusted for maternal HIV disease progression did not show associations between maternal vitamin D insufficiency at delivery and child morbidity/mortality, or 24-month-of-life growth faltering.
  
  
  CONCLUSIONS
  Vitamin D insufficiency was common among ART-treated pregnant women in Botswana, but was not associated with morbidity, mortality or growth impairment in their HIV-uninfected children.
authors.affiliation: From the *Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital; †Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA; ‡Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana; §Brigham and Women's Hospital, Infectious Disease Division; ¶Center for Biostatistics in AIDS Research, Harvard School of Public Health; ‖Department of Global Health and Population, Harvard School of Public Health; **Division of Endocrinology, Boston Children's Hospital; and ††Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Powis
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Laura
authors.initials: L
authors.lastname: Smeaton
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hughes
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.forename: Anthony
authors.initials: A
authors.lastname: Ogwu
authors.forename: Sikhulile
authors.initials: S
authors.lastname: Moyo
authors.forename: Erik
authors.initials: E
authors.lastname: van Widenfelt
authors.forename: Julia
authors.initials: J
authors.lastname: von Oettingen
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D001902:Botswana; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002657:Child Development; D002658:Developmental Disabilities / Q000209:etiology; D005260:Female; D006678:HIV / Q000235:genetics; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D008297:Male; D036801:Parturition / Q000097:blood; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012367:RNA, Viral / Q000097:blood*; D012621:Seasons; D012737:Sex Factors; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D014807:Vitamin D