Low maternal 25-hydroxyvitamin D concentration increases the risk of severe and mild preeclampsia.
The objective of this case-cohort study was to evaluate the relationship between maternal 25-hydroxyvitamin D (25(OH)D) concentration and preeclampsia overall and by severity.



From an eligible cohort of 12,861 women who had serum banked from aneuploidy screening in Pittsburgh, Pennsylvania from 1999 to 2010, we randomly sampled a subcohort of 2327 pregnancies and all remaining preeclampsia cases (n = 650 cases). Preeclampsia (defined as new-onset hypertension and proteinuria) and its mild and severe forms were identified using ICD-9 codes. Maternal serum collected at 20 weeks or less gestation was measured for 25(OH)D. We used log-binomial regression with restricted cubic splines to estimate the association between 25(OH)D and preeclampsia after adjusting for confounders.



Approximately 21% of the randomly selected sample had 25(OH)D less than 50 nmol per L. We found that the adjusted risk of preeclampsia declined as serum 25(OH)D increased to 50 nmol per L and then plateaued (test of nonlinearity P < .05). The adjusted preeclampsia risk ratios (95% confidence intervals) for 25(OH)D less than 25 nmol per L, 25 to 49.9 nmol per L, and 50 to 74.9 nmol per L were 2.4 (1.2-4.8), 1.1 (0.69-1.7), and 1.3 (0.89-1.8), respectively, compared with those with 25(OH)D 75 nmol per L and over. Similar associations were observed with severe and mild preeclampsia.



Vitamin D deficiency increases risks of severe and mild forms of preeclampsia.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.
Katharyn M
KM
Baca
Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA.
Hyagriv N
HN
Simhan
Department of Pediatrics, McGill University, Montreal, QC, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
Robert W
RW
Platt
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA; Magee-Womens Research Institute, Pittsburgh, PA. Electronic address: bodnar@edc.pitt.edu.
Lisa M
LM
Bodnar
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D011247:Pregnancy; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000175:diagnosis
D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D
25-Hydroxyvitamin D; Hypertension; Preeclampsia; Pregnancy; Vitamin D deficiency