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doi: 10.1097/EDE.0000000000000039

Maternal Vitamin D Status and the Risk of Mild and Severe Preeclampsia

Bodnar, Lisa M.a,b,c; Simhan, Hyagriv N.b,c; Catov, Janet M.a,b,c; Roberts, James M.a,b,c; Platt, Robert W.d; Diesel, Jill C.a; Klebanoff, Mark A.e,f

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Background: We sought to determine the association between maternal vitamin D status at ≤26 weeks’ gestation and the risk of preeclampsia by clinical subtype.

Methods: We conducted a case–cohort study among women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project. In serum collected at ≤26 weeks’ gestation (median 20.9 weeks) from 717 women who later developed preeclampsia (560 mild and 157 severe cases) and from 2986 mothers without preeclampsia, we measured serum 25-hydroxyvitamin D, over 40 years later, using liquid chromatography–tandem mass spectrometry.

Results: Half of women in the subcohort had 25-hydroxyvitamin D (25(OH)D) >50 nmol/L. Maternal 25(OH)D 50 to 74.9 nmol/L was associated with a reduction in the absolute and relative risk of preeclampsia and mild preeclampsia compared with 25(OH)D <30 nmol/L in the crude analysis but not after adjustment for confounders, including race, prepregnancy body mass index, and parity. For severe preeclampsia, 25(OH)D ≥50 nmol/L was associated with a reduction in three cases per 1000 pregnancies (adjusted risk difference = −0.003 [95% confidence interval = −0.005 to 0.0002]) and a 40% reduction in risk (0.65 [0.43 to 0.98]) compared with 25(OH)D <50 nmol/L. Conclusions were unchanged (1) after restricting to women with 25(OH)D measured before 22 weeks’ gestation or (2) with formal sensitivity analyses for unmeasured confounding.

Conclusions: Maternal vitamin D deficiency may be a risk factor for severe preeclampsia but not for its mild subtypes. Contemporary cohorts with large numbers of severe preeclampsia cases would be needed to confirm or refute these findings.

© 2014 by Lippincott Williams & Wilkins, Inc

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