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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0000000000000428
HIV Reports

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

Powis, Kathleen MD, MPH*†‡; Lockman, Shahin MD, MSc†‡§; Smeaton, Laura MS; Hughes, Michael D. PhD; Fawzi, Wafaie MBBS, DrPH; Ogwu, Anthony MBBS; Moyo, Sikhulile MSc, MPH; van Widenfelt, Erik; von Oettingen, Julia MD**; Makhema, Joseph MB, ChB, MRCP; Essex, Max DVM, PhD†‡; Shapiro, Roger L. MD, MPH†‡††

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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.

Copyright © 2014 by Lippincott Williams & Wilkins.

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