Vitamin D Deficiency and the Risk of Preeclampsia and Eclampsia in Bangladesh

Abstract

Maternal vitamin D deficiency has been proposed as a risk factor for preeclampsia, but no significant studies have been conducted to evaluate its relationship with eclampsia. Our goal in this study was to assess the prevalence and potential risk of vitamin D deficiency for both preeclampsia and eclampsia in Bangladesh. Using a case-control design, we measured serum 25(OH)D levels in pregnant women receiving care at the Dhaka Medical College Hospital with preeclampsia (n=33), eclampsia (n=79), and normal pregnancy (controls, n=76). Odds of developing preeclampsia and eclampsia with vitamin D deficiency were calculated using logistic regression analysis. The prevalence of vitamin D insufficiency was very high with more than 3 quarters (78%) of all subjects having a serum 25(OH)D level<30 ng/ml. The mean serum 25(OH)D level was 24.86 ng/ml in controls, 23.96 ng/ml in pre-eclamptic women, and 21.56 ng/ml in eclampsia patients. Comparing to those who had a serum 25(OH)D level of ≥30 ng/ml, the odds ratio (95% CI) of developing preeclampsia and eclampsia in mothers with vitamin D insufficiency were 3.9 (95% CI=1.18–12.87) and 5.14 (95% CI=1.98–13.37), respectively (adjusting for age, BMI and duration of pregnancy). The odds of developing preeclampsia and eclampsia may increase by up to 5-fold in women with vitamin D insufficiency. Since preeclampsia and eclampsia can lead to serious complications for both mother and the offspring, vitamin D may be supplemented during pregnancy in high risk populations to decrease these adverse consequences.

Key words

vitamin D deficiency - preeclampsia - eclampsia - hypertension

• References

• 1 Ganji V, Zhang X, Shaikh N, Tangpricha V. Serum 25-hydroxyvitamin D concentrations are associated with prevalence of metabolic syndrome and various cardiometabolic risk factors in US children and adolescents based on assay-adjusted serum 25-hydroxyvitamin D data from NHANES 2001-2006. Am J Clin Nutr 2011; 94: 225-233
• 2 Judd SE, Tangpricha V. Vitamin D deficiency and risk for cardiovascular disease. Am J Med Sci 2009; 338: 40
• 3 Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, Benjamin EJ, D’Agostino RB, Wolf M, Vasan RS. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117: 503-511
• 4 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-281
• 5 Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85: 1586-1591
• 6 Garland CF, Garland FC, Gorham ED, Lipkin M, Newmark H, Mohr SB, Holick MF. The role of vitamin D in cancer prevention. Am J Public Health 2006; 96: 252
• 7 Giapros VI, Challa AS, Cholevas VL, Evagelidou EN, Bairaktari ET, Andronikou SK. Vitamin D Levels and Insulin Resistance in Children Born with Severe Growth Restriction. Horm Metab Res 2013; 45: 226-230
• 8 Devaraj S, Jialal G, Cook T, Siegel D, Jialal I. Low vitamin D levels in Northern American adults with the metabolic syndrome. Horm Metab Res 2011; 43: 72-74
• 9 Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102: 181-192
• 10 Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol 2007; 103: 620-625
• 11 Al-Saleh Y, Al-Daghri NM, Alkharfy KM, Al-Attas OS, Alokail MS, Al-Othman A, Sabico S, Chrousos GP. Normal Circulating PTH in Saudi Healthy Individuals with Hypovitaminosis D. Horm Metab Res 2013; 45: 43-46
• 12 Bodnar LM, Catov JM, Simhan HN, Zmuda JM, Cooper ME, Parrott MS, Roberts JM, Marazita ML, Simhan HN. Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia. J Clin Endocrinol Metab 2007; 92: 3517-3522
• 13 Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am J Obstet Gynecol 2010; 203: 366, e 361–366
• 14 Baker AM, Haeri S, Camargo CA, Espinola JA, Stuebe AM. A Nested Case-Control Study of Midgestation Vitamin D Deficiency and Risk of Severe Preeclampsia. J Clin Endocrinol Metab 2010; 95: 5105-5109
• 15 Haugen M, Brantsaeter AL, Trogstad L, Alexander J, Roth C, Magnus P, Meltzer HM. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology 2009; 20: 720-726
• 16 National High Blood Pressure Education Program. Working Group on High Blood Pressure in Pregnancy Working group report on high blood pressure in pregnancy: US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute 2000
• 17 Hollis BW. Assessment and interpretation of circulating 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in the clinical environment. Endocrinol Metab Clin North Am 2010; 39: 271-286
• 18 Ahmed T, Mahfuz M, Ireen S, Ahmed AM, Rahman S, Islam MM, Alam N, Hossain MI, Rahman SM, Ali MM, Choudhury FP, Cravioto A. Nutrition of children and women in Bangladesh: trends and directions for the future. J Health Popul Nutr 2012; 30: 1
• 19 Melcescu E, Griswold M, Xiang L, Belk S, Montgomery D, Bray M, Del Ben KS, Uwaifo GI, Marshall GD, Koch CA. Prevalence and cardiometabolic associations of the glucocorticoid receptor gene polymorphisms N363S and BclI in obese and non-obese black and white Mississippians. Hormones 2012; 11: 166-177
• 20 Kalantaridou SN, Zoumakis E, Makrigiannakis A, Lavasidis LG, Vrekoussis T, Chrousos GP. Corticotropin-releasing hormone, stress and human reproduction: an update. J Reprod Immunol 2010; 85: 33-39
• 21 Roberts JM, Cooper DW. Pathogenesis and genetics of pre-eclampsia. Lancet 2001; 357: 53-56
• 22 Roberts JM, Hubel CA. The two stage model of preeclampsia: variations on the theme. Placenta 2009; 30: 32-37
• 23 Huppertz B. Placental origins of preeclampsia challenging the current hypothesis. Hypertension 2008; 51: 970-975
• 24 Fischer D, Schroer A, Ludders D, Cordes T, Bücker B, Reichrath J, Friedrich M. Metabolism of vitamin D3 in the placental tissue of normal and preeclampsia complicated pregnancies and premature births. Clin Exp Obstet Gynecol 2007; 34: 80-84
• 25 Novakovic B, Sibson M, Ng HK, Manuelpillai U, Rakyan V, Down T, Beck S, Fournier T, Evain-Brion D, Dimitriadis E, Craig JM, Morley R, Saffery R. Placenta-specific methylation of the vitamin D 24-hydroxylase gene. J Biol Chem 2009; 284: 14838-14848
• 26 Elenkov IJ, Wilder RL, Bakalov VK, Link AA, Dimitrov MA, Fisher S, Crane M, Kanik KS, Chrousos GP. IL-12, TNF-a, and hormonal changes during late pregnancy and early postpartum: implications for autoimmune disease activity during these times. J Clin Endocrinol Metab 2001; 86: 4933-4938
• 27 Hypponen E. Vitamin D for the prevention of preeclampsia? A hypothesis. Nutr Rev 2005; 63: 225-232
• 28 Wamberg L, Cullberg KB, Rejnmark L, Richelsen B, Pedersen SB. Investigations of the Anti-inflammatory Effects of Vitamin D in Adipose Tissue: Results from an In Vitro Study and a Randomized Controlled Trial. Horm Metab Res 2013; Jan 15 [Epub ahead of print]
• 29 Saito S, Sakai M. Th1/Th2 balance in preeclampsia. J Reprod Immunol 2003; 59: 161-173
• 30 Darmochwal-Kolarz D, Leszczynska-Gorzelak B, Rolinski J, Oleszczuk J. T helper 1-and T helper 2-type cytokine imbalance in pregnant women with pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 1999; 86: 165-170
• 31 Liu NQ, Kaplan AT, Lagishetty V, Ouyang YB, Ouyang Y, Simmons CF, Equils O, Hewison M. Vitamin D and the Regulation of Placental Inflammation. J Immunol 2011; 186: 5968-5974
• 32 Kalantaridou SN, Zoumakis E, Makrigiannakis A, Godoy H, Chrousos GP. The Role of Corticotropin-releasing Hormone in Blastocyst Implantation and Early Fetal Immunotolerance. Horm Metab Res 2007; 39: 474
• 33 Ullah MI, Uwaifo GI, Nicholas WC, Koch CA. Does vitamin D deficiency cause hypertension? Current evidence from clinical studies and potential mechanisms. Int J Endocrinol 2010; 2010: 579-640
• 34 Li YC, Qiao G, Uskokovic M, Xiang W, Zheng W, Kong J. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Mol Biol 2004; 89: 387-392
• 35 Elsammak MY, Al-Wosaibi AA, Al-Howeish A, Alsaeed J. Vitamin d deficiency in Saudi Arabs. Horm Metab Res 2010; 42: 364-368
• 36 Islam M, Akhtaruzzaman M, Lamberg-Allardt C. Hypovitaminosis D is common in both veiled and nonveiled Bangladeshi women. Asia Pac J Clin Nutr 2006; 15: 81-87
• 37 Islam MZ, Shamim AA, Kemi V, Nevanlinna A, Akhtaruzzaman M, Laaksonen M, Jehan AH, Jahan K, Khan HU, lamberg-Allardt C. Vitamin D deficiency and low bone status in adult female garment factory workers in Bangladesh. Br J Nutr 2008; 99: 1322-1329
• 38 Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26: 2341-2357
• 39 Roth DE, Al-Mahmud A, El Arifeen S. Randomized open-label trial of two weekly oral vitamin D3 supplementation regimens during the third trimester of pregnancy in Bangladeshi women: effects on maternal vitamin D status and safety. FASEB J 2011; 25: 236 .236 (abstract)
• 40 de Boer IH, Levin G, Robinson-Cohen C, Biggs ML, Hoofnagle AN, Siscovick DS, Kestenbaum B. Serum 25-hydroxyvitamin D concentration and risk for major clinical disease events in a community-based population of older adults: a cohort study. Ann Intern Med 2012; 156: 627-634
• 41 Weisman Y, Harell A, Edelstein S, David M, Spirer Z, Golander A. 1α, 25-Dihydroxyvitamin D3, and 24, 25-dihydroxyvitamin D3 in vitro synthesis by human decidua and placenta. Nature 1979; 281: 317-319