Low Bioactive Vitamin D Is Associated with Pregnancy-Induced Hypertension in a Cohort of Pregnant HIV-Infected Women Sampled Over a 23-Year Period

Abstract

Objective To examine the association of vitamin D insufficiency and risk of pregnancy-induced hypertension (PIH) among human immunodeficiency virus (HIV)-infected pregnant women. Study Design This is a retrospective cohort study evaluating the impact of low maternal vitamin D levels on PIH and perinatal outcomes among HIV-infected pregnant women receiving care at an urban HIV center from 1991 to 2014. Results A total of 366 pregnant women were included, of which 11% developed PIH. Lower levels of 25-hydroxyvitamin D (25(OH)D) and bioactive 1,25-dihydroxyvitamin D (1,25(OH)2D) were associated with increased HIV disease activity. 25(OH)D levels were not significantly associated with the incidence of PIH. Higher 1,25(OH)2D levels were associated with reduced incidence of PIH in univariate (odds ratio, OR: 0.87 [95% confidence interval, CI: 0.79–0.95], p = 0.004) and multivariate (OR: 0.88 [95% CI: 0.80–0.97], p = 0.010) analyses. No association was found between 25(OH)D levels and other obstetric outcomes. Lower 1,25(OH)2D levels were associated with group B Streptococcus colonization (OR: 0.92 [95% CI: 0.86–0.99]) and low birth weight (LBW) (OR: 0.90 [95% CI: 0.83–0.98]) on multivariate analysis. Mean 1,25(OH)2D levels were significantly lower in women with preterm delivery and LBW infants. Conclusion Lower bioactive vitamin D levels are related to PIH in HIV-infected women. This association may be related to the coexistence of abnormal placental vitamin D metabolism and abnormal placental implantation.

Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications

“…Although correlation does not imply causation, our results, together with the well-known ability of placental calcitriol to reach the maternal circulation [ 10 , 11 , 12 ] and act as a negative endocrine regulator of RAS [ 48 ], strongly support a role of placental calcitriol in the control of maternal blood pressure. In agreement with our observations, low maternal calcitriol serum levels in a cohort of infected women have been associated with pregnancy-induced hypertension and group B Streptococcus colonization [ 49 ]. Moreover, calcitriol is known to exert a potent vasodilator effect due to the presence of the vitamin D receptor in blood vessels, playing an essential role in endothelial cell function and blood pressure control [ 50 , 51 ].…”

“…Various clinical and epidemiological studies have suggested a correlation between VD-deficiency and high blood pressure in different clinical and physiological settings [ 13 , 14 , 15 , 18 , 19 , 20 , 48 , 49 ]; however, this is the first study showing an inverse correlation between umbilical venous serum calcitriol and both SBP and DBP of pregnant subjects with UTI. Interestingly, significantly lower SBP and DBP have been reported among children and adolescents with higher cord-calcidiol levels at birth [ 21 , 57 ].…”

Low maternal vitamin D is associated with increased risk of congenital and peri/postnatal transmission of Cytomegalovirus in women with HIV

“…There is growing evidence suggesting the importance of vitamin D in placental-related functions including placental development and implantation, calcium transport, immunomodulatory functions, as well as an association between low calcitriol levels and pregnancy induced hypertension. [15,[30][31][32][33] During pregnancy, non-classical, extra-renal production of 1,25(OH)D 2 occurs in the placenta. In fact, healthy pregnancy is associated with a doubling or tripling of pre-pregnancy 1,25(OH)D 2 levels while 25(OH)D levels typically remain unchanged.…”

Vitamin D and Streptococci: The Interface of Nutrition, Host Immune Response, and Antimicrobial Activity in Response to Infection

“…It was shown that this effect of GBS colonization on cathelicidin mRNA levels was largely mediated by cubulin and CYP27B1 mRNA expression, further supporting the idea that vitamin D and its metabolites support antimicrobial peptide production. 66 In another study, vitamin D levels in cord blood at birth were used to investigate the link between vaginal carriage of GBS and maternal vitamin D levels. GBS vaginal carriage was significantly greater in women whose newborns showed deficient (<10 mg/mL) or insufficient (10− 30 mg/mL) vitamin D levels at birth compared to women whose newborns showed sufficient (>30 mg/mL) vitamin D levels at birth.…”

“…Vitamin D deficiency is associated with increased risk of infection and supplementation alters host–pathogen interactions. Micronutrient deficiencies, such as vitamin D inadequacy, has been associated with increased risk of infection, including those caused by Streptococcus . , Specifically, vitamin D deficiency has been correlated with increased risk of community acquired streptococcal pneumonia and tonsillopharyngitis. , Neutrophils upregulate CYP27B1 in the presence of IFN-y thus resulting in the upregulation of alpha-defensins (HNP1–3) that mediates the killing of pneumococci . A retrospective study of 54 patients with recurrent tonsillopharyngitis caused by GAS demonstrated that serum levels of vitamin D (25­(OH)­D) less than 20 ng/mL were associated with the disease .…”