Preeclampsia and Blood Pressure Trajectory during Pregnancy in Relation to Vitamin D Status

Abstract

Every tenth pregnancy is affected by hypertension, one of the most common complications and leading causes of maternal death worldwide. Hypertensive disorders in pregnancy include pregnancy-induced hypertension and preeclampsia. The pathophysiology of the development of hypertension in pregnancy is unknown, but studies suggest an association with vitamin D status, measured as 25-hydroxyvitamin D (25(OH)D). The aim of this study was to investigate the association between gestational 25(OH)D concentration and preeclampsia, pregnancy-induced hypertension and blood pressure trajectory. This cohort study included 2000 women. Blood was collected at the first (T1) and third (T3) trimester (mean gestational weeks 10.8 and 33.4). Blood pressure at gestational weeks 10, 25, 32 and 37 as well as symptoms of preeclampsia and pregnancy-induced hypertension were retrieved from medical records. Serum 25(OH)D concentrations (LC-MS/MS) in T1 was not significantly associated with preeclampsia. However, both 25(OH)D in T3 and change in 25(OH)D from T1 to T3 were significantly and negatively associated with preeclampsia. Women with a change in 25(OH)D concentration of ≥30 nmol/L had an odds ratio of 0.22 (p = 0.002) for preeclampsia. T1 25(OH)D was positively related to T1 systolic (β = 0.03, p = 0.022) and T1 diastolic blood pressure (β = 0.02, p = 0.016), and to systolic (β = 0.02, p = 0.02) blood pressure trajectory during pregnancy, in adjusted analyses. There was no association between 25(OH)D and pregnancy-induced hypertension in adjusted analysis. In conclusion, an increase in 25(OH)D concentration during pregnancy of at least 30 nmol/L, regardless of vitamin D status in T1, was associated with a lower odds ratio for preeclampsia. Vitamin D status was significantly and positively associated with T1 blood pressure and gestational systolic blood pressure trajectory but not with pregnancy-induced hypertension.

Serum 25(OH) Vitamin D Levels in Polish Women during Pregnancies Complicated by Hypertensive Disorders and Gestational Diabetes

“…Our study showed that pregnant women with GH and healthy controls did not differ significantly in terms of their 25(OH)D concentrations (18.20 ng/mL vs. 22.10 ng/mL, p = 0.1481), and serum 25(OH)D has not been identified as a significant predictor of GH on either logistic regression analysis or ROC analysis. These observations are consistent with the results published by Bärebring et al [13] who demonstrated that vitamin D status correlates significantly with blood pressure during the first trimester and gestational systolic blood pressure trajectory, but not with the prevalence of GH. The relationship between vitamin D status and GH has also been a subject of other studies.…”

“…Our results presented here, obtained in a cohort of pregnant Polish women, are consistent with previously reported findings [32]. According to Barebring et al, at least a 30 nmol/L increase in serum 25(OH)D concentration is associated with lower odds of PE, regardless of vitamin D status in early pregnancy [13]. Similar to our study, these authors found an inverse association between the occurrence of PE and serum concentration of 25(OH)D during the third trimester.…”

“…Every tenth pregnant woman is diagnosed with gestational hypertension (GH), one of the most common complications and a leading cause of maternal mortality worldwide [12,13]. GH is the second most common cause of perinatal mortality due to hemorrhage in pregnant Polish women [14].…”

Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort

“…In Sweden, approximately 3% of pregnancies are complicated by preeclampsia [6] and just below 5% of singletons are born prematurely [7]. We have previously shown that 25-hydroxyvitamin D (25(OH)D) concentrations in the third trimester and changes in 25(OH)D during pregnancy are associated with lower odds of preeclampsia [8]. …”

An exploration of the association between vitamin D intake in early pregnancy and fetal and maternal clinical outcomes

“…During pregnancy, vitamin D influences calcium and phosphorous homeostasis (6) to enable fetal bone mineral accretion. More recent evidence however, suggests that maternal serum 25(OH)D levels may also influence extra-skeletal maternal and fetal health outcomes; including birthweight and the risk of pre-eclampsia (PET), gestational diabetes mellitus (GDM), pre-term birth and small for gestational age (SGA) (6,7) .This observational study examined maternal vitamin D intakes in the first trimester. Women were recruited at their convenience after sonographic confirmation of a singleton pregnancy in the first trimester.…”