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

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 238-262-Vitamin D Action, Deficiency & Disorders
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-246
M Iftekhar Ullah1, Christian A Koch*2, Sadeka Tamanna3, Salma Rouf4 and Latifa Shamsuddin5
1University of Mississippi Medical Center, Jackson, MS, 2Univ of Mississippi Med Ctr, Jackson, MS, 3G.V. (Sonny) Montgomery VA Medical Center Home, Jackson, MS, 4Dhaka Medical College Hospital, Bangladesh, 5Enam Medical College, Bangladesh
Background: Vitamin D deficiency has been associated with various chronic diseases including hypertension, diabetes, cardiovascular disease, malignancies and immunologic disorders.1 Although this condition is also common during pregnancy and has been found to be a risk factor for preeclamsia, no significant studies have been conducted yet to assess its association with eclampsia.2-5Our goal in this study was to assess the prevalence of vitamin D deficiency and its association with both preeclampsia and eclampsia in Bangladesh.

Materials and methods: Using a case-control design, we measured serum 25(OH)D levels on pregnant women receiving care after 20 weeks of gestation at Dhaka Medical College Hospital in Bangladesh with preeclampsia (n=33), eclampsia (n=79) and normal pregnancy (controls, n=76). The patients with prior medical history of renal insufficiency, seizure disorder or essential hypertension were excluded from the study. Information about maternal age, BMI, maternal education, smoking status during pregnancy and the use of multivitamin in the last trimester of pregnancy was obtained. Odds of developing preeclampsia and eclampsia with vitamin D deficiency were calculated using logistic regression analysis.

Results:The prevalence of vitamin D insufficiency was very high in our study subjects with more than three quarters (78%) of all pregnant women 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 preeclamptic 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). When vitamin D was analyzed as a continuous variable, we estimated that with every 10 ng/ml decrease in serum 25(OH)D level, the adjusted risks of developing preeclampsia and eclampsia increased by 1.66 (95% CI=1.05-3.02) and  2.42 times  (95% CI=1.54-3.82), respectively.

Conclusions: The odds of developing preeclampsia and eclampsia are increased by up to 3-5 folds with vitamin D insufficiency. Since preeclampsia and eclampsia can lead to serious complications for both mother and the offspring, vitamin D may be safely supplemented during pregnancy in high risk populations to decrease these adverse consequences.

1. 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;2010:579640. 2.  Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal Vitamin D Deficiency Increases the Risk of Preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-3522. 3.  Wei SQ, Audibert F, Hidiroglou N, et al. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG: An International Journal of Obstetrics & Gynaecology. 2012;119(7):832-839. 4.  Wei SQ, Qi HP, Luo ZC, Fraser WD. Maternal Vitamin D Status and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis. J Matern Fetal Neonatal Med. 2013;Epub ahead of print. 5.  Christesen HT, Falkenberg T, Lamont RF, Jorgensen JS. The impact of vitamin D on pregnancy: a systematic review. Acta Obstet Gynecol Scand. 2012;91(12):1357-1367.

Nothing to Disclose: MIU, CAK, ST, SR, LS

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