Christopher R Sudfeld1, Denise L Jacobson2, Noé M Rueda3, Daniela Neri4, Armando J Mendez5, Laurie Butler6, Suzanne Siminski6, Kristy M Hendricks7, Claude A Mellins8, Christopher P Duggan1,9,10, Tracie L Miller6. 1. Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA. 2. Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA. 3. Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. 4. Center for Epidemiological Research in Nutrition and Health, University of São Paulo, São Paulo, Brazil. 5. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism and the Diabetes Research Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, FL. 6. Frontier Science Technology Research Foundation INC, Amherst Office, NY. 7. Gessel School of Medicine at Dartmouth, Lebanon, NH. 8. HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York City, NY. 9. Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA. 10. Department of Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Vitamin D status in pregnancy may influence the risk of prematurity, birth size, and child postnatal growth, but few studies have examined the relationship among pregnant women living with HIV. METHODS: We conducted a prospective cohort study of 257 HIV-infected mothers and their HIV-exposed uninfected infants who were enrolled in the 2009-2011 nutrition substudy of the Surveillance Monitoring for ART Toxicities (SMARTT) study. HIV-infected pregnant women had serum 25-hydroxyvitamin D (25(OH)D) assessed in the third trimester of pregnancy, and their infants' growth and neurodevelopment were evaluated at birth and approximately 1 year of age. RESULTS: The mean third trimester serum 25(OH)D concentration was 35.4 ± 14.2 ng/mL with 15% of women classified as vitamin D deficient (<20 ng/mL) and 21% as insufficient (20-30 ng/mL). In multivariable models, third trimester vitamin D deficiency and insufficiency were associated with -273 g [95% confidence interval (CI): -450 to -97] and -203 g (95% CI: -370 to -35) lower birth weights compared with vitamin D sufficient women, respectively. Maternal vitamin D deficiency was also associated with shorter gestation (mean difference -0.65 weeks; 95% CI: -1.22 to -0.08) and lower infant length-for-age z-scores at 1 year of age (mean difference: -0.65; 95% CI: -1.18 to -0.13). We found no association of vitamin D status with infant neurodevelopment at 1 year of age. CONCLUSION: Third trimester maternal vitamin D deficiency was associated with lower birth weight, shorter length of gestation, and reduced infant linear growth. Studies and trials of vitamin D supplementation in pregnancy for women living with HIV are warranted.
BACKGROUND:Vitamin D status in pregnancy may influence the risk of prematurity, birth size, and child postnatal growth, but few studies have examined the relationship among pregnant women living with HIV. METHODS: We conducted a prospective cohort study of 257 HIV-infected mothers and their HIV-exposed uninfected infants who were enrolled in the 2009-2011 nutrition substudy of the Surveillance Monitoring for ART Toxicities (SMARTT) study. HIV-infected pregnant women had serum 25-hydroxyvitamin D (25(OH)D) assessed in the third trimester of pregnancy, and their infants' growth and neurodevelopment were evaluated at birth and approximately 1 year of age. RESULTS: The mean third trimester serum 25(OH)D concentration was 35.4 ± 14.2 ng/mL with 15% of women classified as vitamin D deficient (<20 ng/mL) and 21% as insufficient (20-30 ng/mL). In multivariable models, third trimester vitamin Ddeficiency and insufficiency were associated with -273 g [95% confidence interval (CI): -450 to -97] and -203 g (95% CI: -370 to -35) lower birth weights compared with vitamin D sufficient women, respectively. Maternal vitamin D deficiency was also associated with shorter gestation (mean difference -0.65 weeks; 95% CI: -1.22 to -0.08) and lower infant length-for-age z-scores at 1 year of age (mean difference: -0.65; 95% CI: -1.18 to -0.13). We found no association of vitamin D status with infant neurodevelopment at 1 year of age. CONCLUSION: Third trimester maternal vitamin D deficiency was associated with lower birth weight, shorter length of gestation, and reduced infant linear growth. Studies and trials of vitamin D supplementation in pregnancy for women living with HIV are warranted.
Authors: Jennifer Jao; Laura Freimanis; Marisa M Mussi-Pinhata; Rachel A Cohen; Jacqueline Pontes Monteiro; Maria Leticia Cruz; Andrea Branch; Rhoda S Sperling; George K Siberry Journal: Am J Perinatol Date: 2016-10-07 Impact factor: 1.862
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