Evaluation of vitamin D status, parathyroid hormone, and calcium among Iranian pregnant women with preeclampsia: A case-control study


Background: Preeclampsia is considered as a serious life-threatening condition that could affect both maternal and fetal outcome. Many studies have examined the association of nutritional factors with the incidence of preeclampsia. However, little is known about the possible role of vitamin D in the development of preeclampsia among the Iranian population.

Objective: The aim of the present study was to evaluate the association between vitamin D status and preeclampsia.

Materials and Methods: A total of 120 pregnant women who were referred to Kamali and Alborz General Hospital located in the Karaj City were enrolled in this study and categorized into preeclamptic and control groups (n = 60/each). The clinical details of patients such as demographic characteristics and laboratory findings were obtained from the patients. The serum levels of vitamin D, calcium, phosphorus, and parathormone were also measured. Multivariate logistic regression analysis was used to assess for independent predictors of preeclampsia.

Results: The mean age among pregnant women with preeclampsia and control group were 31.48 ± 5.25 and 29.01 ± 5.28, respectively. The mean body mass index among the preeclamptic group was 27.92 ± 4.98, which was significantly higher compared to the control group (p < 0.001). The serum vitamin D levels were significantly lower in women with preeclampsia compared to the control subjects (p = 0.007). Moreover, no correlation between vitamin D deficiency and predisposing factors of preeclampsia was observed after adjusting for confounding factors.

Conclusion: Our study revealed that serum vitamin D level is significantly lower in among the pregnant women diagnosed with preeclampsia compared to the healthy subjects. However, no correlation was observed between the vitamin D status and the risk of preeclampsia development.

Key words: Preeclampsia, Vitamin D, 25-Hydroxyvitamin D, Pregnancy.

[1] Duhig K, Vandermolen B, Shennan A. Recent advances in the diagnosis and management of pre-eclampsia. F1000Res 2018; 7: 242.

[2] Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag 2011; 7: 467–474.

[3] Srinivas SK, Morrison AC, Andrela CM, Elovitz MA. Allelic variations in angiogenic pathway genes are associated with preeclampsia. Am J Obstet Gynecol 2010; 202: 445. e1–11.

[4] Infante-Rivard C. Genetic association family-based studies and preeclampsia. Paediatr Perinat Epidemiol 2018; 32: 13–15.

[5] Sánchez-Aranguren LC, Prada CE, Riaño-Medina CE, Lopez M. Endothelial dysfunction and preeclampsia: role of oxidative stress. Front Physiol 2014; 5: 372.

[6] Brown CM, Turner ST, Bailey KR, Mosley TH Jr, Kardia SL, Wiste HJ, et al. Hypertension in pregnancy is associated with elevated C-reactive protein levels later in life. J Hypertens 2013; 31: 2213–2219.

[7] Sharma K, Singh R, Kumar M, Gupta U, Rohil V, Bhattacharjee J. First-trimester inflammatory markers for risk evaluation of pregnancy hypertension. J Obstet Gynaecol India 2018; 68: 27–32.

[8] Chirumbolo S, Bjorklund G, Sboarina A, Vella A. The role of vitamin d in the immune system as a pro-survival molecule. Clin Ther 2017; 39: 894–916.

[9] Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta 2010; 31: 1027–1034.

[10] Evans KN, Nguyen L, Chan J, Innes BA, Bulmer JN, Kilby MD, et al. Effects of 25-hydroxyvitamin D3 and 1,25- dihydroxyvitamin D3 on cytokine production by human decidual cells. Biol Reprod 2006; 75: 816–822.

[11] Hypponen E, Cavadino A, Williams D, Fraser A, Vereczkey A, Fraser WD, et al. Vitamin D and preeclampsia: original data, systematic review and metaanalysis. Ann Nutr Metab 2013; 63: 331–340.

[12] Ganguly A, Tamblyn JA, Finn-Sell S, Chan SY, Westwood M, Gupta J, et al. Vitamin D, the placenta and early pregnancy: effects on trophoblast function. J Endocrinol 2018; 236: R93–R103.

[13] Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002; 110: 229–238.

[14] Zhang W, Chen L, Zhang L, Xiao M, Ding J, Goltzman D, et al. Administration of exogenous 1,25(OH)2D3 normalizes overactivation of the central renin-angiotensin system in 1α(OH)ase knockout mice. Neurosci Lett 2015; 588: 184–189.

[15] ACOG Committee on Obstetric Practice. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. American college of obstetricians and gynecologists. Int J Gynaecol Obstet 2002; 77: 67–75.

[16] World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent 2014; 81: 14–18.

[17] Baca KM, Simhan HN, Platt RW, Bodnar LM. Low maternal 25-hydroxyvitamin D concentration increases the risk of severe and mild preeclampsia. Ann Epidemiol 2016; 26: 853–857.

[18] Achkar M, Dodds L, Giguere Y, Forest JC, Armson BA, Woolcott C, et al. Vitamin D status in early pregnancy and risk of preeclampsia. Am J Obstet Gynecol 2015; 212: 511. e1–7.

[19] Sadin B, Pourghassem Gargari B, Pourteymour Fard Tabrizi F. Vitamin D status in preeclamptic and nonpreeclamptic pregnant women: a case-control study in the north west of Iran. Health Promot Perspect 2015; 5: 183–190.

[20] Ma R, Gu Y, Zhao S, Sun J, Groome LJ, Wang Y. Expressions of vitamin D metabolic components VDBP, CYP2R1, CYP27B1, CYP24A1, and VDR in placentas from normal and preeclamptic pregnancies. Am J Physiol Endocrinol Metab 2012; 303: E928–935.

[21] Brodowski L, Burlakov J, Myerski AC, von Kaisenberg CS, Grundmann M, Hubel CA, et al. Vitamin D prevents endothelial progenitor cell dysfunction induced by sera from women with preeclampsia or conditioned media from hypoxic placenta. PLoS One 2014; 9: e98527.

[22] Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA, et al. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension 2010; 56: 758–763.

[23] Mrema D, Lie RT, Østbye T, Mahande MJ, Daltveit AK. The association between pre pregnancy body mass index and risk of preeclampsia: a registry based study from Tanzania. BMC Pregnancy Childbirth 2018; 18: 56–63.

[24] Young OM, Twedt R, Catov JM. Pre-pregnancy maternal obesity and the risk of preterm preeclampsia in the American primigravida. Obesity (Silver Spring) 2016; 24: 1226–1269.

[25] Tsai IH, Chen CP, Sun FJ, Wu CH, Yeh SL. Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women. Asia Pac J Clin Nutr 2012; 21: 82–87.

[26] Hemmingway A, O’Callaghan KM, Hennessy Á, Hull GLJ, Cashman KD, Kiely ME. Interactions between vitamin D status, calcium intake and parathyroid hormone concentrations in healthy white-skinned pregnant women at northern latitude. Nutrients 2018; 10: 916–925.

[27] Roberts JM, Balk JL, Bodnar LM, Belizán JM, Bergel E, Martinez A. Nutrient involvement in preeclampsia. J Nutr 2003; 133 (Suppl.): 1684S–1692S.

[28] Brantsaeter AL, Haugen M, Samuelsen SO, Torjusen H, Trogstad L, Alexander J, et al. A dietary pattern characterized by high intake of vegetables, fruits, and vegetable oils is associated with reduced risk of preeclampsia in nulliparous pregnant Norwegian women. J Nutr 2009; 139: 1162–1168.

[29] Kazemian E, Sotoudeh G, Dorosty-Motlagh AR, Eshraghian MR, Bagheri M. Maternal obesity and energy intake as risk factors of pregnancy-induced hypertension among Iranian women. J Health PopulNutr 2014; 32: 486–493.

[30] Clausen T, Slott M, Solvoll K, Drevon CA, Vollset SE, Henriksen T. High intake of energy, sucrose, and polyunsaturated fatty acids is associated with increased risk of preeclampsia. Am J Obstet Gynecol 2001; 185: 451–458.