Division of Nephrology, Massachusetts General Hospital and Harvard Medical School, Boston, Mass 02114, USA.
Hypertension. 2010 Oct;56(4):758-63. doi: 10.1161/HYPERTENSIONAHA.110.158238. Epub 2010 Aug 23.
Previous studies report an association between vitamin D deficiency and hypertension, including the pregnancy-specific disorder preeclampsia. Circulating vitamin D is almost entirely bound to vitamin D binding protein, which increases 2-fold during pregnancy and previous studies have not examined vitamin D binding protein or free vitamin D levels. We performed a nested case-control study within the Massachusetts General Hospital Obstetric Maternal Study, measuring first trimester total 25-hydroxyvitamin D (25[OH]D) and vitamin D binding protein and calculating free 25(OH)D levels. We compared these levels from pregnancies complicated by subsequent preeclampsia (cases, n=39) with those from normotensive pregnancies (controls, n=131). First trimester total 25(OH)D levels were similar in cases and controls (27.4±1.9 versus 28.8±0.80 ng/mL; P=0.435). Despite an association between higher first trimester blood pressures and subsequent preeclampsia, first trimester total 25(OH)D was not associated with first trimester systolic (r=0.11; P=0.16) or diastolic blood pressures (r=0.03; P=0.72). Although there was a trend toward increased risk of preeclampsia with 25(OH)D levels <15 ng/mL (odds ratio: 2.5 [95% CI: 0.89 to 6.90]), this was attenuated after adjustment for body mass index and other covariates (odds ratio: 1.35 [95% CI: 0.40 to 4.50]). First trimester vitamin D binding protein and free 25(OH)D levels were similar in cases and controls and were not associated with first trimester blood pressures. These data suggest that first trimester total and free 25(OH)D levels are not independently associated with first trimester blood pressure or subsequent preeclampsia.
先前的研究报告表明，维生素 D 缺乏与高血压之间存在关联，包括妊娠特有的子痫前期。循环中的维生素 D 几乎完全与维生素 D 结合蛋白结合，而这种结合蛋白在妊娠期间会增加 2 倍，先前的研究并未检测维生素 D 结合蛋白或游离维生素 D 水平。我们在马萨诸塞州总医院产科母婴研究中进行了一项嵌套病例对照研究，测量了妊娠早期的总 25-羟维生素 D（25[OH]D）和维生素 D 结合蛋白，并计算了游离 25(OH)D 水平。我们将这些水平与随后发生子痫前期的妊娠（病例，n=39）与血压正常的妊娠（对照组，n=131）进行了比较。病例组和对照组的妊娠早期总 25(OH)D 水平相似（27.4±1.9 与 28.8±0.80ng/mL；P=0.435）。尽管血压较高与随后发生子痫前期之间存在关联，但妊娠早期总 25(OH)D 与妊娠早期收缩压（r=0.11；P=0.16）或舒张压（r=0.03；P=0.72）均无相关性。尽管 25(OH)D 水平<15ng/mL 时子痫前期的风险呈增加趋势（比值比：2.5[95%CI：0.89 至 6.90]），但在调整体重指数和其他协变量后，这种趋势减弱（比值比：1.35[95%CI：0.40 至 4.50]）。病例组和对照组的妊娠早期维生素 D 结合蛋白和游离 25(OH)D 水平相似，且与妊娠早期血压无关。这些数据表明，妊娠早期的总 25(OH)D 和游离 25(OH)D 水平与妊娠早期血压或随后发生的子痫前期均无独立相关性。
