Person:

Von Oettingen, Julia Elisabeth

Background

Low maternal 25(OH)D (vitamin D) values have been associated with higher mortality and impaired growth among HIV-exposed uninfected (HEU) infants of antiretroviral (ART)-naïve women. These associations have not been studied among HEU infants of women receiving ART.

Methods

We performed a nested case-control study in the Botswana Mma Bana Study, a study providing ART to women during pregnancy and breastfeeding. Median maternal vitamin D values, and the proportion with maternal vitamin D insufficiency, were compared between women whose HEU infants experienced morbidity/mortality during 24 months of follow-up and women with non-hospitalized HEU infants. Growth faltering was assessed for never hospitalized infants attending the 24-month-of-life visit. Multivariate logistic regression models determined associations between maternal vitamin D insufficiency and infant morbidity/mortality and growth faltering.

Results

Delivery plasma was available and vitamin D levels assayable from 119 (86%) of 139 cases and 233 (84%) of 278 controls, and did not differ significantly between cases and controls (median 36.7 ng/mL; IQR 29.1- 44.7 vs. 37.1 ng/mL; IQR 30.0 - 47.2; p = 0.32). Vitamin D insufficiency (< 32 ng/mL) was recorded among 112 (31.8%) of 352 women at delivery and occurred most frequently among women delivering in winter. Multivariate logistic regression models adjusted for maternal HIV disease progression did not show associations between maternal vitamin D insufficiency at delivery and child morbidity/mortality, or 24-month-of-life growth faltering.

Conclusions

Vitamin D insufficiency was common among ART treated pregnant women in Botswana, but was not associated with morbidity, mortality or growth impairment in their HIV-uninfected children.

Objectives: To assess whether routinely measuring pancreatic autoantibodies (PAA) in pediatric new onset diabetes (NODM) is necessary, and to evaluate serum bicarbonate (HCO3) as a substitute for venous pH (vpH) in the diagnosis of diabetic ketoacidosis (DKA). Methods: Retrospective analysis of all patients with NODM admitted to Boston Children's Hospital from 10/1/07-7/1/13. Logistic regression was used to develop a clinical score to classify diabetes type. Linear and logistic regression were used to assess serum HCO3 as a predictor of vpH and DKA, respectively. Results: Of 1089 patients (45.1% female, 76.7% white, age 10.6±4.5 years), < 6% had a change in diagnosis of diabetes type following PAA panel results. A scoring system using weight z-score, age and race had 91.7% sensitivity and 82% specificity to predict type 1 diabetes. In a subset of 690 patients (19.4% DKA), HCO3 predicted vpH using the formula vpH=6.81301+(0.17823*ln[HCO3]); R2 0.75 (p<0.001), DKA and severe DKA (c-statistic 0.97 [95% CI 0.96-0.99, p<0.001] and 0.99 [95% CI 0.991-0.999, p<0.001], respectively). Conclusions: A simple scoring system may reduce to ~15% the number of PAA measurements needed to classify diabetes type. Serum HCO3 concentration alone can substitute for vpH to diagnose DKA and classify severity in children with NODM.