We thank the authors for bringing up this important association and for presenting relevant studies. Our review1 does not suggest that the association between preeclampsia and future cardiovascular risk is a result of shared risk factors alone. Indeed, we discuss the evidence that preeclamptic pregnancies can result in vascular changes that could modify a woman's risk for future cardiovascular disease (CVD).
Certainly, hypovitaminosis D may be associated both with preeclampsia and subsequent risk for CVD. However, we agree with a recent meta-analysis concluding that the role of vitamin D supplementation in pregnancy, as a part of routine antenatal care, is yet to be determined as “the number of high quality trials and outcomes reported is too limited to draw conclusions on its usefulness and safety.”2 Similarly, further trials are required to evaluate whether hypovitaminosis D may be one of the mechanisms underlying the association between preeclampsia and future CVD. This underscores the need for prospective, randomized, and likely multicenter trials that will be adequately powered to study the benefits of vitamin D supplementation during pregnancy, with respect to both immediate and long-term outcomes. Until then, the decision to pursue with intervention should remain a matter of carefully weighing the benefits of vitamin D supplementation for each individual pregnant woman.3