| Summary: | The risk for preeclampsia (PE) is enhanced ~4-fold by the presence of maternal type 1 diabetes (T1DM). Vitamin D is essential for healthy pregnancy. We assessed the total, bioavailable, and free concentrations of plasma 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)<sub>2</sub>D), and vitamin D binding protein (VDBP) at ~12, ~22, and ~32 weeks’ gestation (“Visits” (V) 1, 2, and 3, respectively) in 23 T1DM women who developed PE, 24 who remained normotensive, and 19 non-diabetic, normotensive women (reference controls). 25(OH)D deficiency was more frequent in diabetic than non-diabetic women (69% vs. 22%, <i>p</i> < 0.05), but no measure of 25(OH)D predicted PE. By contrast, higher 1,25(OH)<sub>2</sub>D concentrations at V2 (total, bioavailable, and free: <i>p</i> < 0.01) and V3 (bioavailable: <i>p</i> < 0.05; free: <i>p</i> < 0.01), lower concentrations of VDBP at V3 (<i>p</i> < 0.05), and elevated ratios of 1,25(OH)<sub>2</sub>D/VDBP (V2, V3: <i>p</i> < 0.01) and 1,25(OH)<sub>2</sub>D/25(OH)D (V3, <i>p</i> < 0.05) were all associated with PE, and significance persisted in multivariate analyses. In summary, in women with T1DM, concentrations of 1,25(OH)<sub>2</sub>D were higher, and VDBP lower, in the second and third trimesters in women who later developed PE than in those who did not. 1,25(OH)<sub>2</sub>D may serve as a new marker for PE risk and could be implicated in pathogenesis.
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