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Category: Volume 06 Issue 01 January 2018
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Title: Hypovitaminosis D in Gestational Diabetes Mellitus: The Impact of Vitamin D Status on Insulin Resistance, Parathyroid Hormone, and Perinatal Outcome

Authors: Mohamed A Youssry MD, Ahmed M Radwan MD, Hossam M El-Saadany MD, Mohamed A Gabreel MD, Huda S Al-Jedaani, Tabarak A Patel MD

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i1.112

Abstract

Objective: to evaluate serum 25-hydroxyvitamin D (25OHD) level in pregnant women who developed gestational diabetes mellitus(GDM)in comparison to healthy pregnant women, and to investigate the relationship between maternal hypovitaminosis D and insulin resistance, parathyroid hormone, and perinatal outcome.

Methods: One hundred and sixty pregnant women between 24-28 weeks gestation were recruited. Group (A) 80 pregnant women with established diagnosis of GDM, and Group (B) 80 healthy pregnant women as control.GDM was diagnosed by 75 gm oral glucose tolerance test, and insulin resistance was measured by homeostasis model assessment of IR (HOMA-IR).25-hydroxyvitamin D, and parathyroid hormone (PTH) were measured in all participants.

Results: 116 (72.5%) of participants had 25OHD deficiency. The mean serum 25OHD level was significantly lower in GDM group compared to control (29.7±14.6 vs. 48.4±22.5 respectively).Serum 25OHD levels showed significant negative correlation with BMI, blood glucose, HOMA-IR and PTH.

Conclusions: Vitamin D deficiency is a prevalent problem among the pregnant women and can be considered as potential risk factor for development of GDM with subsequent deleterious effects on maternal and neonatal outcome.

Keywords: Hypovitaminosis D, Gestational diabetes mellitus, Insulin resistance, Parathyroid hormone.

References

  1. Standards of Medical Care in Diabetes. Diabetes Care2014; 37: 14-80.
  2. Danam P. Gestational Diabetes mellitus and subsequent development of overt Diabetes mellitus. Dan Med Bull1998; 45:495-509.
  3. RossAC, Taylor CL, Yaktine AL, et al. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Washington (DC): National Academies Press (US)  
  4. Kumar S, Davies M, Zakaria Y, et al. Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D. Postgrad Med J1994; 70:440–443.
  5. Palomer X, Gonzalez-Clemente JM, Blanco-Vaca F, et al. Role of vitamin D in the pathogenesis of type 2 diabetes mellitus. Diabetes ObesMetab 2008; 10:185-197.
  6. Christakos S, Hewison M, Gardner DG, et al. Vitamin D: beyond bone. Annals of the New York Academy of Sciences 2013; 1287:45-58.
  7. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.Diabetes Care2010; 33:676-682.
  8. Ascaso JF, Romero P, Real JT, et al. Insulin resistance quantification by fasting insulin plasma values and HOMA index in a non-diabetic population. Med Clin (Barc) 2001; 117: 530-533.
  9. Stroud ML, Stilgoe S, Stott VE, et al.Aust Fam Physician2008; 37:1002-1005. 
  10. Al Kalbani M, Elshafie O, Rawahi M, et al. Vitamin D status in pregnant Omanis: A disturbingly high proportion of patients with low vitamin D stores. SQU Med J 2011; 11:52-55.
  11. Al-Shaikh GK, Ibrahim GH, Fayed AA, et al. Impact of vitamin D deficiency on maternal and birth outcomes in the Saudi population: a cross-sectional study. BMC Pregnancy Childbirth2016, 16:119.
  12. Karras S, Paschou SA, Kandaraki E, et al. Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review. Eur J ClinNutr 2016;70:979-986.
  13. Vinkhuyzen AA, Eyles DW, Burne TH, et al. Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: The Generation R Study.J Steroid Biochem Mol Biol 2016; 164:161-167.
  14. Poel YH, Hummel P, Lips P, et al. Vitamin d and gestational diabetes: A systematic review and meta-analysis. Eur J Intern Med 2012; 23:465–469.
  15. Soheilykhah S, Mojibian M, Rashidi M, et al. Maternal vitamin D status in gestational diabetes mellitus. Nutr Clin Pract 2010; 25:524-527.
  16. Farrant HJ, Krishnaveni GV, Hill JC, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J ClinNutr 2009; 63:646-652.
  17. Makgoba M, Nelson SM, Savvidou M, et al. First-trimester circulating 25-hydroxy vitamin D levels and development of gestational diabetes mellitus. Diabetes Care2011; 34: 1091-1093.
  18. Mutlu N, Esra H, Begum A, et al. Relation of maternal vitamin D status with gestational diabetes mellitus and perinatal outcome. Afr Health Sci 2015; 15:523-531.
  19. Lacroix M, Battista MC, Doyon M, et al. Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus. Acta Diabetol2014; 51:609-616.
  20. Daniel M. and Keller D. Low First-Trimester Vitamin D Predicts Gestational Diabetes.2012
  21. Ford E S, Ajani U A, McGuire L C, et al. Concentrations of Serum Vitamin D and the Metabolic Syndrome among US Adults. Diabetes Care2006; 28: 1228-1230.
  22. Vilarrasa N , Vendrell  J , Maravall  J , et al. Is Plasma 25(OH) D Related to Adipokines, Inflammatory Cytokines and Insulin Resistance in Both a Healthy and Morbidly Obese Population? Endocrine 2010; 38: 235-242.
  23. GrimnesG, Emaus N, Joakimsen RM, eta. Baseline serum 25-hydroxyvitamin D concentrations in the Tromsø Study 1994-95 and risk of developing type 2 diabetes mellitus during 11 years of follow-up. Diabet Med. 2010;27:1107–11
  24. McCarty MF, Thomas CA. PTH excess may promote weight gain by impeding catecholamine-induced lipolysis-implica-tions for the impact of calcium, vitamin D, and alcohol on body weight. Med Hypotheses2003; 61:535-542.
  25. Reichetzeder C, Chen H, Föller M, et al. Maternal vitamin D deficiency and fetal programming--lessons learned from humans and mice. Kidney Blood Press Res2014; 39:315-329.

Corresponding Author

Mohamed A Youssry MD   

Assistant Professor of Obstetrics and Gynecology, Faculty of Medicine,

Alexandria University, Alexandria, Egypt

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