Vitamin D Levels are found to be higher in Gestational Diabetics in Vitamin D Depleted Population
Abstract
Objective:b> Vitamin D levels are studied in Gestational Diabetes in many researches. Our aim is to investigate the relationship of vitamin D deficiency with gestational diabetes mellitus (GDM) in pregnancy.
Methods:b> In this study, 210 Pregnant women were included, of them 108 had GDM, 102 were controls. 25-hydroxyvitamin D (25(OH)D) levels of GDM group were compared with healthy pregnant controls. The maternal and fetal outcomes were recorded.
Results: GDM group had significantly higher mean 25(OH)D (11.8±8.0 ng/ml) compared to controls (7.7±6.1 ng/ml, p<0.01). There was no correlation of vitamin D levels with; maternal age, Apgar levels, birth week and fetal weight. Furthermore, there was no correlation of 25(OH)D levels with mode of delivery, intensive care need of new-born and macrosomia.
Conclusions: Although there are numerous reports about positive correlation between vitamin D deficiency and GDM in pregnancy, we found the opposite. In severe vitamin D deficiency, the mechanisms may differ and should be identified further.
Keywords: Gestational Diabetes; 25OHD; Fetal; Maternal outcomes
Introduction
Deficiency of 25-hydroxyvitamin D [25(OH)D] levels are found to be correlated with many adverse pregnancy outcomes like preeclampsia, stillbirth, intrauterine growth retardation, gestational diabetes (GDM), preterm birth [1,2]. The major source of vitamin D in humans is ultraviolet B induced dermal synthesis of cholecalciferol, whereas food sources are believed to play a lesser role [3]. Factors like skin pigmentation, age, attire, environment and sun exposure affect this cycle. GDM is characterized by increased resistance to and impaired secretion of insulin, may affect up to 18% of pregnant women and results in higher risk of adverse pregnancy outcomes [4].
There isn’t still full agreement on the association between GDM and vitamin D deficiency up till now [1,2,5]. Some studies report positive, some report negative or none association. Our aim is to investigate the correlation vitamin D deficiency with GDM in our vitamin D depleted population.
Methods
In this prospective cohort study, fasting serum levels of 25(OH) D were measured in pregnant women grouped according to Oral Glucose Tolerance Test (OGTT) at 24 weeks. 108 GDM patients and 102 normal healthy pregnant women were compared according to their fasting serum levels of 25(OH)D in second trimester after GDM screening (24-28 weeks of gestation). Vitamin D was measured by chemiluminescence assay and deficiency was defined as < 20 ng/ mL. Participants were followed until puerperium. GDM screening is performed to the pregnant attending to our hospital.
For GDM, screening is done by one step 75 g OGTT. Diagnosis of GDM is confirmed if one of the glucose levels exceeds the IADPSG criteria (International Association of Diabetes Pregnancy Study Group): fasting ≥ 92 mg/dl, 1-hour ≥ 180 mg/dl, 2-hour ≥ 153mg/dl [4]. After reviewing the results of the HAPO Study, many international diabetes study groups, including the IADPSG and American Diabetes Association, have adopted the 75-g OGTT at 24–28 weeks as a screening and diagnostic test.
Body Mass Indexes (BMI) were calculated by weight/height2 and compared. After delivery, Maternal and infant medical outcomes were recorded. Gestational diabetes group (study group) compared with healthy pregnant regarding 25(OH)D levels at the same season (spring). Maternal and fetal outcomes were recorded in our hospital. The study was approved by Hospital’s Ethics Committee.
Statistical analyses were performed using SPSS, version 16.0 (SPSS Inc, Chicago, Ill, USA). Student t test is used for parametric variables; χ2 square test is used for nonparametric variables. Pearson correlation analysis is used for normally distributed data. Relation of continuous variables with dichotom outcomes were analysed by Logistic regression analysis. A p value <0.05 was considered statistically significant.
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