Vitamin D Deficiency and Gestational Diabetes Mellitus in Egyptian Women

Abstract

Background: Although recent meta-analyses indicates a consistent significant inverse relation of serum 25 (OH) D and the prevalence of gestational diabetes mellitus (GDM), the mechanism is unclear and conflicting opinions continue to be reported. Objectives: The objectives are: 1) comparison of vitamin D status in diabetic and non-diabetic pregnant women; 2) trying to determine the level of vitamin D associated with GDM, and its sensitivity and specificity; 3) determination of the relation of hypovitaminosis D with insulin resistance. Subjects and Methods: One hundred consecutive pregnant women (<28 weeks gestational period) from the attendants of the out-patient clinic at our hospital were diagnosed for GDM by glucose tolerance test (GTT) (75 g 2 h). Among them, 40 patients met the inclusion criteria for this study (group I). As a comparative group, another 40 pregnant ladies were included, 20 of them (group II) had pre-gestational type II DM, and the other 20 (group III) had normal glucose tolerance (NGT) as a control. For all the participants, we estimated fasting blood glucose, fasting serum insulin, homeostasis model assessment of (HOMA-IR and HOMA-B), quantitative insulin sensitivity check index (QUICKI), and serum 25-OH vit D. The ROC curve analysis was used to determine the optimal threshold value of vit D in relation to DM. Results: Compared to the control group, the diabetic patients showed a statistically significant increase in the levels of fasting glucose, 1-hour postprandial glucose, 2-hour post prandial glucose, fasting insulin, and HOMA-IR, (P=0.000 for all). None of the diabetic patients showed optimal vit D level. Vit D insuficiency (10 -29 ng/ml) was found in 32.5% of patients in group I, 55% in group II, and 50% in group III. Vit D deficiency (<10 ng/ml) was found in 67.5% of patients in group I, 45% in group II, and 0% in group III. Significant negative correlation was found for vit D with fasting insulin and FBS. The AUC for 25 OH vit D was 97%, CI was 95% and p-value was 0.0001. The sensitivity, specificity, and positive and negative predictive values of 25 OH vit D in GDM versus control persons were 97%, 90%, 95.1%, 94.7% respectively at a cut-off level <22 ng/ml. Conclusions: Although it might seem premature to draw a sharp relation between hypovi- taminosis D and GDM, this study showed the importance of vit D in GDM, the need for supplementation below 22 ng/ml, and the role of hypovitaminosis D in increasing insulin resistance. Further randomized studies with vit D supplementation are recommended.

Association of gestational diabetes mellitus with vitamin D status among women attending at Bangabandhu Sheikh Mujib Medical University

“…11 In another Egyptian study, a significant correlation was notice regarding the family history of DM where both the pregestational and gestational diabetic group compared with the control group. 12 In this study, the majority of respondent's vitamin D levels were deficient (≤ 20ng/ml) in both the case (70%) and control (52.5%) groups, whereas only 5.0% of the cases and 27.5% of the controls had vitamin D level ≥30ng/ml. Insufficient level (21-29ng/ml) was observed in 25.0% of cases compared to 20.0% controls.…”

Maternal Vitamin D Deficiency and Risk of Development of Gestational Diabetes Mellitus: A Scoping Review

“…Out of 8 case control studies, only 4 studies had found that maternal 25(OH)D deficiency is associated with incidence of developing GDM [49] [50] [51] [52]. A study conducted in Turkey reported that vitamin D deficiency in the second trimester was inversely correlated with fasting and 1-h plasma glucose after 75 g glucose challenge test, and low 25OHD3 levels were associated with insulin resistance [49].…”

Maternal Vitamin D Status in Gestational Diabetes Mellitus Women

“…The pancreas needs to secrete more insulin to control this resistance; where 1.5-2.5 times more insulin is produced than in a normal pregnancy [20]. The association between low vitamin D levels and insulin resistance was demonstrated in different studies [15,21,22].…”