Relationship of Early Vitamin D Concentrations and Gestational Diabetes Mellitus in Indian Pregnant Women.

Pratibha Dwarkanath,George Shirley,Ponnusamy Vinotha,Annamma Thomas,C N Sheela,Tinku Thomas,Saurabh Mehta,Siji Joseph,Anura V Kurpad

doi:10.3389/fnut.2019.00116

Abstract

Background: A high prevalence of vitamin D deficiency exists in pregnant Indian women (~90%). Increasing evidence suggests that vitamin D could play a pivotal role in maintaining normal glucose homeostasis. We aimed to determine the association between maternal vitamin D concentrations in early pregnancy and the risk of gestational diabetes mellitus (GDM).Methods: A prospective observational study was conducted on healthy pregnant women (n = 392) attending routine antenatal care at St. John's Medical College Hospital, Bangalore recruited at ~12 weeks of gestation. At baseline, details on socio-economic status, obstetric history, dietary intakes, and anthropometry were collected. Venous plasma total vitamin D concentration was assessed using tandem liquid chromatography mass spectrophotometry (LC-MS/MS). Oral glucose tolerance test (OGTT) at recruitment, followed by glucose tolerance test (GTT) at mid-pregnancy was conducted. GDM was diagnosed and confirmed using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) classification. Univariate and adjusted logistic regression models were used to evaluate the associations between total vitamin D concentrations at enrollment with GDM.Results: Of the cohort, 10.2% were diagnosed as GDM. Women with GDM were older (26 vs. 24 years) and heavier (51.6 vs. 51.2 kg) compared to the rest. A higher prevalence of GDM was observed among women with 1st trimester plasma total vitamin D in the lowest quartile (≤23.6 nmol/L) compared to the subjects in the other three quartiles (16.1 vs. 8.6%, p = 0.033). Adjusted multivariable regression analysis showed that women in the lowest quartile of plasma total vitamin D had twice the odds of GDM compared to women belonging to the remaining quartiles [OR = 2.32 (95%CI: 1.10, 4.91), p = 0.028].Conclusions: Low plasma total vitamin D concentrations in early pregnancy may be associated with a higher risk of GDM.

Highlights

Gestational Diabetes Mellitus (GDM) is considered as an early marker of glucose intolerance, associated with both insulin resistance and impaired insulin secretion [1] and an increased risk of maternal and fetal complications during pregnancy
Adjusted multivariable regression analysis showed that women in the lowest quartile of plasma total vitamin D had twice the odds of gestational diabetes mellitus (GDM) compared to women belonging to the remaining quartiles [OR = 2.32 (95%CI: 1.10, 4.91), p = 0.028]
Low plasma total vitamin D concentrations in early pregnancy may be associated with a higher risk of GDM

Summary

Introduction

Gestational Diabetes Mellitus (GDM) is considered as an early marker of glucose intolerance, associated with both insulin resistance and impaired insulin secretion [1] and an increased risk of maternal and fetal complications during pregnancy. Either observational, prospective or nested case-control designs, have shown associations between maternal serum vitamin D concentrations in the 1st or early 2nd trimester and the development of GDM after the 2nd trimester [8,9,10]. These findings were supported by a meta-analysis of observational studies that indicated a consistent association between vitamin D deficiency and an increased risk of maternal GDM [11]. We aimed to determine the association between maternal vitamin D concentrations in early pregnancy and the risk of gestational diabetes mellitus (GDM)

Objectives

Methods

Results

Conclusion