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Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus

Med J Aust 2011; 194 (7): 334-337.

Summary

Objective: To test the hypothesis that lower 25-hydroxyvitamin D (25[OH]D) levels in late pregnancy are associated with poorer glucose control in gestational diabetes mellitus (GDM).

Design and setting: Retrospective cross-sectional study, in a GDM clinic at a tertiary referral centre.

Patients: Women attending the GDM clinic at Westmead Hospital from 1 February 2007 to 1 February 2008, excluding those with prepregnancy glucose intolerance.

Main outcome measures: Levels of glycated haemoglobin (HbA1c) and 25(OH)D measured during the third trimester; maternal age, ethnicity, body mass index (BMI) and occupational status; and results of oral glucose tolerance testing (OGTT).

Results: 147 women with a mean gestational age of 35 ± 2 weeks were included, of whom 41% had insufficient or deficient levels of 25(OH)D (≤ 50 nmol/L). Ethnicity, occupational status and season significantly influenced 25(OH)D levels (P < 0.01 for all) but BMI did not. 25(OH)D levels were inversely associated with fasting and 2-hour blood glucose levels during OGTT (Spearman r =  0.16; P = 0.05 for both) and with log[HbA1c] (Spearman r =  0.32; P < 0.001). BMI and insulin doses were also associated with HbA1c levels. Multivariable analysis identified 25(OH)D and blood glucose levels during the OGTT as independent predictors of HbA1c levels.

Conclusions: Lower 25(OH)D levels are independently associated with poorer glycaemic control. Future randomised trials are needed to determine whether vitamin D plays a role in glycaemic control in GDM. Regardless, maternal vitamin D insufficiency has adverse effects including neonatal hypocalcaemia and rickets. The 41% prevalence of inadequate 25(OH)D levels in the women in our study is unacceptably high. We propose routine 25(OH)D testing of all pregnant women at screening for GDM or earlier, and treatment of women who are found to be deficient.

  • Sue Lynn Lau1,2,3
  • Jenny E Gunton1,2,3,4
  • Neil P Athayde1,3,0
  • Karen Byth1
  • N Wah Cheung1,3

  • 1 Westmead Hospital, Sydney, NSW.
  • 2 Diabetes and Transcription Factors Laboratory, Garvan Institute of Medical Research, Sydney, NSW.
  • 3 Western Clinical School, University of Sydney, Sydney, NSW.
  • 4 St Vincent’s Clinical School, University of New South Wales, Sydney, NSW.

Correspondence: j.gunton@garvan.org.au

Acknowledgements: 

Sue Lynn Lau was supported by the Royal Australasian College of Physicians (RACP), the National Health and Medical Research Council (NHMRC) and a Diabetes Australia Research Trust grant. Jenny Gunton was supported by the NHMRC, the Juvenile Diabetes Research Foundation, the RACP and the Diabetes Australia Research Trust.

Competing interests:

None identified.

  • 1. Bodnar LM, Simhan HN, Powers RW, et al. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr 2007; 137: 447-452.
  • 2. Dawodu A, Wagner CL. Mother-child vitamin D deficiency: an international perspective. Arch Dis Child 2007; 92: 737-740.
  • 3. Munns C, Zacharin MR, Rodda CP, et al. Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement. Med J Aust 2006; 185: 268-272. <MJA full text>
  • 4. Robinson PD, Högler W, Craig ME, et al. The re-emerging burden of rickets: a decade of experience from Sydney. Arch Dis Child 2006; 91: 564-568.
  • 5. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008; 87: 1080S-1086S.
  • 6. Norman AW, Frankel BJ, Helt AM, Grodsky GM. Vitamin D deficiency inhibits pancreatic secretion of insulin. Science 1980; 209: 823-825.
  • 7. Gedik O, Akalin S. Effects of vitamin D deficiency and repletion on insulin and glucagon secretion in man. Diabetologia 1986; 29: 142-145.
  • 8. Orwoll E, Riddle M, Prince M. Effects of vitamin D on insulin and glucagon secretion in non insulin dependent diabetes mellitus. Am J Clin Nutr 1994; 59: 1083-1087.
  • 9. Boucher BJ, Mannan N, Noonan K, et al. Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in east London Asians. Diabetologia 1995; 38: 1239-1245.
  • 10. Kadowaki S, Norman AW. Dietary vitamin D is essential for normal insulin secretion from the perfused rat pancreas. J Clin Invest 1984; 73: 759-766.
  • 11. Van Assche FA, Holemans K, Aerts L. Long-term consequences for offspring of diabetes during pregnancy. Br Med Bull 2001; 60: 173-182.
  • 12. Palomer X, Gonzalez-Clemente JM, Blanco-Vaca F, Mauricio D. Role of vitamin D in the pathogenesis of type 2 diabetes mellitus. Diabetes Obes Metab 2008; 10: 185.
  • 13. Clifton-Bligh RJ, McElduff P, McElduff A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med 2008; 25: 678-684.
  • 14. Farrant HJW, 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 Clin Nutr 2008; 63: 646-652.
  • 15. Maghbooli Z, Hossein-Nezhad A, Karimi F, et al. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24: 27-32.
  • 16. Rudnicki PM, Molsted-Pedersen L. Effect of 1,25-dihydroxycholecalciferol on glucose metabolism in gestational diabetes mellitus. Diabetologia 1997; 40: 40-44.
  • 17. Zhang C, Qui C, Hu FB, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One 2008; 3: e3753.
  • 18. Hoffman L, Nolan C, Wilson JD, et al. Gestational diabetes mellitus — management guidelines. Med J Aust 1998; 169: 93-97. <MJA full text>
  • 19. Holick MF, Siris ES, Binkley N, et al. Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005; 90: 3215-3224.
  • 20. Wharton B, Bishop N. Rickets. Lancet 2003; 362: 1389-1400.
  • 21. Nozza JM, Rodda CP. Vitamin D deficiency in mothers of infants with rickets. Med J Aust 2001; 175: 253-255. <MJA full text>
  • 22. Ramos-Lopez E, Jansen T, Ivaskevicius V, et al. Protection from type 1 diabetes by vitamin D receptor haplotypes. Ann N Y Acad Sci 2006; 1079: 327-334.
  • 23. The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991-2002.
  • 24. Cheung NW, Byth K. The population health significance of gestational diabetes. Diabetes Care 2003; 26: 2005-2009.

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