Vitamin D status and association with gestational diabetes mellitus in a pregnant cohort in Iceland
Abstract
Background: Vitamin D deficiency has been associated with an increased risk of gestational diabetes mellitus (GDM), one of the most common pregnancy complications. The vitamin D status has never previously been studied in pregnant women in Iceland.
Objective: The aim of this research study was to evaluate the vitamin D status of an Icelandic cohort of pregnant women and the association between the vitamin D status and the GDM incidence.
Design: Subjects included pregnant women (n = 938) who attended their first ultrasound appointment, during gestational weeks 11–14, between October 2017 and March 2018. The use of supplements containing vitamin D over the previous 3 months, height, pre-pregnancy weight, and social status were assessed using a questionnaire, and blood samples were drawn for analyzing the serum 25‑hydroxyvitamin D (25OHD) concentration. Information regarding the incidence of GDM later in pregnancy was collected from medical records.
Results: The mean ± standard deviation of the serum 25OHD (S-25OHD) concentration in this cohort was 63±24 nmol/L. The proportion of women with an S-25OHD concentration of ≥ 50 nmol/L (which is considered adequate) was 70%, whereas 25% had concentrations between 30 and 49.9 nmol/L (insufficient) and 5% had concentrations < 30 nmol/L (deficient). The majority of women (n = 766, 82%) used supplements containing vitamin D on a daily basis. A gradual decrease in the proportion of women diagnosed with GDM was reported with increasing S-25OHD concentrations, going from 17.8% in the group with S-25OHD concentrations < 30 nmol/L to 12.8% in the group with S-25OHD concentrations ≥75 nmol/L; however, the association was not significant (P for trend = 0.11).
Conclusion: Approximately one-third of this cohort had S-25OHD concentrations below adequate levels (< 50 nmol/L) during the first trimester of pregnancy, which may suggest that necessary action must be taken to increase their vitamin D levels. No clear association was observed between the vitamin D status and GDM in this study.
Downloads
References
- Guideline: Vitamin D supplementation in pregnant women [Internet]. World Health Organization; 2012 [cited 18 March 2020]. Available from: https://apps.who.int/iris/bitstream/handle/10665/85313/9789241504935_eng.pdf
- Nordic Council of Ministers. Nordic nutrition recommendations 2012. Integrating nutrition and physical activity. 5th ed. Copenhagen: Narayana Press; 2014.
- Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 2005; 294(18): 2336–41. doi: 10.1001/jama.294.18.2336
- The Directorate of Health. Dietary guidelines, for adults and children from two years of age [Internet]. Reykjavik: The Directorate of Health; 2017 [cited 2 April 2020]. Available from: https://www.landlaeknir.is/servlet/file/store93/item25796/R%C3%A1%C3%B0leggingar%20um%20matar%C3%A6%C3%B0i%20LR_20.01.2015.pdf
- Institute of Medicine. Dietary reference intakes for calcium and vitamin D [Internet]. Washington, DC: The National Academies Press (US); 2011 [cited 20 April 2020]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK56070/
- Shahgheibi S, Farhadifar F, Pouya B. The effect of vitamin D supplementation on gestational diabetes in high-risk women: results from a randomized placebo-controlled trial. J Res Med Sci 2016; 21: 2. doi: 10.4103/1735-1995.175148
- Ojo O, Weldon SM, Thompson T, Vargo EJ. The effect of vitamin D supplementation on glycaemic control in women with gestational diabetes mellitus: a systematic review and meta-analysis of randomised controlled trials. Int J Environ Res Public Health 2019; 16(10): 1716. doi: 10.3390/ijerph16101716
- Jain M, Kapry S, Jain S, Singh SK, Singh TB. Maternal vitamin D deficiency: a risk factor for gestational diabetes mellitus in North India. Gynecol Obstet 2015; 5(1): 264. doi: 10.4172/2161-0932.1000264
- Grammatiki M, Rapti E, Karras S, Ajjan RA, Kotsa K. Vitamin D and diabetes mellitus: causal or casual association? Rev Endocr Metab Disord 2017; 18(2): 227–41. doi: 10.1007/s11154-016-9403-y
- Maghbooli Z, Hossein-Nezhad A, Karimi F, Shafaei AR, Larijani B. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24(1): 27–32. doi: 10.1002/dmrr.737
- Amraei M, Mohamadpour S, Sayehmiri K, Mousavi SF, Shirzadpour E, Moayeri A. Effects of vitamin D deficiency on incidence risk of gestational diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2018; 9: 7. doi: 10.3389/fendo.2018.00007
- Hu L, Zhang Y, Wang X, You L, Xu P, Cui X, et al. Maternal vitamin D status and risk of gestational diabetes: a meta-analysis. Cell Physiol Biochem 2018; 45(1): 291–300. doi: 10.1159/000486810
- Zhang Y, Gong Y, Xue H, Xiong J, Cheng G. Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect. BJOG 2018; 125(7): 784–93. doi: 10.1111/1471-0528.15060
- Hrolfsdottir L, Gunnarsdottir I, Birgisdottir BE, Hreidarsdottir IT, Smarason AK, Hardardottir H, et al. Can a simple dietary screening in early pregnancy identify dietary habits associated with gestational diabetes? Nutrients 2019; 11(8): e1868. doi: 10.3390/nu11081868
- Hrolfsdottir L, Halldorsson TI, Birgisdottir BE, Hreidarsdottir IT, Hardardottir H, Gunnarsdottir I. Development of a dietary screening questionnaire to predict excessive weight gain in pregnancy. Matern Child Nutr 2019; 15(1): e12639. doi: 10.1111/mcn.12639
- Adalsteinsdottir S, Tryggvadottir EA, Hrolfsdottir L, Halldorsson TI, Birgisdottir BE, Hreidarsdottir IT, et al. Insufficient iodine status in pregnant women as a consequence of dietary changes. Food Nutr Res 2020; 6: 64. doi: 10.29219/fnr.v64.3653
- Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33(3): 676–82. doi: 10.2337/dc09-1848
- The Directorate of Health. Basis of dietary guidelines and recommended daily intake of nutrients [Internet]. Reykjavik: The Directorate of Health; 2016 [cited 2 April 2020]. Available from: https://www.landlaeknir.is/servlet/file/store93/item25582/Grundv%C3%B6llur%20r%C3%A1%C3%B0legginga%20um%20matar%C3%A6%C3%B0i%20og%20r%C3%A1%C3%B0lag%C3%B0ir%20dagskammtar%20n%C3%A6ringarefna.pdf
- Brembeck P, Winkvist A, Olausson H. Determinants of vitamin D status in pregnant fair-skinned women in Sweden. Br J Nutr 2013; 110(5): 856–64. doi: 10.1017/S0007114512005855
- Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess 2007; 158: 1–235. [cited 4 April 2020]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18088161
- Autier P, Gandini S, Mullie P. A systematic review: influence of vitamin D supplementation on serum 25-hydroxyvitamin D concentration. J Clin Endocrinol Metab 2012; 97(8): 2606–13. doi: 10.1210/jc.2012-1238
- van Groningen L, Opdenoordt S, van Sorge A, Telting D, Giesen A, de Boer H. Cholecalciferol loading dose guideline for vitamin D-deficient adults. Eur J Endocrinol 2010; 162(4): 805–11. doi: 10.1530/EJE-09-0932
- O’Callaghan KM, Hennessy A, Hull GLJ, Healy K, Ritz C, Kenny LC, et al. Estimation of the maternal vitamin D intake that maintains circulating 25-hydroxyvitamin D in late gestation at a concentration sufficient to keep umbilical cord sera ≥25-30 nmol/L: a dose-response, double-blind, randomized placebo-controlled trial in pregnant women at northern latitude. Am J Clin Nutr 2018; 108(1): 77–91. doi: 10.1093/ajcn/nqy064
- Palacios C, Kostiuk LK, Pena-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2019; 7(7): CD008873. doi: 10.1002/14651858.CD008873.pub4
- Hollis BW. Vitamin D requirement during pregnancy and lactation. J Bone Miner Res 2007; 22(S2): V39–44. doi: 10.1359/jbmr.07s215
- Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26(10): 2341–57. doi: 10.1002/jbmr.463
- Lu M, Xu Y, Lv L, Zhang M. Association between vitamin D status and the risk of gestational diabetes mellitus: a metaanalysis. Arch Gynecol Obstet 2016; 293(5): 959–66. doi: 10.1007/s00404-016-4010-4
- Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S. Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med 2012; 23(5): 465–9. doi: 10.1016/j.ejim.2012.01.007
- Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients 2015; 7(10): 8366–75. doi: 10.3390/nu7105398
- De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JR. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2016; (1): CD008873. doi: 10.1002/14651858.CD008873.pub3
- Asemi Z, Hashemi T, Karamali M, Samimi M, Esmaillzadeh A. Effects of vitamin D supplementation on glucose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: a double-blind randomized controlled clinical trial. Am J Clin Nutr 2013; 98(6): 1425–32. doi: 10.3945/ajcn.113.072785
- Yap C, Cheung NW, Gunton JE, Athayde N, Munns CF, Duke A, et al. Vitamin D supplementation and the effects on glucose metabolism during pregnancy: a randomized controlled trial. Diabetes Care 2014; 37(7): 1837–44. doi: 10.2337/dc14-0155
- Batista MC, Menegat FD, Ferreira CES, Faulhaber ACL, Campos DALS, Mangueira CLP. Analytical and clinical validation of the new Roche Elecsys Vitamin D Total II assay. Clin Chem Lab Med 2018; 56(12): e298–301. doi: 10.1515/cclm-2018-0406
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.