Lacroix Marilyn, Battista Marie-Claude, Doyon Myriam, Houde Ghislaine, Ménard Julie, Ardilouze Jean-Luc, Hivert Marie-France, Perron Patrice
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
Acta Diabetol. 2014 Aug;51(4):609-16. doi: 10.1007/s00592-014-0564-4. Epub 2014 Feb 14.
The progressive increase of insulin resistance observed in pregnancy contributes to the pathophysiology of gestational diabetes mellitus (GDM). There is controversy whether vitamin D deficiency contributes to abnormal glycemic regulation in pregnancy. We tested the associations between first trimester 25-hydroxyvitamin D (25OHD) levels and: 1) the risk of developing GDM; 2) insulin resistance/sensitivity, beta cell function and compensation indices in a large population-based prospective cohort of pregnant women. Participants (n = 655) were seen at first (6-13 weeks) and second (24-28 weeks) trimesters for blood samples. At first trimester, 25OHD levels were measured. At second trimester, glucose and insulin were measured 3 times during the oral glucose tolerance test to estimate insulin resistance (HOMA-IR), beta cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUCins/gluc) and beta cell compensation (ISSI-2). Based on IADPSG criteria, 54 participants (8.2 %) developed GDM. Lower first trimester 25OHD levels were associated with higher risk of developing GDM even after adjustment for vitamin D confounding factors and GDM risk factors (OR = 1.48 per decrease of one SD in 25OHD levels; P = 0.04). Lower first trimester 25OHD levels were associated with higher HOMA-IR (r = - 0.08; P = 0.03), lower Matsuda index (r = 0.13; P = 0.001) and lower ISSI-2 (r = 0.08; P = 0.04). After adjustment for confounders, we found no significant association with HOMA-B and AUCins/gluc. Our results suggest that low levels of 25OHD at first trimester are (1) an independent risk factor for developing GDM and (2) associated with insulin resistance at second trimester.
孕期观察到的胰岛素抵抗的逐渐增加是妊娠期糖尿病（GDM）病理生理学的一部分。维生素D缺乏是否会导致孕期血糖调节异常仍存在争议。我们在一个基于人群的大型前瞻性孕妇队列中，测试了孕早期25-羟维生素D（25OHD）水平与以下因素之间的关联：1）患GDM的风险；2）胰岛素抵抗/敏感性、β细胞功能和代偿指数。参与者（n = 655）在孕早期（6 - 13周）和孕中期（24 - 28周）接受血样采集。在孕早期测量25OHD水平。在孕中期，在口服葡萄糖耐量试验期间测量3次血糖和胰岛素，以评估胰岛素抵抗（HOMA-IR）、β细胞功能（HOMA-B）、胰岛素敏感性（松田指数）、胰岛素分泌（AUCins/gluc）和β细胞代偿（ISSI-2）。根据国际糖尿病和妊娠研究组（IADPSG）标准，54名参与者（8.2%）患了GDM。即使在调整了维生素D混杂因素和GDM风险因素后，孕早期较低的25OHD水平仍与患GDM的较高风险相关（25OHD水平每降低一个标准差，OR = 1.48；P = 0.04）。孕早期较低的25OHD水平与较高的HOMA-IR（r = -0.08；P = 0.03）、较低的松田指数（r = 0.13；P = 0.001）和较低的ISSI-2（r = 0.08；P = 0.04）相关。在调整混杂因素后，我们发现与HOMA-B和AUCins/gluc无显著关联。我们的结果表明，孕早期低水平的25OHD是（1）患GDM的独立危险因素，（2）与孕中期的胰岛素抵抗相关。
