BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine, University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
J Endocrinol Invest. 2017 Oct;40(10):1049-1059. doi: 10.1007/s40618-017-0696-9. Epub 2017 May 29.
Gestational diabetes mellitus (GDM), defined as any glucose intolerance with the onset or first recognition during pregnancy, is characterized by rising incidence, fostered by the worldwide increase of pathological nutritional status from young age. Clinical research has intended to identify potential risk factors, suggested improvements in screening strategies, and recommended the combination between promotion of an appropriate lifestyle before and during pregnancy and selected therapeutic approaches. Preventing pathological hyperglycemia could have several benefits, ranging from clinical side (reduction in the risk of adverse perinatal and long-term sequelae) to financial side (cost reduction to healthcare systems). Among risk factors recognized, deficiency in 25-hydroxyvitamin D [25(OH)D], already acknowledged as involved in calcium homeostasis, pathogenesis of cardiovascular, oncological, infective and immunity diseases, could predispose to the development of both type 1 and 2 diabetes, modifying the activity of pancreatic β-cells vitamin D (VD) receptor. In pregnant women, lower 25(OH)D concentrations have been suggested to present an inverse association with maternal glycaemia, insulin resistance, and increased risk of GDM. In spite of growing body of evidence, there is not full agreement on the therapeutic association between GDM based on VD deficiency and 25(OH)D supplementation. In the attempt to bring up-to-date the role of low VD levels on subsequent development of GDM, this narrative review, based on medium-high-quality randomized clinical trials, systematic reviews, and meta-analysis published in last decade, has a twofold purpose: firstly, to elucidate the relationship between maternal VD status and GDM; and secondly, to illuminate the impact of VD supplementation on GDM onset.
妊娠期糖尿病(GDM)定义为任何妊娠期发生或首次发现的葡萄糖不耐受,其发病率不断上升,这与全球范围内年轻人群病理性营养状态的增加有关。临床研究旨在确定潜在的危险因素,提出改进筛查策略的建议,并推荐在妊娠前后促进适当的生活方式与选择治疗方法相结合。预防病理性高血糖可能带来多种益处,包括临床方面(降低不良围产期和长期后果的风险)和经济方面(降低医疗保健系统的成本)。在已识别的危险因素中,25-羟维生素 D [25(OH)D] 缺乏症已被认为与钙稳态、心血管疾病、肿瘤、感染和免疫疾病的发病机制有关,可能导致 1 型和 2 型糖尿病的发生,从而改变胰腺 β 细胞维生素 D(VD)受体的活性。有研究表明,孕妇体内 25(OH)D 浓度较低与母体血糖、胰岛素抵抗以及 GDM 风险增加呈负相关。尽管有越来越多的证据表明,基于 VD 缺乏和 25(OH)D 补充的 GDM 治疗关联存在争议。为了探讨 VD 水平降低与随后发生 GDM 的关系,本综述基于过去十年发表的高质量随机临床试验、系统评价和荟萃分析,具有双重目的:首先阐明母体 VD 状态与 GDM 之间的关系;其次阐明 VD 补充对 GDM 发病的影响。