Gynécologie-Obstétrique, Hôpital Antoine-Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Clamart, France.
URC/CIC Paris Descartes Necker Cochin, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.
Clin Nutr. 2021 Jan;40(1):79-86. doi: 10.1016/j.clnu.2020.04.028. Epub 2020 Apr 25.
BACKGROUND & AIMS: Gestational diabetes mellitus (GDM) is one of the most frequent medical complications during pregnancy. It has been associated with many adverse pregnancy, fetal and neonatal outcomes, as well as with an increased risk for mothers and children in the long term. There is a growing interest in vitamin D and its potential role in the development of metabolic disorders. However, the medical literature is not consensual. The aim of this study was to assess the risk of GDM according to vitamin D status during the first trimester.
This study is a nested case-control study performed from a multicenter prospective observational cohort of pregnant women assessed for 25-hydroxyvitamin D levels (25OHD). Three hundred ninety-three patients were included in the initial cohort. After applying exclusion criteria, a total of 1191 pregnant women were included. Two hundred fifty women with GDM (cases) were matched to 941 women without GDM (controls) for parity, age, body mass index before pregnancy, the season of conception, and phototype. This study was funded by a grant from the "Programme Hospitalier de Recherche Publique 2010".
The GDM risk was significantly greater for patients with 25OHD levels <20 ng/mL (OR = 1∙42, 95% CI 1∙06-1∙91; p = 0∙021). However, there was no significant relationship with other thresholds. The study of 25OHD levels with the more precise cutting of 5 units intervals showed a variable relationship with GDM risk, as the risk was low for very low 25OHD levels, increased for moderated levels, decreased for normal levels, and finally increased for higher levels.
According to our study, there seems to be no linear relationship between GDM and 25OHD levels in the first trimester of pregnancy since GDM risk does not continuously decrease as 25OHD concentrations increase. Our results most probably highlight the absence of an association between 25OHD levels and GDM risk.
妊娠期糖尿病（GDM）是孕期最常见的医学并发症之一。它与许多不良的妊娠、胎儿和新生儿结局有关，并且母亲和儿童在长期内的风险也会增加。人们对维生素 D 及其在代谢性疾病发展中的潜在作用越来越感兴趣。然而，医学文献并不一致。本研究的目的是评估在孕早期维生素 D 状态与 GDM 风险之间的关系。
这是一项嵌套病例对照研究，来自一项多中心前瞻性观察性孕妇队列研究，评估了 25-羟维生素 D 水平（25OHD）。最初的队列纳入了 393 名患者。在应用排除标准后，共有 1191 名孕妇纳入研究。250 名患有 GDM（病例）的患者与 941 名未患有 GDM（对照组）的患者按产次、孕前 BMI、受孕季节和肤色相匹配。这项研究由“2010 年医院公共研究计划”资助。
25OHD 水平<20ng/mL 的患者 GDM 风险显著增加（OR=1.42，95%CI 1.06-1.91；p=0.021）。然而，与其他阈值没有显著关系。更精确的 5 个单位间隔的 25OHD 水平研究显示与 GDM 风险之间存在可变关系，因为非常低的 25OHD 水平风险较低，中等水平的风险增加，正常水平的风险降低，最后高水平的风险增加。
根据我们的研究，似乎在妊娠早期 GDM 与 25OHD 水平之间没有线性关系，因为 GDM 风险不会随着 25OHD 浓度的增加而连续降低。我们的结果很可能突出了 25OHD 水平与 GDM 风险之间不存在关联。
