Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia (National University of Malaysia), Kuala Lumpur, Malaysia.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia (National University of Malaysia), Kuala Lumpur, Malaysia.
J Obstet Gynaecol. 2021 Aug;41(6):899-903. doi: 10.1080/01443615.2020.1820462. Epub 2020 Dec 2.
We investigated if vitamin D is independently associated with hyperglycaemia in gestational diabetes mellitus (GDM). Serum 25 hydroxy vitamin D (25OHD), fasting blood glucose (FBG), HbA1c, fructosamine, insulin sensitivity (QUICKI equation), body mass index, clothing style and outdoor activity were measured in 58 pregnant women with GDM during the third trimester. 25OHD was also measured in 20 women with normal pregnancies. There was no significant difference in mean 25OHD concentrations between GDM (14.43 ± 5.27 ng/ml) and normal (15.45 ± 5.29 ng/ml) pregnancies, = .354. However, a higher percentage of GDM subjects had 25OHD concentration <19.8 ng/ml (86 versus 65%, = .003). 25OHD did not correlate with FBG, HbA1c, fructosamine, insulin sensitivity or insulin dosage ( > .05). On multivariate analysis, only ethnicity ( = .006) and outdoor activity ( = .004) were associated with 25OHD. We conclude that the lower 25OHD levels in our GDM patients were related to ethnicity and outdoor activity (Study FF-2017-111, National University of Malaysia, 16 March 2017).IMPACT STATEMENT Vitamin D deficiency in pregnancy is widespread and particularly in certain ethnic groups. Low vitamin D levels may be an aetiological factor for gestational diabetes mellitus (GDM) but previous studies provide conflicting results perhaps due to confounding factors. In this study of pregnant women with GDM from different ethnic backgrounds, we analysed serum 25-hydroxy vitamin D (25OHD) levels together with other confounding factors, that is, body mass index, ethnicity and sunlight exposure. Furthermore, instead of using consensus values, we determined cut-offs for different vitamin D status from normal pregnancies matched for gestational age and ethnicity. We found that a higher percentage of GDM subjects had lower vitamin D status but there was no correlation with hyperglycaemia or insulin sensitivity. The study showed that lower vitamin D levels in GDM was associated with ethnicity and less outdoor activity. In GDM patients, low vitamin D levels may be modifiable by supplementation or lifestyle change. Longitudinal studies are needed to determine whether this would impact on the occurrence of GDM.
我们研究了维生素 D 是否与妊娠期糖尿病（GDM）的高血糖独立相关。在妊娠晚期，对 58 名 GDM 孕妇和 20 名正常妊娠孕妇进行了血清 25 羟维生素 D（25OHD）、空腹血糖（FBG）、糖化血红蛋白（HbA1c）、果糖胺、胰岛素敏感性（QUICKI 方程）、体重指数、着装风格和户外活动的测量。还测量了 20 名正常妊娠妇女的 25OHD。GDM（14.43±5.27ng/ml）和正常妊娠（15.45±5.29ng/ml）之间的 25OHD 浓度平均值无显著差异， = .354。然而，GDM 患者中有更高比例的 25OHD 浓度<19.8ng/ml（86%比 65%， = .003）。25OHD 与 FBG、HbA1c、果糖胺、胰岛素敏感性或胰岛素剂量均无相关性（ > .05）。多变量分析显示，只有种族（ = .006）和户外活动（ = .004）与 25OHD 相关。我们得出结论，我们的 GDM 患者的 25OHD 水平较低与种族和户外活动有关（马来西亚国立大学研究 FF-2017-111，2017 年 3 月 16 日）。
影响陈述：妊娠期间维生素 D 缺乏症很普遍，尤其是在某些种族群体中。低维生素 D 水平可能是妊娠期糖尿病（GDM）的病因，但以前的研究结果存在冲突，这可能是由于混杂因素所致。在这项来自不同种族背景的 GDM 孕妇的研究中，我们分析了血清 25-羟维生素 D（25OHD）水平以及其他混杂因素，即体重指数、种族和阳光照射。此外，我们不是使用共识值，而是根据与种族和孕龄相匹配的正常妊娠确定了不同维生素 D 状态的截止值。我们发现，较高比例的 GDM 患者的维生素 D 状态较低，但与高血糖或胰岛素敏感性无关。该研究表明，GDM 中较低的维生素 D 水平与种族和户外活动减少有关。在 GDM 患者中，低维生素 D 水平可以通过补充或生活方式改变来调节。需要进行纵向研究，以确定这是否会影响 GDM 的发生。
