Private Clinic Obstetrics and Gynecology, Diyarbakır, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Jan;27(2):511-516. doi: 10.26355/eurrev_202301_31051.
To determine the efficacy of VD in preventing the development of gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH). The secondary purpose is to investigate the effect of VD on the mode and time of delivery.
A vitamin D value of <20 ng/mL during pregnancy is considered a deficiency according to the Endocrine Society, and 400-600 IU/day VD replacement is recommended. Forty patients whose serum VD levels were below 20 ng/mL during routine pregnancy follow-up and who were planned for VD replacement therapy were included in the study. They were divided into two equal groups with 20 patients in each group. Twenty pregnant women with serum VD levels greater than 20 ng/mL were considered as the control group. While 400 IU/day VD replacement was applied to the patients in Group 1, 600 IU/day VD was given to Group 2. Group 3 consisted of control patients who did not undergo VD replacement. VD replacement was continued from the 14th week of pregnancy until delivery. Each group of participants was screened with a 50-g GCT at 24-28 weeks of gestation. Following 50-g GCT if serum glucose level was found >140 mg/dL, patients underwent 100-g OGTT. GDM was diagnosed in the presence of at least two of the following results: fasting serum glucose ≥92 mg/dL and/or 1-hour glycemia ≥180 mg/dL, and/or 2-hour glycemia ≥153 mg/dL. PIH was defined as systolic blood pressure >140 mmHg and diastolic blood pressure >90 mmHg. Patients in each group delivered by cesarean section or normal vaginal route. In addition to the incidence of PIH and GDM, the time and mode of delivery were recorded.
PIH was detected in two patients in each of the 400 IU/day and 600 IU/day vitamin D replacement groups (10%). In the control group, PIH developed in 3 patients (15%). Although PIH was detected in an extra case in the control group, no significant difference was found between the replacement group and the control group in terms of PIH (p<0.44). While GDM was not detected in the 400 IU/day vitamin D group, GDM was detected in one patient (5%) in the 600 IU/day vitamin D group. No case of GDM was found in the control group either. There was no significant difference between the VD replacement and the control groups in terms of GDM rates. No significant difference was found between the VD replacement and the control groups in terms of mode of delivery. While the C/S ratio was 65% in the 400 IU/day vitamin D group, this ratio was 75% in the 600 IU/day vitamin D group. There was an insignificant trend of increase in C/S ratios in the group given 600 IU/day of vitamin D. The C/S ratio of the control group, which could not be given VD replacement, was found to be 70%.
VD replacement therapy during pregnancy does not prevent the development of PIH and GDM, and does not significantly contribute to the time and mode of delivery.
确定维生素 D（VD）在预防妊娠糖尿病（GDM）和妊娠高血压（PIH）发展中的疗效。次要目的是研究 VD 对分娩方式和时间的影响。
根据内分泌学会的标准，妊娠期间 VD 值<20ng/mL 被认为是缺乏症，建议补充 400-600IU/天 VD。在常规妊娠随访中发现血清 VD 水平低于 20ng/mL 的 40 名患者且计划进行 VD 替代治疗的患者被纳入研究。他们被分为两组，每组 20 名患者。血清 VD 水平>20ng/mL 的 20 名孕妇被视为对照组。第 1 组患者接受 400IU/天 VD 替代治疗，第 2 组患者接受 600IU/天 VD 治疗。第 3 组由未接受 VD 替代治疗的对照组患者组成。VD 替代治疗从妊娠第 14 周持续到分娩。每组参与者在妊娠 24-28 周时均接受 50g GCT 筛查。如果 50g GCT 后血清葡萄糖水平>140mg/dL，则患者进行 100g OGTT。至少有以下两项结果时诊断为 GDM：空腹血糖≥92mg/dL 和/或 1 小时血糖≥180mg/dL，和/或 2 小时血糖≥153mg/dL。PIH 定义为收缩压>140mmHg 和舒张压>90mmHg。每组患者均通过剖宫产或正常阴道分娩。除了 PIH 和 GDM 的发生率外，还记录了分娩的时间和方式。
在接受 400IU/天和 600IU/天 VD 替代治疗的两组患者中（每组 10%）各有 2 例患者出现 PIH。对照组中，3 例患者（15%）出现 PIH。虽然对照组中多发现了 1 例 PIH，但替代组和对照组之间的 PIH 发生率无显著差异（p<0.44）。400IU/天 VD 组未发现 GDM，600IU/天 VD 组 1 例患者（5%）发生 GDM。对照组也未发现 GDM 病例。VD 替代组和对照组之间的 GDM 发生率无显著差异。VD 替代组和对照组之间的分娩方式无显著差异。400IU/天 VD 组的 C/S 比值为 65%，600IU/天 VD 组的 C/S 比值为 75%。600IU/天 VD 组 C/S 比值呈上升趋势，但无统计学意义。无法给予 VD 替代治疗的对照组的 C/S 比值为 70%。
妊娠期间的 VD 替代治疗不能预防 PIH 和 GDM 的发生，也不能显著影响分娩的时间和方式。
