European Journal of Internal Medicine, online 20 February 2012
Y.H.M. Poel a, Corresponding author contact information, E-mail the corresponding author,
P. Hummel b,
P. Lips c,
F. Stam a,
T. van der Ploeg d,
S. Simseka c
a Department of Internal Medicine, Gynaecology and Reproductive Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
b Department of Obstetrics, Gynaecology and Reproductive Medicine, Medical Centre Alkmaar, Alkmaar, The Netherlands
c Department of Internal Medicine/Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands
d Department of Biostatistics, Medical Centre Alkmaar, Alkmaar, The Netherlands
Received 15 November 2011. Revised 23 January 2012. Accepted 25 January 2012. Available online 20 February 2012.
Background: Conflicting results currently exists on the association between vitamin D and glucose metabolism. The role of maternal vitamin D status in gestational diabetes mellitus (GDM) is not clear. This meta-analysis aimed to examine this role in women with GDM compared with normal glucose tolerance (NGT).
Methods: We performed a systematic review and meta-analysis by searching MEDLINE database, the Cochrane library and Uptodate® Online for English-language literature up to September 2011. Summary odds ratios were calculated using a random-effects model meta-analysis.
Results: Seven observational studies were eligible for the meta-analysis, including 2146 participants of whom 433 were diagnosed with GDM. Four studies reported a high incidence of vitamin D deficiency in pregnant women (> 50%). Overall vitamin D deficiency (serum 25-hydroxyvitamin D (25OHD) < 50 nmol/l) in pregnancy was significantly related to the incidence of GDM with an odds ratio of 1.61 (95% CI 1.19–2.17; p = 0.002). Serum 25OHD was significant lower in participants with GDM than in those with NGT (? 5.33 nmol/l (95% CI ? 9.73 to ? 0.93; p = 0.018).
Conclusions: This meta-analysis indicates a significant inverse relation of serum 25OHD and the incidence of GDM. However, it remains unclear whether this association is causal due to the observational study design of the studies. Clinical trials are needed to examine whether vitamin D supplementation will improve glycemic control in women with GDM.
J Obstet Gynecol Neonatal Nurs. 2012 May;41(3):328-38. doi: 10.1111/j.1552-6909.2012.01366.x.
Senti J, Thiele DK, Anderson CM.
OBJECTIVE: To synthesize published research to determine the evidence for the association between maternal vitamin D status during pregnancy and the development of gestational diabetes mellitus (GDM).
DATA SOURCES: Literature searches were conducted for data based articles that examined maternal vitamin D during pregnancy, GDM, glucose tolerance, and insulin resistance using the PubMed, CINAHL, and SCOPUS data bases and reference lists from reviewed papers.
STUDY SELECTION: Primary research studies published in the English language between 1999 and 2011 reporting findings regarding the association of vitamin D with glucose homeostasis during pregnancy and GDM.
DATA EXTRACTION: Study characteristics and findings related to vitamin D status determinants, gestational timing, and measures of glucose homeostasis and insulin resistance.
DATA SYNTHESIS: Six data based articles met the criteria for study inclusion. Study findings comprised solely Level-2 evidence for the association of maternal vitamin D deficiency and risk of GDM. The majority of studies (66%) were conducted between 24 and 30 weeks gestation. Five (83%) studies reported an inverse relationship between circulating vitamin D levels and markers of glucose homeostasis associated with gestational diabetes or an increased risk for GDM associated with reduced maternal levels of vitamin D. In one study, researchers did not identify an association between vitamin D and GDM but did identify an association between higher vitamin D levels and lower fasting glucose and insulin levels.
CONCLUSION: Maternal vitamin D deficiency and insufficiency is prevalent among gravid women and is associated with markers of altered glucose homeostasis. These findings underscore the need for mechanistic and clinical studies to determine optimal vitamin D status in pregnancy for reduction in the risk for GDM with implications for vitamin D supplementation as a potential target for GDM prevention.
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
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