Comparison of Serum Levels of Vitamin D and Inflammatory Markers Between Women With Gestational Diabetes Mellitus and Healthy Pregnant Control
Abstract
Objective: Vitamin D appears to be involved in regulation of glycemic and inflammatory responses in gestational diabetes. The purpose of this study was to compare the serum levels of 25-hydroxyvitamin D (25(OH)D), inflammatory biomarkers and glycemic profile between gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) pregnant women.
Materials and methods: In this cross-sectional study, fasting serum levels of 25(OH)D, insulin, glucose, HOMA-IR, hs-CRP and TNF-α were measured in 45 GDM and 45 NGT women at week 20-30 gestation whom referred to Reference Medical Laboratory of Ahvaz, Iran in 1394.
Results: Serum 25(OH)D levels were significantly lower (p = 0.003 ) in the GDM group compared to the NGT group which remained even after controlling for confounders. Insulin and TNF-α levels were not statistically different between groups (p > 0.05). However, in unadjusted model, HOMA-IR and hs-CRP were significantly different between groups that disappeared in adjusted model. In the GDM group, there was a negative significant correlation between 25 (OH) D and fasting blood sugar (p = 0.009) and pre pregnancy BMI (p < 0.001). Levels of 25(OH)D were also negatively correlated with pre pregnancy BMI
(p < 0.001) and hs-CRP levels (p = 0.003) in the NGT group.
Conclusion: The lower level of vitamin D may be responsible for impairments of some glycemic and inflammatory markers in pregnant women. This is more important in overweight pregnant women. However, further studies with larger sample size are recommended in this regards.
Fowler MJ. Diabetes: Magnitude and mechanisms. Clinical Diabetes 2007;25:25-8.
Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care 2013;36(Suppl 1):S67-74.
Sayehmiri F, Bakhtyari S, Darvishi P, Sayehmiri K. Prevalence of Gestational Diabetes Mellitus in Iran: A Systematic Review and Meta-Analysis Study. The Iranian Journal of Obstetric, Gynecology and Infertility 2013;15:16-23.
Krishnaveni GV, Hill JC, Veena SR, Geetha S, Jayakumar MN, Karat CL, Fall CH. Gestational diabetes and the incidence of diabetes in the 5 years following theindex pregnancy in South Indian women. Diabetes Res Clin Pract 2007;78:398-404.
Kirwan JP, Hauguel-De Mouzon S, Lepercq J, Challier J-C, Huston-Presley L, et al. TNF-α is a predictor of insulin resistance in human pregnancy. Diabetes
;51:2207-13.
Zhang C, Ning Y. Effect of dietary and lifestyle factors on the risk ofgestational diabetes: review of epidemiologic evidence. Am J Clin Nutr 2011;94:1975S-1979S.
Burris HH, Rifas-Shiman SL, Kleinman K, Litonjua AA, Huh SY, Rich-Edwards JW, et al . Vitamin D deficiency in pregnancy and gestationaldiabetes mellitus. Am J Obstet Gynecol 2012;207:182.e1-8.
Cheung NW. The management of gestational diabetes. Vascular health and risk management 2009;5:153-61.
Getahun D, Fassett MJ, Jacobsen SJ. Gestational diabetes: risk of recurrence in subsequent pregnancies. American journal of obstetrics and gynecology 2010;203:467. e1-. e6.
Ozuguz U, Isik S, Berker D, Arduc A, Tutuncu Y, Akbaba G, et al. Gestational diabetes and subclinical inflammation: Evaluation of first year postpartum outcomes. Diabetes Research and Clinical Practice 2011;94:426-33.
WANG O, NIE M, HU YY, ZHANG K, LI W, PING F, et al. Association between vitamin D insufficiency and the risk for gestational diabetes mellitus in pregnant Chinese women. Biomedical and Environmental Sciences 2012;25:399-406.
Senti J, Thiele DK, Anderson CM. Maternal vitamin D status as a critical determinant in gestational diabetes. J Obstet Gynecol Neonatal Nurs 2012;41:328-38.
Bener A, Al-Hamaq AO, Saleh NM. Association between vitamin D insufficiency and adverse pregnancy outcome: global comparisons. Int J Womens Health 2013;5:523-31.
Pittas AG, Dawson-Hughes B. Vitamin D and diabetes. J Steroid Biochem Mol Biol 2010;121:425-9.
Talaei A, Mohamadi M, Adgi Z. The effect of vitamin D on insulin resistance in patients with type 2 diabetes. Diabetol Metab Syndr 2013;5:8.
Salekzamani S, Neyestani TR, Alavi-Majd H, Houshiarrad A, Kalayi A,Shariatzadeh N, Gharavi A. Is vitamin D status a determining factor for metabolic syndrome? A case-control study. Diabetes Metab Syndr Obes 2011;4:205-12.
Neyestani TR, Nikooyeh B, Alavi-Majd H, Shariatzadeh N, Kalayi A, Tayebinejad N, et al. Improvement of vitamin D status via daily intake of fortified yogurt drink either with or without extra calcium ameliorates systemic inflammatory biomarkers, including adipokines, in the subjects with type 2 diabetes. J Clin Endocrinol Metab 2012;97:2005-11.
Chagas CEA, Borges MC, Martini LA, Rogero MM.
Focus on vitamin D, inflammation and type 2 diabetes. Nutrients 2012;4:52-67.
Hypponen E, Boucher BJ. Avoidance of vitamin D deficiency in pregnancy in the United Kingdom: the case for a unified approach in National policy. Brit J Nutr 2010;104:309-14.
Taylor C, Lamparello B, Kruczek K, Anderson EJ, Hubbard J, Misra M. Validation of a food frequency questionnaire for determining calcium and vitamin D intake by adolescent girls with anorexia nervosa. J Am Diet Assoc 2009;109:479-85.
McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr 2008;87:1097S-101S.
Olmos-Ortiz A, Avila E, Durand-Carbajal M, Díaz L. Regulation of Calcitriol Biosynthesis and Activity: Focus on Gestational Vitamin D Deficiency and Adverse Pregnancy Outcomes. Nutrients 2015;7:443-80.
Maghbooli Z, Hossein‐nezhad A, Karimi F, Shafaei AR, Larijani B. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008;24:27-32.
Salek M, Hashemipour M, Aminorroaya A, Gheiratmand A, Kelishadi R, Ardestani PM, Nejadnik H, Amini M, Zolfaghari B. Vitamin D deficiency among pregnant women and their newborns in Isfahan, Iran. Exp Clin Endocrinol Diabetes 2008;116:352-6.
El Lithy A, Abdella RM, El-Faissal YM, Sayed AM, Samie RM. The relationship between low maternal serum vitamin D levels and glycemic control in gestational diabetes assessed by HbA1c levels: an observational cross-sectional study. BMC Pregnancy Childbirth 2014;14:362.
Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health 2004;4:38.
Asemi Z, Jazayeri S, Najafi M, Samimi M, Shidfar F, Tabassi Z, Shahaboddin M, Esmaillzadeh A. Association between markers of systemic inflammation, oxidativestress, lipid profiles, and insulin resistance in pregnant women. ARYA Atheroscler 2013;9:172-8.
Sonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res 2014;8:CC01-3.
Park J, Gong J, Hong H, Ha C, Kang H. Serum Vitamin D status and its relations to body fatness and fitness and risk factors in young adults. J Exerc Nutrition Biochem 2013;17:143-50.
Zavalza-Gómez AB, Anaya-Prado R, Rincón-Sánchez
AR, Mora-Martínez JM. Adipokines and insulin resistance during pregnancy. Diabetes Res Clin Pract 2008;80:8-15.
Cruz NG, Sousa LP, Sousa MO, Pietrani NT, Fernandes AP, Gomes KB. The linkage between inflammation and Type 2 diabetes mellitus. Diabetes Res Clin Pract 2013;99:85-92.
McManus R, Summers K, de Vrijer B, Cohen N, Thompson A, Giroux I. Maternal,umbilical arterial and umbilical venous 25-hydroxyvitamin D and adipocytokine concentrations in pregnancies with and without gestational diabetes. Clin Endocrinol (Oxf) 2014;80: 635-41.
Rota S, Yildirim B, Kaleli B, Aybek H, Duman K, Kaptanoglu B. C-reactive protein levels in non-obese pregnant women with gestational diabetes. Tohoku J Exp Med 2005;206:341-5.
Desoye G, Hauguel-de Mouzon S. The human placenta in gestational diabetes mellitus. The insulin and cytokine network. Diabetes Care 2007;30 Suppl2:S120-6.
Vrachnis N, Belitsos P, Sifakis S, Dafopoulos K, Siristatidis C, Pappa KI, et al. Role of adipokines and other inflammatory mediators in gestational diabetes mellitus and previous gestational diabetes mellitus. Int J
Endocrinol 2012; 2012: 549748.
Daniel D, Hardigan P, Bray N, Penzell D, Savu C. The incidence of vitamin D deficiency in the obese: A retrospective chart review. J Community Hosp Intern Med Perspect 2015 3;5:26069.
Mohammadshahi M, Haidari F, Karandish M, Ebrahimi S, Haghighizadeh MH. A randomized clinical trial of nutrition education for improvement of diet quality and nflammation in Iranian obese women. J Nutr Metab 2014;2014:605782.
Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010;2010:351385.
Alzaim M, Wood RJ. Vitamin D and gestational diabetes mellitus. Nutr Rev 2013 ;71:158-67.
Ngo DT, Sverdlov AL, McNeil JJ, Horowitz JD. Does vitamin D modulate asymmetric dimethylarginine and C-reactive protein concentrations? Am J Med 2010;123:335-41.
Chen N, Wan Z, Han S-F, Li B-Y, Zhang Z-L, Qin L-Q. Effect of Vitamin D Supplementation on the Level of Circulating High-Sensitivity C-Reactive Protein: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2014;6:2206-16.
Files | ||
Issue | Vol 10, No 1 (March 2016) | |
Section | Original Articles | |
Keywords | ||
Gestational Diabetes TNF-α HS-CRP HOMA-IR Vitamin D |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |