Does Vitamin D Intake Decrease the Risk for Gestational Diabetes Mellitus?
BACKGROUND AND PURPOSE:
Previous studies on the association between vitamin D levels and gestational diabetes mellitus (GDM) have been inconsistent
Previous meta-analyses may have included studies that were not free of the Hawthorne effect
Hawthorne effect: Participants aware of their conditions and are therefore motivated to adopt healthier behaviors such as altering their vitamin D status
Also known as ‘observer effect’, such that study participants modify their behavior because they are aware of being observed
Zhang et al. (BJOG, 2017) sought to design a meta-analysis that would include as many relevant GDM-related indices as possible to better determine the association between Vitamin D intake and risk for GDM
Systematic review and meta-analysis
Literature review included
Observational studies on the relationship between vitamin D and GDM, free from Hawthorne effect
Randomized controlled trials (RCT) of vitamin D supplements during pregnancy for preventing or treating GDM
There was lack of agreement as to the definition of vitamin D deficiency
Some researchers used 50 nmol/l (20 ng/ml) and 75 nmol/l (30 ng/ml), while others used 25 nmol/l (10 ng/ml) and 50 nmol/l (20 ng/ml) to differentiate vitamin D deficiency, vitamin D insufficiency and vitamin D sufficiency
87 observational studies (55,859 participants) and 25 RCTs (2,445 participants) were included
Low blood vitamin D level during pregnancy was associated with a higher risk of GDM (odds ratio [OR] 1.850; 95% CI 1.471-2.328)
Blood vitamin D level was inversely correlated with HbA1c, FPG (fasting plasma glucose), HOMA-IR (homeostasis model of assessment for insulin resistance index) and FINS (fasting insulin)
Vitamin D supplementation during pregnancy impacted the blood levels of 25-hydroxyvitamin D, FINS FPG, GSH (glutathione), CRP (C-reactive protein), TC (total cholesterol), LDL, HDL and HOMA-IR
Results seen regarding the effect of vitamin D on, CRP, TC, LDL and HDL may have been related to publication biases
There was an association between low blood vitamin D levels and risk for GDM
Pregnant women with low blood vitamin D levels had 85% higher risk of GDM than those with regular vitamin D levels
Taking vitamin D supplements during pregnancy could help ameliorate GDM, although association strength is modest
While further research on effectiveness of vitamin D supplementation during pregnancy is still needed, it is likely that other lifestyle interventions to prevent GDM will still be necessary
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