Relationship between Serum Vitamin D Level and Gestational Diabetes Mellitus in Patients Referring to Imam Hossein Hospital in Tehran, Iran, during 2015

Document Type : Original Article


1 Professor, Department of Obstetrics and Gynecology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Gynecologist, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Assistant Professor, Department of Infectious Diseases, Faculty of Paramedicine, Army University of Medical Sciences, University of Medical Sciences, Tehran, Iran.

4 M.Sc. of Health and Food Safety, Food and Drug Administration, Hamedan, Iran.

5 Instructor, Department of Biostatistics, Faculty of Paramedicine, Army University of Medical Sciences (AJA), Tehran, Iran.


Introduction: Gestational diabetes is one of the most important abnormalities occur over the 24 weeks of gestation. The recognition of the gestational diabetes factors can play an important role in the improvement of the pregnancy condition; therefore,this study was to investigate the relationship between serum vitamin D level and gestational diabetes mellitus in patients referred to Imam Hossein Hospital in Tehran, Iran, during 2015.
Materials and Methods: In this cross-sectional study was conducted on 164 pregnant women in Tehran during 2015. Patients were tested for gamma-glutamyl transferase using a oral glucoseof 50 g and then a 3-hour glucose tolerance test was used. Individuals with diabetes mellitus were considered case group and individuals without gestational diabetes mellitus (control group). Blood samples were taken to determine and compare serum vitamin D level between the two groups. The data were analyzed using SPSS (version 21) through the Chi-square and independent t-test.
Results: The mean values of 25-hydrozxy-vitamin D level were 29.4±19 and 24.13±13.3 in the case and control groups, respectively.  In this regard, the results of independent t-test revealed a significant difference between the two groups  (P=0.042). Moreover, the ROC curve analysis of vitamin D with a cut point of 20 indicated a sensitivity level of 53% and a specialty of 45%. Based on the results of this study, pregnant women with vitamin D deficiency are twice at risk of developing gestational diabetes, compared to their healthy counterparts.
Conclusion: The low level of serum vitamin D is the independent risk factor for gestational diabetes mellitus. However, due to the limitations of this study it is essential to conduct further evaluations.


  1. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest2005;115(3):485-91.
  2. Szymańska M, Bomba-Opoń DA, Celińska AM, Wielgoś M. Diagnostic of gestational diabetes mellitus and the prevalence of LGA (Large for Gestational Age). Ginekol Pol 2008; 79(3):177-81.
  3. Burris HH, Rifas-Shiman SL, Kleinman K, Litonjua AA, Huh SY, Rich-Edwards JW, et al. Vitamin D deficiency in pregnancy and gestational diabetes mellitus. Am J Obstet Gynecol 2012; 207(3):182.e1-8.
  4. Hosseinzadeh-Shamsi-Anar M, Mozaffari-Khosravi H, Salami MA, Hadinedoushan H, Mozayan MR. The efficacy and safety of a high dose of vitamin d in mothers with gestational diabetes mellitus: a randomized controlled clinical trial. Iran J Med Sci 2012; 37(3):159-65.
  5. 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. Biomed Environ Sci 2012; 25(4):399-406.
  6. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2008; 31(1):55-60.
  7. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373(9677):1773-9.
  8. Kim C, Newton KM, Knopp RH. Gestational diabetesand the incidence of type 2 diabetes a systematic review. Diabetes Care 2002; 25(10):1862-8.
  9. Albrecht SS, Kuklina EV, Bansil P, Jamieson DJ, Whiteman MK, Kourtis AP, et al. Diabetes trends among delivery hospitalizations in the US, 1994-2004. Diabetes Care 2010; 33(4):768-73.
  10. Nodine PM, Hastings-Tolsma M. Maternal obesity: improving pregnancy outcomes. MCN Am J Maternal Child Nurs 2012; 37(2):110-5.
  11. Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30(8):2070-6.
  12. Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011; 34(1):223-9.
  13. Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PloS One 2008; 3(11):e3753.
  14. Kaaja R, Rönnemaa T. Gestational diabetes: pathogenesis and consequences to mother and offspring. Rev Diabet Stud 2008; 5(4):194-202.
  15. Gagnon AJ, McDermott S, Rigol-Chachamovich J, Bandyopadhyay M, Stray-Pedersen B, Stewart D, et al. International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis. Paediatr Perinat Epidemiol 2008; 25(6):575-92.
  16. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr 2008; 79(5):820-5.
  17. Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010; 2010:351385.
  18. Tai K, Need AG, Horowitz M, Chapman IM. Vitamin D, glucose, insulin, and insulin sensitivity. Nutrition 2008; 24(3):279-85.
  19. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007; 92(6):2017-29.
  20. Park S, Yoon HK, Ryu HM, Han YJ, Lee SW, Park BK, et al. Maternal vitamin D deficiency in early pregnancy is not associated with gestational diabetes mellitus development or pregnancy outcomes in Korean pregnant women in a prospective study. J Nutr Sci Vitaminol 2014; 60(4):269-75.
  21. Makgoba M, Nelson SM, Savvidou M, Messow CM, Nicolaides K, Sattar N. First-trimester circulating 25-hydroxyvitamin D levels and development of gestational diabetes mellitus.Diabetes Care 2011; 34(5):1091-3.
  22. Baker AM, Haeri S, Camargo CA Jr, Stuebe AM, Boggess KA. First-trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case-control study. Diabetes Metab Res Rev 2012; 28(2):164-8.
  23. Schneuer FJ, Roberts CL, Guilbert C, Simpson JM, Algert CS, Khambalia AZ, et al. Effects ofmaternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr 2014; 99(2):287-95.
  24. Arnold DL, Enquobahrie DA, Qiu C, Huang J, Grote N, VanderStoep A, er al. Early pregnancy maternal vitamin D concentrations and risk of gestational diabetes mellitus. Paediatr Perinat Epidemiol 2015; 29(3):200-10.
  25. Lacroix M, Battista MC, Doyon M, Houde G, Ménard J, Ardilouze JL, et al. Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus. Acta Diabetol 2014; 51(4):609-16.
  26. Lau SL, Gunton JE, Athayde NP, Byth K, Cheung NW. Serum 25-hydroxyvitamin D and glycated haemoglobin levels in women with gestational diabetes mellitus. Med J Aust 2011; 194(7):334-7.
  27. 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.
  28. Lu M, Xu Y, Lv L, Zhang M. Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet 2016; 293(5):959-66.
  29. Pérez-López FR, Pasupuleti V, Mezones-Holguin E, Benites-Zapata VA, Thota P, Deshpande A, et al. Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril 2015; 1032(5):1278-88.
  30. Palacios C, De-Regil LM, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation during pregnancy: Updated meta-analysis on maternal outcomes. J Steroid Biochem Mol Biol 2016; 164:148-55.