بررسی ارتباط بین کمبود ویتامین D و بروز دیابت بارداری

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 رزیدنت گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 استادیار گروه طب اورژانس، دانشکده پزشکی، دانشگاه علوم پزشکی خراسان شمالی، بجنورد، ایران.

4 کارشناس کتابداری، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

10.22038/ijogi.2023.20092

چکیده

مقدمه: دیابت شیرین بارداری شایع‌ترین مشکل بارداری است و حدود 20-1% از زنان باردار مبتلا به دیابت بارداری هستند، بنابراین جلوگیری و درمان دیابت بارداری اهمیت زیادی دارد. تحقیقات متعددی به ارزیابی ریسک فاکتورهای دیابت بارداری پرداخته‌اند. کمبود ویتامین D یکی از این ریسک فاکتورهاست که دارای نتایج دو پهلو می‌باشد، از این رو مطالعه حاضر با بررسی ارتباط بین سطح سرمی ویتامین D و دیابت بارداری انجام شد.
روشکار: این مطالعه آینده‌نگر در سال 97-1396 بر روی زنان باردار 40-15 ساله که در تریمستر اول بارداری برای مراقبت‌های پره‌ناتال به مراکز خدمات جامع سلامت شهر مشهد مراجعه کردند و معیارهای ورود را داشتند، انجام شد. اطلاعات مربوط به سن و شاخص توده بدنی واحدهای پژوهش ثبت شد. سپس از تمامی شرکت‌کنندگان 5 سی‌سی خون به‌منظور اندازه‌گیری سطح 25- هیدروکسی ویتامین D3 گرفته شد. در هفته 28-24 بارداری تمامی شرکت‌کنندگان آزمون تحمل خوراکی گلوکز (OGTT) را انجام دادند. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری  SPSS(نسخه 16) و آزمون‌های تی مستقل، من‌ویتنی، کای اسکوئر و دقیق فیشر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر
 گرفته شد.
یافته‌ها: از 449 فرد شرکت‌کننده، 320 نفر (2/71%) دارای سطح کمتر از حد طبیعی ویتامین D بودند که 68 نفر (1/15%) کمبود و 252 نفر (1/56%) سطح ناکافی ویتامین D داشتند. 7 نفر (6/1%) سطح بالاتری از ویتامین D و 122 نفر (27%) سطح نرمال ویتامین D داشتند. از بین واحدهای پژوهش، 41 نفر (1/9%) مبتلا به دیابت بارداری شدند. میانه سطح سرمی ویتامین D در افراد بدون دیابت بارداری 22 و در افراد با دیابت بارداری 18 نانو‌گرم بر سی‌سی بود که هرچند متفاوت بود، ولی تفاوت معناداری بین سطح ویتامین D در دو گروه وجود نداشت (555/0=p).
نتیجه‌گیری: هرچند میزان ویتامین D در افراد مبتلا به دیابت بارداری پایین‌تر بود، اما ارتباط معنی‌داری بین سطح ویتامین D و دیابت بارداری وجود نداشت و هر دو گروه سطح کمتر از حد طبیعی ویتامین D را داشتند.

کلیدواژه‌ها


عنوان مقاله [English]

The relationship between vitamin D deficiency and gestational diabetes mellitus

نویسندگان [English]

  • Marzieh Lotfalizadeh 1
  • Negar Ramezanpour 2
  • Kosar Deldar 3
  • Mansoureh Mohammadnezhad 4
1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Assistant professor, Department of Emergency Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnord, Iran.
4 Librarian, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: Gestational diabetes mellitus (GDM) is the most common problem in pregnancy and about 1-20% of pregnant women have GDM. Therefore, it is significantly importance to prevent and treat GDM. Numerous researchers have explored the possible risk factors of GDM. Vitamin D deficiency is one of these risk factors that has ambiguous results, therefore, this study was performed with aim to investigate the relationship between serum vitamin D levels and gestational diabetes.
Methods: This prospective study was conducted in 2017-2018 on pregnant women aged 15-40 years with inclusion criteria who referred to health services centers in Mashhad in first trimester of pregnancy for prenatal care. Data related to age and BMI was recorded. Then, 5 cc of blood was taken from all participants to measure 25-hydroxyvitamin D3. All participants underwent the Oral Glucose Tolerance Test (OGTT) at 24-28 weeks of gestation. Data were analyzed by SPSS software (version 16) and Independent t-test, Mann-Whitney, Chi-square and Fisher's exact test. P<0.05 was considered statistically significant
Results: From 449 participants, 320 (71.2%) had lower than normal levels of vitamin D that 68 (15.1%) of participants suffered from vitamin D deficiency and 252 (56.1%) suffered from vitamin D insufficiency. In addition, 7 participants (1.6%) had the higher levels of vitamin D and 122 (27%) had normal vitamin D. Among the subjects, 41 (9.1%) developed gestational diabetes. The median of vitamin D levels within non-diabetic group was 22 ng/cc and 18 ng/cc for diabetic group, although there was difference, but the difference was not significant between the two groups (p=0.555).
Conclusion: Although vitamin D level was lower in GDM patients, but there was no relationship between vitamin D and gestational diabetes and both groups had vitamin D level lower than normal range.

کلیدواژه‌ها [English]

  • Gestational diabetes
  • Vitamin D
  1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 23nd New York: McGraw-Hill Education; 2014.
  2. Dirar AM, Doupis J. Gestational diabetes from A to Z. World journal of diabetes 2017; 8(12):489.
  3. Ramachandran A, Snehalatha C, Shyamala P, Vijay V, Viswanathan M. Prevalence of diabetes in pregnant women—a study from southern India. Diabetes research and clinical practice 1994; 25(1):71-4.
  4. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. Bmj 2013; 346.
  5. Hossein-Nezhad A, Maghbooli Z, Vassigh AR, Larijani B. Prevalence of gestational diabetes mellitus and pregnancy outcomes in Iranian women. Taiwanese Journal of Obstetrics and Gynecology 2007; 46(3):236-41.
  6. Henriksen T. The macrosomic fetus: a challenge in current obstetrics. Acta obstetricia et gynecologica Scandinavica 2008; 87(2):134-45.
  7. Gibbs RS, Kaelan BY, Haney AF, Nygaard IE. Danforth's Obstetrics and Gynecology. 10nd Lippincott Williams & Wilkins; 2008.
  8. Jafari-Shobeiri M, Ghojazadeh M, Azami-Aghdash S, Naghavi-Behzad M, Piri R, Pourali-Akbar Y, et al. Prevalence and risk factors of gestational diabetes in Iran: a systematic review and meta-analysis. Iranian journal of public health 2015; 44(8):1036.
  9. Kampmann U, Madsen LR, Skajaa GO, Iversen DS, Moeller N, Ovesen P. Gestational diabetes: a clinical update. World journal of diabetes 2015; 6(8):1065.
  10. Sobhani AR, Heidarnezhad Z, Mansour Ghanaei M, Salamat F. Association between Vitamin D and Gestational Diabetes. J Guil Uni Med Sci 2016; 25(98):45-50.
  11. Ghomian N, Lotfalizade M, Movahedian A. Comparative study of serum level of vitamin D in pregnant women with preeclampsia and normal pregnant women. Iran J Obstet Gynecol Infertil 2015; 18(140):1-6.
  12. Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. European journal of clinical nutrition 2009; 63(5):646-52.
  13. Wang TJ, Pencina MJ, Booth SL, Jacques PF, Ingelsson E, Lanier K, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117(4):503-11.
  14. Cheraghpour M, Naghashian F, Ehrampoush E, Davoodi H, Homayounfar R. Investigating the Protective Effects of Vitamin D on Diabetes. Journal of Fasa University of Medical Sciences 2014; 4(1).
  15. Rostami M, Ramezani Tehrani F, Simbar M, Hossein Panah F. Relationship between maternal blood vitamin D levels and pregnancy outcomes: a review article. Journal of fasa university of medical sciences 2016; 6(1):1-18.
  16. Fairfield KM, Fletcher RH. Vitamins for chronic disease prevention in adults: scientific review. Jama 2002; 287(23):3116-26.
  17. Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients 2015; 7(10):8366-75.
  18. Azami M, Beigom Bigdeli Shamloo M, Parizad Nasirkandy M, Veisani Y, Rahmati S, YektaKooshali MH, et al. Prevalence of vitamin D deficiency among pregnant women in Iran: A systematic review and meta-analysis. Koomesh 2017; 19(3):505-14.
  19. Senti J, Thiele DK, Anderson CM. Maternal vitamin D status as a critical determinant in gestational diabetes. Journal of Obstetric, Gynecologic & Neonatal Nursing 2012; 41(3):328-38.
  20. 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. American journal of obstetrics and gynecology 2012; 207(3):182-e1.
  21. 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 and childbirth 2014; 14(1):1-6.
  22. Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Critical reviews in food science and nutrition 2018; 58(5):755-69.
  23. Ede G, Keskin U, Cemal Yenen M, Samur G. Lower vitamin D levels during the second trimester are associated with developing gestational diabetes mellitus: an observational cross-sectional study. Gynecological Endocrinology 2019; 35(6):525-8.
  24. Keller A, Stougård M, Frederiksen P, Thorsteinsdottir F, Vaag A, Damm P, et al. In utero exposure to extra vitamin D from food fortification and the risk of subsequent development of gestational diabetes: The D-tect study. Nutrition journal 2018; 17(1):1-9.
  25. Krishnaveni GV, Veena SR, Winder NR, Hill JC, Noonan K, Boucher BJ, et al. Maternal vitamin D status during pregnancy and body composition and cardiovascular risk markers in Indian children: the Mysore Parthenon Study–. The American journal of clinical nutrition 2011; 93(3):628-35.
  26. Haidari F, Jalali MT, Shahbazian N, Haghighizadeh MH, Azadegan E. Comparison of serum levels of vitamin D and inflammatory markers between women with gestational diabetes mellitus and healthy pregnant control. Journal of family & reproductive health 2016; 10(1):1-8.
  27. Ou W, Min NI, Hu YY, Zhang K, Wei LI, Fan PI, et al. Association between vitamin D insufficiency and the risk for gestational diabetes mellitus in pregnant Chinese women. Biomedical and Environmental Sciences 2012; 25(4):399-406.
  28. Zhang Y, Gong Y, Xue H, Xiong J, Cheng G. Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect. BJOG: An International Journal of Obstetrics & Gynaecology 2018; 125(7):784-93.
  29. Hauta-Alus HH, Viljakainen HT, Holmlund-Suila EM, Enlund-Cerullo M, Rosendahl J, Valkama SM, et al. Maternal vitamin D status, gestational diabetes and infant birth size. BMC pregnancy and childbirth 2017; 17(1):1-9.
  30. 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.
  31. Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, et al. Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. European journal of clinical nutrition 2009; 63(5):646-52.
  32. 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. Journal of nutritional science and vitaminology 2014; 60(4):269-75.
  33. Baker AM, Haeri S, Camargo Jr CA, Stuebe AM, Boggess KA. First‐trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case‐control study. Diabetes/metabolism research and reviews 2012; 28(2):164-8.
  34. Triunfo S, Lanzone A, Lindqvist PG. Low maternal circulating levels of vitamin D as potential determinant in the development of gestational diabetes mellitus. Journal of Endocrinological Investigation 2017; 40(10):1049-59.