cholecalciferol and Diabetes--Gestational

Vitamin D has historically been considered to play a role solely in bone and calcium metabolism. Human disease associations and basic physiological studies suggest that vitamin D deficiency is plausibly implicated in adverse health outcomes including mortality, malignancy, cardiovascular disease, immune functioning and glucose metabolism. There is considerable evidence that low maternal levels of 25 hydroxyvitamin D are associated with adverse outcomes for both mother and fetus in pregnancy as well as the neonate and child. Vitamin D deficiency during pregnancy has been linked with a number of maternal problems including infertility, preeclampsia, gestational diabetes and an increased rate of caesarean section. Likewise, for the child, there is an association with small size, impaired growth and skeletal problems in infancy, neonatal hypocalcaemia and seizures, and an increased risk of HIV transmission. Other childhood disease associations include type 1 diabetes and effects on immune tolerance. The optimal concentration of 25 hydroxyvitamin D is unknown and compounded by difficulties in defining the normal range. Whilst there is suggestive physiological evidence to support a causal role for many of the associations, whether vitamin D deficiency is a marker of poor health or the underlying aetiological problem is unclear. Randomised controlled trials of vitamin D supplementation with an appropriate assessment of a variety of health outcomes are required.

Topics: Cholecalciferol; Diabetes Mellitus; Diabetes, Gestational; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Lactation; Muscle, Skeletal; Parathyroid Hormone; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Reference Values; Skin; Vitamin D Deficiency

Vitamin D deficiency is a common finding in overweight/obese pregnant women and is associated with increased risk for adverse pregnancy outcome. Both maternal vitamin D deficiency and maternal obesity contribute to metabolic derangements in pregnancy. We aimed to assess the effects of vitamin D3 supplementation in pregnancy versus placebo on maternal and fetal lipids. Main inclusion criteria were: women <20 weeks’ gestation, BMI ≥ 29 kg/m2. Eligible women (n = 154) were randomized to receive vitamin D3 (1600 IU/day) or placebo. Assessments were performed <20, 24−28 and 35−37 weeks and at birth. Linear regression models were used to assess effects of vitamin D on maternal and cord blood lipids. In the vitamin D group significantly higher total 25-OHD and 25-OHD3 levels were found in maternal and cord blood compared with placebo. Adjusted regression models did not reveal any differences in triglycerides, LDL-C, HDL-C, free fatty acids, ketone bodies or leptin between groups. Neonatal sum of skinfolds was comparable between the two groups, but correlated positively with cord blood 25-OH-D3 (r = 0.34, p = 0.012). Vitamin D supplementation in pregnancy increases maternal and cord blood vitamin D significantly resulting in high rates of vitamin D sufficiency. Maternal and cord blood lipid parameters were unaffected by Vitamin D3 supplementation.

Topics: Body Fat Distribution; Cholecalciferol; Cholesterol, LDL; Diabetes, Gestational; Dietary Supplements; Fatty Acids, Nonesterified; Female; Humans; Infant, Newborn; Ketone Bodies; Leptin; Life Style; Obesity; Overweight; Pregnancy; Pregnancy Outcome; Pregnant Women; Triglycerides; Vitamin D; Vitamin D Deficiency; Vitamins

Vitamin D status and requirements of infants of women with gestational diabetes mellitus (GDM) are unclear.. The objectives were to assess vitamin D status in infants of mothers with GDM and compare vitamin D status in response to 400 vs. 1000 IU/d vitamin D supplementation in infants born with serum 25-hydroxyvitamin D [25(OH)D] <50 nmol/L.. Women with GDM delivering full-term infants (n = 98; March 2017-2019, Montreal, Canada) were surveyed for demographic and lifestyle factors. Pregnancy history was obtained from medical records. Newborn serum 25(OH)D was measured (immunoassay) and categorized as <30 (deficient) or ≥40 nmol/L (adequate). Breastfed neonates (n = 16) with serum 25(OH)D <50 nmol/L at birth were randomly assigned to 400 or 1000 IU/d of supplemental cholecalciferol (vitamin D. Mean newborn serum 25(OH)D was 46.4 (95% CI: 43.9, 49.9) nmol/L, with 15.3% (95% CI: 8.2%, 22.4%) <30 nmol/L and 61.2% (95% CI: 51.6%, 70.9%) ≥40 nmol/L. During the trial, most infants were breastfed to 3 mo (400 IU/d: 87.5%; 1000 IU/d: 75.0%). Mean (± SEM) infant serum 25(OH)D was higher in the 1000-IU/d group at 3 mo (79.9 ± 5.9 vs. 111.5 ± 15.2 nmol/L; P = 0.0263), and although not different at 6-12 mo, was maintained at >50 nmol/L.. Most infants of women with GDM had adequate vitamin D status in this study. In those born with serum 25(OH)D <50 nmol/L, vitamin D status was corrected by 3 mo of age in response to 400 or 1000 IU/d of supplemental vitamin D. Dietary guidance should continue to recommend that all women who could become pregnant take a multivitamin supplement and that breastfed infants receive 400 IU/d of supplemental vitamin D. This study and ancillary trial were registered at clinicaltrials.gov (https://www.. gov/ct2/show/NCT02563015) as NCT02563015.

Topics: Cholecalciferol; Diabetes, Gestational; Dietary Supplements; Female; Humans; Infant; Infant, Newborn; Pregnancy; Vitamin D; Vitamin D Deficiency; Vitamins

The present study was designed to assess the effects of Ca+vitamin D supplementation on pregnancy outcomes in women with gestational diabetes mellitus (GDM).. A randomized, double-blind, placebo-controlled trial was conducted among sixty women with GDM. Participants were divided into two groups to receive Ca+vitamin D supplements or placebo. Individuals in the Ca+vitamin D group (n 30) received 1000 mg Ca/d and two pearls containing 1250 µg (50 000 IU) of cholecalciferol (vitamin D(3)) during the intervention (one at study baseline and another at day 21 of the intervention); those in the placebo group (n 30) received two placebos of vitamin D at the mentioned times and placebos of Ca every day for 6 weeks. Pregnancy outcomes were determined.. A urban community setting in Arak, Iran.. Sixty women with GDM and their newborns, living in Arak, Iran were enrolled.. Women treated with Ca+vitamin D had a significant decrease in caesarean section rate (23·3 % v. 63·3 %, P=0·002) and maternal hospitalization (0 v. 13·3 %, P=0·03) compared with those receiving placebo. In addition, newborns of GDM women randomized to Ca+vitamin D had no case of macrosomia, while the prevalence of macrosomia among those randomized to placebo was 13·3 % (P=0·03). Lower rates of hyperbilirubinaemia (20·0 % v. 56·7 %, P=0·03) and hospitalization (20·0 % v. 56·7 %, P=0·03) were also seen in the supplemented group of newborns than in the placebo group.. Ca+vitamin D supplementation for 6 weeks among pregnant women with GDM led to decreased caesarean section rate and maternal hospitalization, and decreased macrosomia, hyperbilirubinaemia and hospitalization in newborns.

Topics: Adolescent; Adult; Blood Glucose; Body Mass Index; Body Weight; Calcium, Dietary; Cesarean Section; Cholecalciferol; Diabetes, Gestational; Dietary Supplements; Double-Blind Method; Female; Fetal Macrosomia; Follow-Up Studies; Hospitalization; Humans; Hyperbilirubinemia; Iran; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Vitamin D; Young Adult

Our study aimed to examine the effects of daily consumption of vitamin D3-supplemented yogurt (VDY) drink on insulin resistance and lipid profiles in pregnant gestational diabetes mellitus (GDM) patients.. Participants aged 24-32 years in their second trimester were randomly assigned to consume either plain yogurt or VDY daily for 16 weeks. Metabolic and lipid profiles including levels of fasting plasma glucose (FPG), serum insulin, triacylglycerol (TAG), total cholesterol (TC) and low-density lipoprotein (LDL) were assessed at baseline (week 0) and end of trial (week 16).. After 16 weeks of intervention, insulin-related variables including FPG and serum insulin levels were markedly lower in VDY group participants. Insulin resistance parameters, such as homeostasis model of assessment of insulin resistance and β cell function, were also significantly reduced in VDY group participants. Moreover, levels of TAG, TC and LDL, as well as the TC to high-density lipoprotein ratio, had also significantly decreased in the VDY group.. Daily consumption of VDY drink improves insulin resistance and lipid profiles in women with GDM.

Topics: Adult; Beverages; Biomarkers; Calcifediol; China; Cholecalciferol; Diabetes, Gestational; Double-Blind Method; Female; Food, Fortified; Humans; Hyperglycemia; Hyperinsulinism; Hyperlipidemias; Insulin Resistance; Lipids; Maternal Nutritional Physiological Phenomena; Patient Dropouts; Pregnancy; Pregnancy Trimester, Second; Yogurt; Young Adult

Gestational diabetes mellitus (GDM) has been recognized as a significant risk factor for unfavorable pregnancy outcomes. Prevalence of vitamin D deficiency is highly prevalent among women with GDM. This study was designed to assess the effect of vitamin D supplementation on pregnancy outcomes of pregnant women with GDM who were not on oral hypoglycemic agents. This randomized controlled clinical trial was performed among 45 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either vitamin D supplements (cholecalciferol) or placebo. Individuals in the vitamin D group (n=22) received 50 000 IU vitamin D3 pearl 2 times during the study: at study baseline and day 21 of intervention and those in placebo group (n=23) received 2 placebos at the mentioned times. Fasting blood samples were taken at baseline to measure fasting plasma glucose. Participants underwent a 3-h oral glucose tolerance tests (OGTT) and the blood samples were collected at time 60, 120, and 180 min to measure plasma glucose levels. Newborn's weight, height, head circumference, Apgar score, and hyperbilirubinemia were determined. Taking vitamin D supplements, compared with placebo, resulted in improved pregnancy outcomes; such that those in the vitamin D group had no case of polyhydramnios, while 17.4% of subjects in placebo group had this condition (p=0.04). In addition, newborn's hyperbilirubinemia was significantly lower in vitamin D group than that in placebo group (27.3% vs. 60.9%, p=0.02). In conclusion, vitamin D supplementation for 6 weeks among pregnant women with GDM resulted in decreased maternal polyhydramnios and infant hyperbilirubinemia compared with placebo. Clinical trial registration number www.irct.ir:IRCT201305115623N7.

Topics: Adult; Cholecalciferol; Diabetes, Gestational; Double-Blind Method; Female; Humans; Hyperbilirubinemia, Neonatal; Polyhydramnios; Pregnancy; Pregnancy Outcome; Treatment Outcome

Vitamin D deficiency in pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM) and neonatal vitamin D deficiency. We conducted a double-blind, randomized controlled trial of low-dose (LD) versus high-dose (HD) vitamin D supplementation to investigate the effects of vitamin D supplementation on glucose metabolism during pregnancy.. Women with plasma 25-hydroxyvitamin D (25OHD) levels <32 ng/mL before 20 weeks' gestation were randomized to oral vitamin D3 at 5,000 IU daily (HD) (n = 89) or the recommended pregnancy dose of 400 IU daily (LD) (n = 90) until delivery. The primary end point was maternal glucose levels on oral glucose tolerance test (OGTT) at 26-28 weeks' gestation. Secondary end points included neonatal 25OHD, obstetric and other neonatal outcomes, and maternal homeostasis model assessment of insulin resistance. Analysis was by intention to treat.. There was no difference in maternal glucose levels on OGTT. Twelve LD women (13%) developed GDM versus seven (8%) HD women (P = 0.25). Neonatal cord 25OHD was higher in HD offspring (46 ± 11 vs. 29 ± 12 ng/mL, P < 0.001), and deficiency was more common in LD offspring (24 vs. 10%, P = 0.06). Post hoc analysis in LD women showed an inverse relationship between pretreatment 25OHD and both fasting and 2-h blood glucose level on OGTT (both P < 0.001). Baseline 25OHD remained an independent predictor after multiple regression analysis.. HD vitamin D supplementation commencing at a mean of 14 weeks' gestation does not improve glucose levels in pregnancy. However, in women with baseline levels <32 ng/mL, 5,000 IU per day was well tolerated and highly effective at preventing neonatal vitamin D deficiency.

Topics: Adult; Cholecalciferol; Diabetes, Gestational; Dietary Supplements; Dose-Response Relationship, Drug; Double-Blind Method; Fasting; Female; Glucose; Glucose Tolerance Test; Humans; Insulin Resistance; Pregnancy; Pregnancy Complications; Vitamin D; Vitamin D Deficiency; Young Adult

To our knowledge, there is no study that has examined the effects of vitamin D supplementation on metabolic status in gestational diabetes mellitus (GDM).. This study was designed to assess the effects of vitamin D supplementation on metabolic profiles, high-sensitivity C-reactive protein, and biomarkers of oxidative stress in pregnant women with GDM.. This randomized, double-blind, placebo-controlled clinical trial was conducted in 54 women with GDM. Subjects were randomly assigned to receive either vitamin D supplements or placebo. Individuals in the vitamin D group (n = 27) received capsules containing 50,000 IU vitamin D₃ 2 times during the study (at baseline and at day 21 of the intervention) and those in the placebo group (n = 27) received 2 placebos at the same times. Fasting blood samples were collected at baseline and after 6 wk of the intervention to quantify relevant variables.. Cholecalciferol supplementation resulted in increased serum 25-hydroxyvitamin D concentrations compared with placebo (+18.5 ± 20.4 compared with +0.5 ± 6.1 ng/mL; P < 0.001). Furthermore, intake of vitamin D supplements led to a significant decrease in concentrations of fasting plasma glucose (-17.1 ± 14.8 compared with -0.9 ± 16.6 mg/dL; P < 0.001) and serum insulin (-3.08 ± 6.62 compared with +1.34 ± 6.51 μIU/mL; P = 0.01) and homeostasis model of assessment-insulin resistance (-1.28 ± 1.41 compared with +0.34 ± 1.79; P < 0.001) and a significant increase in the Quantitative Insulin Sensitivity Check Index (+0.03 ± 0.03 compared with -0.001 ± 0.02; P = 0.003) compared with placebo. A significant reduction in concentrations of total (-11.0 ± 23.5 compared with +9.5 ± 36.5 mg/dL; P = 0.01) and low-density lipoprotein (LDL) (-10.8 ± 22.4 compared with +10.4 ± 28.0 mg/dL; P = 0.003) cholesterol was also seen after vitamin D supplementation.. Vitamin D supplementation in pregnant women with GDM had beneficial effects on glycemia and total and LDL-cholesterol concentrations but did not affect inflammation and oxidative stress. This trial was registered at www.irct.ir as IRCT201305115623N7.

Topics: Adult; Biomarkers; C-Reactive Protein; Calcifediol; Cholecalciferol; Diabetes, Gestational; Dietary Supplements; Double-Blind Method; Female; Humans; Hypercholesterolemia; Hyperinsulinism; Insulin Resistance; Intention to Treat Analysis; Iran; Lost to Follow-Up; Oxidative Stress; Pregnancy; Pregnancy Complications; Vitamin D Deficiency

Whether there is a dose-dependent effect of maternal dietary cholecalciferol during pregnancy on maternal glucose tolerance is unknown. In addition, circulating osteocalcin is increased by 1,25-dihydroxyvitamin D [1,25(OH)2D] and may improve glucose homeostasis.. This study was designed to test whether dietary cholecalciferol during pregnancy dose-dependently affects maternal glucose tolerance and maternal and neonatal glucose concentrations in relation to plasma osteocalcin and body composition.. Female guinea pigs (n = 45; 4 mo old) were randomly assigned to 5 doses of cholecalciferol (0, 0.25, 0.5, 1, or 2 IU/g diet) fed from mating to delivery. Plasma vitamin D metabolites, minerals, and osteocalcin, and blood glucose were measured before mating, at midgestation (day 42), and at day 2 postpartum in sows and in 2-d-old pups. At day 50 of pregnancy (early third trimester), a 3-h oral-glucose-tolerance test (OGTT) (2 g/kg) was conducted. Body composition was measured before mating and at day 2 postpartum in sows and in pups.. A positive dose-response to dietary cholecalciferol was observed for change in maternal plasma 25-hydroxyvitamin D [25(OH)D] through pregnancy (P < 0.0001), with 1,25(OH)2D increasing by 198% in the 1-IU/g group by midgestation vs. a reduction of 43.6% in the 0-IU/g group (P = 0.05). Twenty-four (54.5%) sows had gestational diabetes mellitus (GDM) on the basis of nonfed glucose and 39 (88.6%) had GDM on the basis of 2-h OGTT glucose concentrations. There were no group differences in maternal OGTT or changes in glucose, minerals, osteocalcin concentrations, and body composition. Pre-mating 25(OH)D was inversely related to 3-h area under the curve for blood glucose from the OGTT (r = -0.31, P = 0.05). In guinea pig pups, although both 25(OH)D (P < 0.0001) and 1,25(OH)2D (P < 0.0001) followed a dose-response to maternal diet, glucose, osteocalcin, minerals, and body composition were not altered.. Dietary vitamin D intake during pregnancy in guinea pigs does not affect the already high rate of GDM, whereas higher prepregnancy vitamin D status appears to be protective.

Topics: Absorptiometry, Photon; Animals; Blood Glucose; Body Composition; Calcium; Cholecalciferol; Diabetes, Gestational; Dose-Response Relationship, Drug; Female; Glucose Tolerance Test; Guinea Pigs; Maternal Nutritional Physiological Phenomena; Osteocalcin; Pregnancy; Reproduction