Gebelerde İlk Trimester Plazma D Vitamini Düzeyleri ile Gestasyonel Diyabet Arasında İlişki Var mı?

Yıl 2020, , 36 - 40, 23.04.2020

Görker Sel , Selen Seyhan Baydağ Aykut Barut , Adile Yeşim Akdemir , Ülkü Özmen , Müge Harma , Mehmet Harma

https://doi.org/10.25048/tudod.700771

Cited By: 1

Öz

Amaç: Batı Karadeniz Bölgesinde, iki merkezde oral glukoz tarama testi (OGTT) uygulanmış gebelerde, gestasyonel diyabet (GDM)
saptanan ve saptanmayan gruplar arasında ilk trimester plazma D vitamini seviyesinin ilişkisini araştırmaktır.

Gereç ve Yöntemler: 17.09.2014-15.01.2018 tarihleri arasında Bartın Devlet Hastanesi ve Zonguldak Bülent Ecevit Üniversitesi Tıp
Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalına başvuran 18-40 yaş arası, tekil gebeliği olan ve ilk trimesterde maternal
plazmada D vitamini seviyesi bakılmış ve OGTT yapılmış 136 gebe çalışmaya dahil edildi, retrospektif olarak veriler tarandı. Çoğul
gebelikler, gebelik öncesi diyabet gibi ek sistemik hastalığı bulunan, glukoz tarama testi yaptırmak istemeyen, ilk trimesterde D vitamini
seviyesine bakılmamış ya da kan verme zamanında D vitamini takviyesi alan, zararlı madde kullanımı olan, çoğul gebeliği olan gebeler
çalışmaya dahil edilmedi. GDM tanısı almış 52 gebe GDM grubu, diğer 84 gebe kontrol grubu olarak OGTT yapıldığı esnadaki yaş,
gravide, parite, hemoglobin değeri ve vücut kütle indeksi (VKİ) eşleşecek şekilde oluşturuldu.

Bulgular: Yaş, gravida, parite, hemoglobin, VKİ değerleri açısından her iki grup benzerdi (p>0,05). D vitamini seviyelerine bakıldığında
ise GDM gelişen grupta, ilk trimesterdeki maternal D vitamini seviyesinin GDM gelişmemiş gruba göre anlamlı olarak düşük olduğu
saptanmıştır (p=0,031).

Sonuç: D vitamininin diyabet patogenezinde rolü olduğu önceki çalışmalarda da gösterilmiştir. Ayrıca literatürdeki az sayıdaki çalışmada
da saptandığı gibi bizim bölgesel çalışmamızda da GDM saptanan gebelerde D vitamini eksikliği göze çarpmaktadır. Batı Karadeniz
Bölgesi’ni içeren bu çalışmamız daha kapsamlı prospektif çalışmalara yol gösterici nitelikte olacaktır.

Anahtar Kelimeler

D vitamini, gebelik, Gestasyonel diabetes mellitus

Teşekkür

İstatistik verilerinin hesaplanmasında Dr. Sibel Balcı'ya teşekkür ederim.

Is There a Relationship Between First Trimester Plasma Vitamin D Levels and Gestational Diabetes in Pregnant Women?

Öz

Aim: Carried out in pregnant women who had oral glucose tolerance test (OGTT) in two centers in the Western Black Sea Region, this
study aims to investigate the relationship of the first trimester plasma vitamin D levels between the groups with and without gestational
diabetes mellitus (GDM).

Material and Methods: Between the dates of 17.09.2014-15.01.2018 at Bartın State Hospital and Zonguldak Bülent Ecevit University
Faculty of Medicine, Department of Obstetrics and Gynecology, 136 pregnant women aged between 18-40 with a single pregnancy who
took OGTT and whose vitamin D levels in maternal plasma were examined in their first trimester were included in the study, and the
collected data were reviewed retrospectively. Pregnant women who had additional systemic diseases such as pre-pregnancy diabetes, or
those with multiple pregnancies, or the ones who did not want to have a glucose screening test, who had not their vitamin D level tested
in the first trimester, who were taking vitamin D supplements at the time of admission were not included in the study. The GDM Group
of 52 pregnant women who were diagnosed with GDM were matched with the other 84 pregnant women who formed the control group
according to the age, gravida, parity, hemoglobin value and body mass index (BMI) at the time of the OGTT test.

Results: Both groups were similar in terms of age, gravida, parity, hemoglobin and BMI values (p> 0.05). Considering vitamin D levels,
it was found that the level of maternal vitamin D in the first trimester was significantly lower in the group that developed GDM when
compared to the group that did not develop GDM (p=0.031).

Conclusion: Vitamin D has also been shown to play a role in the pathogenesis of diabetes. In addition, as seen in the few previous studies
in the literature, vitamin D deficiency in pregnant women with GDM is found in our regional study, as well. This study, which includes
the Western Black Sea Region, will guide more comprehensive prospective studies.

Anahtar Kelimeler

Gestational diabetes mellitus, Vitamin D, Pregnancy

Kaynakça

• 1. WB Grant, SJ Wimalawansa, MF Holick. Vitamin D supplements and reasonable solar UVB should be recommended to prevent escalating incidence of chronic diseases. Br. Med. J, 2015. 350, h321.
• 2. Haq A, Wimalawansa SJ, Pludowski P, Al Anouti F. Clinical practice guidelines for vitamin D in the United Arab Emirates. The Journal of steroid biochemistry and molecular biology. 2018 Jan 1;175:4-11.
• 3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.
• 4. Kürklü NS, Aylin AY. D Vitamini Ve Gestasyonel Diyabet. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2015;4(3):454-67.
• 5. Bodnar LM, Platt RW, Simhan HN. Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes. Obstetrics and gynecology. 2015 Feb;125(2):439-47.
• 6. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. The Journal of Clinical Endocrinology & Metabolism. 2007 Sep 1;92(9):3517-22.
• 7. Baker AM, Haeri S, Camargo Jr CA, Espinola JA, Stuebe AM. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. The Journal of Clinical Endocrinology & Metabolism. 2010 Nov 1;95(11):5105-9.
• 8. Singla R, Gurung P, Aggarwal N, Dutta U, Kochhar R. Relationship between preeclampsia and vitamin D deficiency: a case control study. Archives of gynecology and obstetrics. 2015 Jun 1;291(6):1247-51.
• 9. Woo J, Giurgescu C, Wagner CL. Evidence of an association between vitamin D deficiency and preterm birth and preeclampsia: a critical review. Journal of midwifery & women's health. 2019 Sep;64(5):613-29.
• 10. Baca KM, Simhan HN, Platt RW, Bodnar LM. Low maternal 25-hydroxyvitamin D concentration increases the risk of severe and mild preeclampsia. Annals of epidemiology. 2016 Dec 1;26(12):853-7.
• 11. Chen S, Villalta SA, Agrawal DK. FOXO1 Mediates Vitamin D Deficiency–Induced Insulin Resistance in Skeletal Muscle. Journal of Bone and Mineral Research. 2016 Mar;31(3):585-95.
• 12. Gulseth HL, Wium C, Angel K, Eriksen EF, Birkeland KI. Effects of vitamin D supplementation on insulin sensitivity and insulin secretion in subjects with type 2 diabetes and vitamin D deficiency: a randomized controlled trial. Diabetes Care. 2017; 40(7):872-8,
• 13. Park S, Kim DS, Kang S. Vitamin D deficiency impairs glucose-stimulated insulin secretion and increases insulin resistance by reducing PPAR-γ expression in nonobese Type 2 diabetic rats. The Journal of nutritional biochemistry. 2016 Jan 1;27:257-65.
• 14. Caughey AB, Turrentine M. ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstetrics and Gynecology. 2018 Feb 1;131(2):E49-64.
• 15. Amraei M, Mohamadpour S, Sayehmiri K, Mousavi SF, Shirzadpour E, Moayeri A. Effects of vitamin D deficiency on incidence risk of gestational diabetes mellitus: A systematic review and meta-analysis. Frontiers in endocrinology. 2018 Feb 1;9:7.
• 16. Weinert LS, Reichelt AJ, Schmitt LR, Boff R, Oppermann ML, Camargo JL, Silveiro SP. Vitamin D deficiency increases the risk of adverse neonatal outcomes in gestational diabetes. PLoS One. 2016;11(10).
• 17. Rajput R, Vohra S, Nanda S, Rajput M. Severe 25 (OH) vitamin-D deficiency: A risk factor for development of gestational diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019 Mar 1;13(2):985-7.
• 18. McCormack C, Leemaqz S, Furness D, Dekker G, Roberts C. Association between vitamin D status and hyperinsulinism. The Journal of Maternal-Fetal & Neonatal Medicine. 2019 Dec 2;32(23):4005-8.
• 19. Xia J, Song Y, Rawal S, Wu J, Hinkle SN, Tsai MY, Zhang C. Vitamin D status during pregnancy and the risk of gestational diabetes mellitus: A longitudinal study in a multiracial cohort. Diabetes, Obesity and Metabolism. 2019 Aug;21(8):1895-905.
• 20. Mihmanlı V, Mihmanlı M. Diabetes Mellitus ve Gebelik. Okmeydanı Tıp Dergisi. 2015;31:17-22.
• 21. Seshadri R. American diabetes association gestational diabetes mellitus. Diabetes Care. 2002;25:S94-6.
• 22. Çelik D, Karaçam Z. Türkiye’de gestasyonel diyabetes mellitus prevalansı ve risk faktörleri: Sistematik derleme ve meta analiz. Adnan Menseres Üniversitesi 1. Sağlık Bilimleri Kongresi; 29 Haziran1 Temmuz 2017; Aydın; 2017. s.802.
• 23. Kaya R, Karaçam Z. Gestasyonel Diyabet Görülme Sıklığı ve Anne-Bebek Sağlığı ile İlişkisi. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi.2019;9(1):10-8.
• 24. Özyurt R, Aşıcıoğlu O, Gültekin T, Güngördük K, Boran B. İstanbul Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’ne başvuran gebelerde gestasyonel diyabet sıklığı. JOPP Derg. 2013;5(1):7-12.
• 25. Gürlek B, Kale İ. Rize İlinde Gestasyonel Diabetes Mellitus Prevalansı. Jinekoloji Obstetrik ve Neonatoloji Tıp Dergisi. 2019 Feb 7;16(1):31-6.
• 26. Şahin ME, Madendağ İÇ. Evaluation of the prevalence of gestational diabetes mellitus in Kayseri city hospital: A cross-sectional study. Journal of Surgery and Medicine. 2019 Oct 1;3(10):715-7.
• 27. Balık G, Şahin SB, Tekin YB, Şentürk Ş, Kağıtcı M, Şahin FK. Bir üniversite hastanesinin doğum polikliniğine başvuran gebelerde gestasyonel diabetes mellitus prevalansı. Ege Tıp Dergisi. 2016 Jun 1;55(2):55-8.
• 28. Roeckner JT, Bennett S, Mitta M, Sanchez-Ramos L, Kaunitz AM. Pregnancy outcomes associated with an abnormal 50-g glucose screen during pregnancy: a systematic review and Meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2019 Dec 31:1-9.
• 29. Akgol S, Budak MS. Obstetric and neonatal outcomes of pregnancies with mild gestational hyperglycemia diagnosed at gestational diabetes mellitus screening. Gynecology Obstetrics & Reproductive Medicine. 2019 Dec 2;25(3):138-41.
• 30. Demircan KD, Demircan V, Pekkolay Z, Çelepkolu T. Gestasyonel Diyabetes Mellitus Taraması: Herkes için Eğitim Şart. Acta Medica Nicomedia.;3(1):5-9.
• 31. 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 Jun;125(7):784-93.
• 32. Nikooyeh B, Neyestani TR. Oxidative stress, type 2 diabetes and vitamin D: past, present and future. Diabetes Metab Res Rev 2016; 32: 260–7.
• 33. Sing LP. The potential protective action of vitamin D in hepatic insulin resistance and pancreatic islet dysfunction in type 2 diabetes mellitus. Nutrients 2016; 8: 147.
• 34. Luong KVQ, Lan THN, Nguyen DNP. The role of vitamin D in protecting type 1 diabetes mellitus. Diabetes Metab Res Rev 2005; 21: 338–46.
• 35. Reeves IV, Bamji ZD, Rosario GB, Lewis KM, Young MA, Washington KN. Vitamin D deficiency in pregnant women of ethnic minority: a potential contributor to preeclampsia. J Perinatol. 2014;34:767–73.
• 36. 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.
• 37. Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3:e3753.
• 38. Thota C, Menon R, Fortunato SJ, Brou L, Lee JE, Al-Hendy A. 1,25-Dihydroxyvitamin D deficiency is associated with preterm birth in African American and Caucasian women. Reprod Sci. 2014;21:244–50.
• 39. Gernand AD, Simhan HN, Caritis S, Bodnar LM. Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol. 2014;123:40–8.
• 40. Poomalar GK. Changing trends in management of gestational diabetes mellitus. World journal of diabetes. 2015 Mar 15;6(2):284.
• 41. Soheilykhah S, Mojibian M, Moghadam MJ, Shojaoddiny-Ardekani A. The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy. Gynecological Endocrinology. 2013 Apr 1;29(4):396-9.
• 42. De-Regil LM, Palacios C, Ansary A, Kulier R, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2012;2:CD008873.
• 43. Persad MD, Staszewski C, Khan F, Perseleni T, Herrera K, Garretto D. Does Antepartum Vitamin D3 Supplementation Prevent Gestational Diabetes Mellitus?[18R]. Obstetrics & Gynecology. 2019 May 1;133:196S.
• 44. Lacroix M, Battista MC, Doyon M, Houde G, Ménard J, Ardilouze JL, Hivert MF, Perron P. Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus. Acta diabetologica. 2014 Aug 1;51(4):609-16.
• 45. Tai K, Need AG, Horowitz M, Chapman IM. Vitamin D, glucose, insulin, and insulin sensitivity. Nutrition. 2008 Mar 1;24(3):279-85.
• 46. Mertoğlu C, Günay M, Kulhan M. Gebelikte, gestasyonel diyabette ve üreme çağı kadınlarında D vitamini düzeyi. Van Tıp Dergisi. 2017;24(4): 328-32.