COGI 2023

ADDED VALUE OF VITAMIN D SUPPLEMENTATION IN THE STANDARD OF CARE FOR TREATING GESTATIONAL MELLITUS DIABETES

Rossella Prospero Elisabetta Stucchi Anna Maria Veronelli Damiana Cavallaro Lucrezia Loda Chiara Dossi Veronica Iannuzzi Silvia Gherardi Martina Podda Sara Cella Anna Maria Marconi Stefania Triunfo
Department of Obstetrics and Gynecology, Milan, Italy, Asst Santi Paolo E Carlo, S. Paolo University Hospital, Universita' Degli Studi Di Milano,, Milan

Problem statement

Gestational diabetes mellitus (GDM), defined as any glucose intolerance with the onset or first recognition during pregnancy, is characterized by rising incidence, fostered by the worldwide increase of pathological nutritional status from young age. In pregnant women, lower 25(OH)D concentrations have been suggested to present an inverse association with maternal glycaemia, insulin resistance, and increased risk of GDM. In spite of growing body of evidence, there is not full agreement on the therapeutic association between GDM based on VD deficiency and 25(OH)D supplementation. In the attempt to bring up-to-date the role of low VD levels in the management of GDM, the aim of this study was to illuminate the impact of VD supplementation in GDM controlling.

Methods

A retrospective study was designed including pregnant women affected by GDM. Data were collected about demographics, pregnancy course, maternal and fetal outcomes, and therapeutical approach. Vitamin D supplementation was revised in all medical records. Student’s t-test for independent samples and Mann–Whitney-U, Pearson-v2, or exact Fisher’s tests were used to compare quantitative and qualitative data, respectively. All tests were two-sided, and p-values lower than .05 were established statistically significant.

Results

A total of 605 pregnancies complicated by GDM were included in the analysis. Among them, 138 (16.5%) pregnant women were supplemented by oral vitamin D, and 467 (83.5%) were treated only by standard of care for DGM (diet, insulin or metformin). Statistical differences were found between study groups in ethnicity (p-value .039), smoking status (p-value .046), BMI at beginning (p-value .022), medical history (chronic hypertension, p-value .022 ; thyroid disease, p-value <.001; neurological disease, p-value .003). Among perinatal outcomes, labor induction (p-value .022) and blood loss (p-value .023) were statistically significant different between study groups.

Conclusion

Vitamin D supplementation in the treatment of GDM can improve perinatal outcomes among those pregnant women with higher risks related to their baseline characteristics and preexisting medical conditions. Additionally, the potential role in controlling blood loss at birth seems to support its recommendation during pregnancy.

Keywords: Pregnancy, diabetes, vitamin D supplementation, diet, metformin, insulin.