Maternal vitamin D status, gestational diabetes and infant birth size

Helena H Hauta-Alus, Heli T Viljakainen, Elisa M Holmlund-Suila, Maria Enlund-Cerullo, Jenni Rosendahl, Saara M Valkama, Otto M Helve, Timo K Hytinantti, Outi M Mäkitie, Sture Andersson, Helena H Hauta-Alus, Heli T Viljakainen, Elisa M Holmlund-Suila, Maria Enlund-Cerullo, Jenni Rosendahl, Saara M Valkama, Otto M Helve, Timo K Hytinantti, Outi M Mäkitie, Sture Andersson

Abstract

Background: Maternal vitamin D status has been associated with both gestational diabetes mellitus (GDM) and fetal growth restriction, however, the evidence is inconsistent. In Finland, maternal vitamin D status has improved considerably due to national health policies. Our objective was to compare maternal 25-hydroxy vitamin D concentrations [25(OH)D] between mothers with and without GDM, and to investigate if an association existed between maternal vitamin D concentration and infant birth size.

Methods: This cross-sectional study included 723 mother-child pairs. Mothers were of Caucasian origin, and infants were born at term with normal birth weight. GDM diagnosis and birth size were obtained from medical records. Maternal 25(OH)D was determined on average at 11 weeks of gestation in pregnancy and in umbilical cord blood (UCB) at birth.

Results: GDM was observed in 81 of the 723 women (11%). Of the study population, 97% were vitamin D sufficient [25(OH)D ≥ 50 nmol/L]. There was no difference in pregnancy 25(OH)D concentration between GDM and non-GDM mothers (82 vs 82 nmol/L, P = 0.99). Regression analysis confirmed no association between oral glucose tolerance test results and maternal 25(OH)D (P > 0.53). Regarding the birth size, mothers with optimal pregnancy 25(OH)D (≥ 80 nmol/L) had heavier newborns than those with suboptimal pregnancy 25(OH)D (P = 0.010). However, mothers with optimal UCB 25(OH)D had newborns with smaller head circumference than those with suboptimal 25(OH)D (P = 0.003), which was further confirmed as a linear association (P = 0.024).

Conclusions: Maternal vitamin D concentration was similar in mothers with and without GDM in a mostly vitamin D sufficient population. Associations between maternal vitamin D status and birth size were inconsistent. A sufficient maternal vitamin D status, specified as 25(OH)D above 50 nmol/L, may be a threshold above which the physiological requirements of pregnancy are achieved.

Trial registration: The project protocol is registered in ClinicalTrials.gov in November 8, 2012 ( NCT01723852 ).

Keywords: 25-hydroxy vitamin D concentration; Birth length; Birth size; Birth weight; Gestational diabetes mellitus; Head circumference; Maternal vitamin D status; Newborn vitamin D status; Ponderal index.

Conflict of interest statement

Ethics approval and consent to participate

Written informed consent was obtained from the parents at recruitment. This study was conducted according to the guidelines laid down in the Declaration of Helsinki. Ethical approval was obtained from the Research Ethics Committee of the Hospital District of Helsinki and Uusimaa (107/13/03/03/2012). The project protocol is registered in ClinicalTrials.gov in November 8, 2012 (NCT01723852).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Maternal vitamin D status and gestational diabetes mellitus. Adjusted mean ± SEM values of pregnancy 25(OH)D (a) and UCB 25(OH)D concentration (nmol/L) (b) in GDM and non-GDM mothers. Adjustments are for season, maternal age, education and prepregnancy BMI. Maternal 25(OH)D concentrations were similar between non-GDM and GDM mothers. Abbreviations: 25(OH)D, 25-hydroxy vitamin D; UCB, umbilical cord blood; GDM, gestational diabetes mellitus
Fig. 2
Fig. 2
Maternal factors and birth size. Adjusted mean ± SEM values of birth weight, length, head circumference SD-scores and ponderal index z-score between (a) maternal prepregnancy BMI groups of underweight, normal weight, overweight and obese; (b) mothers’ inadequate GWG, adequate GWG and excessive GWG; (c) GDM and non-GDM mothers; (d) suboptimal and optimal pregnancy 25(OH)D; and (e) suboptimal and optimal UCB 25(OH)D. Statistical significance is denoted by *P < 0.05, **P < 0.01 and ***P < 0.001. Abbreviations: GWG, gestational weight gain; GDM, gestational diabetes mellitus; 25(OH)D, 25-hydroxy vitamin D; suboptimal, UCB, umbilical cord blood; 25(OH)D < 80 nmol/L; optimal 25(OH)D ≥ 80 nmol/L

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