Gestational Diabetes and Vitamin D

Gestational Diabetes and Vitamin D | Pregnancy

What is Gestational Diabetes?

Gestational diabetes mellitus (sometimes referred to as GDM) is a form of diabetes that occurs during pregnancy. Most women will no longer have diabetes after the baby is born. However, some women will continue to have high blood glucose levels after delivery. It is diagnosed when higher than normal blood glucose levels first appear during pregnancy.

Gestational diabetes is the fastest growing type of diabetes in Australia, affecting thousands of pregnant women. Between 12% and 14% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy. All pregnant women should be tested for gestational diabetes at 24-28 weeks of pregnancy (except those women who already have diabetes). Women who have risk factors for gestational diabetes should be tested earlier in their pregnancy.

Who is at risk for Gestational Diabetes?

Women at increased risk of developing gestational diabetes include those who:

  • Are aged 40 years or over
  • Have a family history of type 2 diabetes or a first-degree relative (mother or sister) who has had gestational diabetes
  • Are above the healthy weight range
  • Have had elevated blood glucose levels in the past
  • Are from Aboriginal and Torres Strait Islander backgrounds
  • Are from a Melanesian, Polynesian, Chinese, Southeast Asian, Middle Eastern or Indian background
  • Have had gestational diabetes during previous pregnancies
  • Have previously had Polycystic Ovary Syndrome
  • Have previously given birth to a large baby (weighing more than 4.5kg)
  • Are taking some types of anti-psychotic or steroid medications
  • Have gained weight too rapidly in the first half of pregnancy.

(Diabetes Australia 2019).

Nutritional insight

As a nutritionist, naturally I cannot help myself but to investigate if there are any nutrients that may help prevent and or treat GDM.  I found some interesting and useful information regarding Vitamin D and GDM, if you are a mum to be, this read is for you!

Low vitamin D during pregnancy has been associated with:

  • maternal calcium malabsorption
  • increased risk of preeclampsia
  • maternal bone loss
  • increased maternal parathyroid hormone levels
  • higher incidence of epidural use during childbirth
  • increased risk of postpartum depression
  • low birth weight
  • preterm birth
  • lower infant bone mass density
  • rickets
  • infantile heart failure
  • large fontanelle in infants
  • neonatal hypocalcaemia
  • infant hypocalcaemic seizures
  • reduced infant development of language skills.

What does the Research say on Vitamin D and GDM?

A trial done in 2011 investigated a possible relationship between low vitamin D status in pregnant women with GDM. 147 women participated in the study, all women had GDM. Out of the 147 women, 41% of the women had a vitamin D level lower than 50nmol/L, which is considered a deficiency.  Lower vitamin D levels were independently associated with poorer glycaemic control.

If deficiency of a nutrient may contribute to a condition, can correcting the deficiency help improve the condition…?

Well, a randomised placebo-controlled trial was designed to assess the effects of calcium and vitamin D supplementation on the metabolic status of pregnant women with GDM.

One group received 1000mg calcium per day and 50.000IU of Vitamin D3 twice, at baseline and at day 21.  The other group of women got placebo.

After the administration of calcium plus vitamin D supplements the researchers observed a reduction in fasting plasma glucose and serum insulin levels compared with placebo.

AND, it gets better. Calcium plus vitamin D supplementation also resulted in a significant increase in glutathione and prevented a rise in reactive oxygen species levels compared with placebo.

Glutathione is the body’s own anti-oxidant which help in supporting our immune system, lower inflammation, as an anti-oxidant, is involved in liver-detoxification and is needed to recycle other anti-oxidants.

How does Vitamin D work to improve GDM?

Long story short, Vitamin D can significant increase up-regulation of GLUT4 expression and its translocation to cell surface. The role of GLUT4 is to transport glucose, and when you up-regulate this transport protein it will help remove glucose from the blood and move it into tissue. Magic!

Maintaining adequate vitamin D levels in pregnancy

In pregnancy, vitamin D requirements can increase up to 4-5 times in order to support the growth and development of the foetus and health of the mother.

Personally, I use a supplement as well as eat foods that contain some Vitamin D and I also make sure to get regular sun exposure! 

How to increase your vitamin D levels

Personally, I use a supplement as well as eat foods that contain some Vitamin D and I also make sure to get regular sun exposure! 

Foods with Vitamin D

Fatty Fish (Salmon, Tuna, Mackerel)

Fish Liver Oil

Butter

Milk

Eggs (cooked)

Cheese (pasteurized) 

THE SUN! Great excuse to hit the beach!

Supplement (please seek advice from your Nutritionist, Naturopath or Doctor)

*This info should not be used as medical treatment. I am simply sharing this as a reminder to get out and get some sun, increase foods with Vitamnin D and possibly start a natal supplement! Take a blood test to measure your Vitamin D before supplementing and always speak to a health professional before starting a new supplement. 

Reference List

Moses RG, Morris G, Petocz P, et al. Impact of the potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011;194:338-1340.

Aghajafari F, Nagulesapillai T, Ronksley PE, et al. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013;346:f1169.

 Teale GR, Cunningham CE. Vitamin D deficiency is common among pregnant women in rural Victoria. Aust NZ J Obstet and Gynaecol. Published online 1 April  2010.

 Carr DB, Gabbe S. Gestational diabetes: detection, management, and implications. Clin Diabetes 1998;16(1):4.5. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J CliniInvest 2005;15(3):485-491.

Kelly L, Evans L. Messenger D. Controversies around gestational diabetes. Practical information for family doctors. Canadian family physician Medecin de famille canadien 2005;5:688-695.

Sung CC, Liao MT, Lu, KC, et al. Role of vitamin D in insulin resistance. J Biomed Biotechnol 2012:634195

Thorand B, Zierer A, Huth C, et al. Effect of serum 25-Hydroxyvitamin D on risk for type 2 diabetes may be partially mediated by subclinical inflammation; Results from the MONICA/KORA Augsburg study. Diabetes Care 2011;10:2320-2322.

Riachy R, Vandewalle B, Moerman E, et al. 1,25-Dihydroxyvitamin D3 protects human pancreatic islets against cytokine-induced apoptosis via down-regulation of the Fas receptor. Apoptosis 2006;11(2):151-159.10.

Seshadria KG, Tamilselvana B, Rajendrana A. Role of vitamin D in diabetes. J Endocrinol Metab 2011;7:7-56.

Manna P, Jain, SJ. Vitamin D upregulates glucose transporter 4 (GLUT4) translocation and glucose utilization mediated by cystathionine-γ-lyase (CSE) activation and H2S formation in 3T3L1 adipocytes. J Biol Chem 2012;7;287.

Chiu KC, Chu A, Go VLW, et al. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutr 2004;79(5):820-825.

Deleskog A, Hilding A, Brismar K, et al. Low serum 25-hydroxyvitamin D level predicts progression to type 2 diabetes in individuals with prediabetes but not with normal glucose tolerance. Diabetologia 2012;55(6):1668-1678.

Forouhi NG, Ye Z, Rickard AP, et al. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updated meta-analysis of prospective studies, Diabetologia 2012;55(8):2173-2182.

Tai K, Need AG, Horowitz M, et al. Vitamin D, glucose, insulin, and insulin sensitivity. Nutrition 2008;24(3):279-285.

 Ropers S, Tran Q, Geller AW, et al. Effect of vitamin D levels on intrapartum epidural consumption. American Society of Anesthesiologists, 2014.

Hanieh S, Ha T, Simpson JA, et al. Maternal vitamin D status and infant outcomes in rural Vietnam: a prospective cohort study. PLOS One 2014;9(6):e99005

Mulligan ML, Felton SK, Reik AE, et al. Vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2010;202(5):429. Br J Nutr. 2012 Nov 14;108(9):1557-61. doi: 10.1017/S0007114511007161. Epub 2012 Jan 23.

Luxwolda MF, Kuipers RS, Kema IP, et al. Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/l. Br J Nutr 2012;108(9):1557-1561.

Daly RM, Gagnon C, Lu ZX, et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study. Clin Endocrinol (Oxf) 2012;77(1):26-35

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