title: Association of low serum 25-hydroxyvitamin D levels in pregnancy with glucose homeostasis and obstetric and newborn outcomes.
abstract: OBJECTIVE
  To evaluate the association of maternal serum 25-hydroxyvitamin D (25[OH]D) status with glucose homeostasis and obstetric and newborn outcomes in women screened for gestational diabetes mellitus (GDM).
  
  
  METHODS
  Consecutive women were screened for GDM at 24 to 28 weeks' gestation during the months of maximal sunlight exposure in Spain (June through September). Serum 25(OH)D levels and parameters of glucose homeostasis were measured. Outcomes of the delivery and newborn were collected.
  
  
  RESULTS
  Two hundred sixty-six women were screened. Vitamin D deficiency (25[OH]D <20 ng/mL) was observed in 157 women (59%). We observed an inverse correlation between 25(OH)D levels and hemoglobin A1c, homeostasis model assessment of insulin resistance, serum insulin, and fasting and 1-hour oral glucose tolerance test glucose levels (P<.001). With a 25(OH)D concentration less than 20 ng/mL, the odds ratios were 3.31 for premature birth (95% confidence interval, 1.52-7.19; P<.002) and 3.93 for cesarean delivery (95% confidence interval, 2.00-7.73; P<.001). A 25(OH)D concentration of 20 ng/mL had 79% sensitivity and 51% specificity for cesarean delivery and 80% sensitivity and 45% specificity for premature birth. The cutoffs with the best combination of sensitivity and specificity were 16 ng/mL for cesarean delivery (62.9% sensitivity and 61.2% specificity) and 14 ng/mL for premature birth (66.7% sensitivity and 71.0% specificity).
  
  
  CONCLUSIONS
  In the population we sampled, vitamin D deficiency is very common during pregnancy. Lower 25(OH)D levels are associated with disorders of glucose homeostasis and adverse obstetric and newborn outcomes.
authors.affiliation: Endocrinology and Nutrition Department, Hospital Clinico San Carlos-IdISSC, Madrid, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Perez-Ferre
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Torrejon
authors.forename: Manuel
authors.initials: M
authors.lastname: Fuentes
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Fernandez
authors.forename: Ana
authors.initials: A
authors.lastname: Ramos
authors.forename: Elena
authors.initials: E
authors.lastname: Bordiu
authors.forename: Laura
authors.initials: L
authors.lastname: del Valle
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rubio
authors.forename: Ana R
authors.initials: AR
authors.lastname: Bedia
authors.forename: Carmen
authors.initials: C
authors.lastname: Montañez
authors.forename: Alfonso L
authors.initials: AL
authors.lastname: Calle-Pascual
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D036861:Delivery, Obstetric; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000503:physiopathology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D014807:Vitamin D; C104450:25-hydroxyvitamin D