Detection Of25(OH)D3Level And Its Significance In Pregnant Women With Gestational Diabetes Mellitus

Background:Gestational diabetes mellitus (GDM)is defined as abnormal glucose metabolism which occurs or discovered during pregnancy. In recent years, the global incidence rate of GDM is increasing. GDM is a serious to the health of maternal and child, and even endanger the life of perinatal. Pregnant woman with GDM is likely to develop pre-eclampsia, increased the dystocia rate, and is long-term risk population of type2diabetes. The fetal of these women are mote likely to suffer huge children, birth trauma such as shoulder dystocia, bone fracture, nerve paralysis, hypoglycemia and hyperbilirubinemia, etc; The pathogenesis of gestational diabetes mellitus is unclear, the consistent view:GDM have a similar incidence foundation with type2diabetes (T2DM), have insulin resistance (insulin resistance, IR) and insulin secretion deficiency on the basis of genetic defects, in which the IR is dominant. IR mrans a certain amount of insulin concentration can not affect the expected metabolism of nutrients and the biological response in target tissues (mainly refers to the muscle, fat and liver). The most important metabolic changes during normal pregnancy is the increased insulin resistance, and the decreased insulin sensitivity in liver, muscle, and adipose tissue, especially in the late pregnancy, the insulin sensitivity decreased by45%to80%. The insulin resistance (IR) in pregnancy can be considered as an evolution adapt to the increase glucose demand in fetal under the concentration of low-carbohydrate, in order to reduce maternal glucose consumption. The insulin levels increased is in order to overcome the insulin resistance after eating, thus can maintain the blood glucose in a normal range of needs. The normal pregnancy is a physiological state of insulin resistance, GDM occurs when the body can not secrete enough insulin to compensate the abnormal exacerbation of insulin resistant.Recently a large number of epidemiological studies show that25(OH)D3deficiency is associated with the T1DM, T2DM.,how ever, there is no clear conclusion for the relationship between the25(OH)D3deficiency and GDM.. The studies of25(OH)D3status of pregnant woman in foreign countries show the deficiency and insufficiency of25(OH)D3is very common. Therefore, this study determinate the25(OH)D3level of the pre-pregnant women, first trimester maternal, normal second trimester maternal and gestational diabetes maternal, in order to investigate the correlation between25(OH)D3level and gestational diabetes.Objective:To evaluate the changes and significances of25(OH)D3level in pregnant women with GDM.Methods:Collected35pregnant women diagnosed with GDM in24-28weeks in accordance with the IADPSG standard at women’s Hospital, school of medicine, Zhejiang University), form June2010until June2011, select30cases of normal pregnant women at the same gestational age on the same period, both age, gestational age, body mass index were no significant differences. In order to understand the change of25(OH)D3level between pre-pregnant women and pregnant women, this study also select30cases of normal reproductive age women to and25cases of termination of pregnancy in early pregnancy, both age, body mass index have no statistically significant differences. All objects have exclude hypertension, diabetes, thyroid disease, other chronic diseases, and pregnancy complications. The4group all have been taken non-anticoagulant and anticoagulant blood each5ml after empty stomach8to14h in the early morning, and avoid strenuous activity stress etc. before blood sampling. The blood samples are standed for1h, then centrifuged, specimened serum and freezed in-70degrees refrigerator. Glucose oxidase colorimetric method determinate the the fasting glucose, double antibody sandwich method determinate the fasting insulin, chemiluminescence method determinate the glycated hemoglobin, using the HOMA homeostasis model (fasting glucose level x fasting insulin level/22.5) according to the fasting plasma glucose and insulin levels to evaluate insulin resistance index (HOMA-IR).25hydroxyvitamin D3(25(OH)2D3) detected use ELISA detection kit (Shanghai Yope Biotechnology Limited)Results:1、 The HOMA-IR in GDM group and normal second-trimester group were2.8±1.6and1.5±0.6, the HOMA-IR in GDM group was significantly higher than the normal second-trimester group, the differences were significant (P<0.05).2、 The25(OH)D3level in normal first-trimester group, normal second-trimester group, and GDM group were102.1±36.5nmol/L,167.9±48.9nmol/L,110.4±30.2nmol/L, were significantly higher than normal non-pregnancy group67.9±20.1nmol/L, the differences were significant (P<0.05).3、The25(OH)D3level in normal second-trimester group was significantly higher than normal first-trimester group(P<0.05).4、The25(OH)D3level in GDM group was significantly lower than normal second-trimester group(P<0.01). 5、Correlation analysis, the25(OH) D3levels was negatively correlated with HOMA-IR and HbAlc in GDM group (r=-0.34,-0.39, P<0.05), while there were no correlation between25(OH)D3level and HOMA-IR, HbAlc levels in normal non-pregnancy group, normal first-trimester group and normal second-trimester group.Conclusions:1、The25(OH) D3level in normal pregnancy was significantly higher than non-pregnant women, prompt that25(OH) D3may participate in the metabolism changes of the normal pregnancy.2、25(OH) D3levels in GDM group were significantly lower than the normal second-trimester group, and were negatively correlated with HOMA and HbAlc. Prompt the reduce of25(OH) D3level may be associated with insulin resistance.3、 The reasonable supplement of25(OH) D3in pregnancy may reduce insulin resistance, and ultimately reduce GDM incidence, but its mechanism is not clear,and needs further more study.