| Objectives To compare the pre-treatment effect of vitamin D between high (1600 IU) and low (400 IU) does on Gestational Diabetes Mellitus(GDM) in women with pre-pregnancy obesity.Methods The study covered 200 cases pregnant women in Child Health Hospital of Tangshan from Dec.2013 to Dec.2014. The female included in this study were randomly divided into 2 groups as low dose group (400 IU/d) and high dose group (1600 IU/d), and the two groups of pregnant women were conducted to lifestyle intervention (diet and regular exercise including meals) and motivated interviews at the same time. The relative information were collected as follows:1)general data(age, Body Mass Index[BMI], and gestational weeks); 2) the level of 25-(OH) D3 in serum; 3) screening of GDM (the level of blood glucose and insulin, oral glucose tolerance test[OGTT], glycosylated hemoglobin[HbAIc], homeostasis model assessment of insulin resistance[HOMA-IR]); 4) blood lipoids (total cholesterol[TC], Triglyceride[TG]); 5) delivery mode(natural delivery and cesarean section); 6) delivery outcomes(weight of newborn, neonatal asphyxia, stillbirth and birth defects). The following statistical tests were used to compare by chi-square test and t-Student test. Statistical analysis was performed by means of SPSS 13.0 software.Results 1 There was no statistical significance between low dose group and high dose group in age, gestational weeks, BMI, OGTT, insulin, HbAlc, TC, TG,25-(OH) D3 and HOMA-IR(P>0.05).2 The gestational weeks of GDM in low dose group was 24.12±1.86 w, higher than 27.12±1.23 w in high dose group(t=17.937, P<0.001). And the incidence rate of GDM in low dose group and high dose group were 24.00% and 12.00%(χ2=4.878, P=0.027).3. The fasting blood-glucose and fasting insulin in low dose group were increased in 4.76±0.22 mmol/L and 16.19±0.67mmol/L compared with 4.55±0.31 mmol/L and 13.36±0.46 mmol/L in high dose group(t=5.524, P<0.001;t=9.252, P<0.001), respectively. The level of TC and TG in low dose group were 3.01 ±0.56 mmol/L and 6.11 ±0.37 mmol/L higher than those in high dose group(2.66±0.32 mmol/L and 5.34±0.29 mmol/L), and all had a statistical significance(t=5.426, P<0.001;t=5.588, P<0.001) The weight gain ratio and insulin resistance index were higher in low dose group by 11.31±2.13 kg and 0.75±0.36 than 8.71±1.52 kg and 0.42±0.20 in high dose group(t=9.9360, P<0.001;t=7.912, P<0.001). In contrast, the level of 25-(OH) D3 in serum was higher in high dose group by 30.75±2.73 ng/mL than 12.61±2.12 ng/mL in low dose group(t=52.481, P<0.001).4 The rate of natural delivery and cesarean section were 54.00% and 38% in high dose group, had a statistical significance with the low dose group(34.00% and 56.00%; χ2=8.117, P=0.004; χ2=6.503, P=0.011).5 The rate of neonatal asphyxia, premature infant and fetal macrosomia were 10.00%,11.00% and 16.00%, higher than those(4.00%,3.00% and 4.00%, respectively) in high dose group((χ2=3.532, P=0.060; x2=4.916, P=0.049; x2=5.107, P=0.024).Conclusions Pretreatment with Vitamin D by 1600 IU/d could reduced the incidence rate of GDM via lipid regulation, inhibition of weight gain during pregnancy and up-regulation of 25-(OH) D3 level and decreased the rate of cesarean section and bad delivery outcomes. |
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