Authors: Dr. Majid Valizadeh Dr. Zahra Piri Dr. Kourosh Kamali Dr. Farnaz Mohammadian Dr. Hamidreza Amirmioghadami Presenter: Piri Z. MD.

 Classical Bone and Calcium homeostasis  Non-classical Glucose metabolism Hypertension and atherogenesis Immune system Cancer

 Reverse association between serum vitamin D and FBS, BS 1h, HOMA-IR, HbA 1 C in GDM women.  Vitamin D deficiency association with increased risk of GDM, pre-eclampsia and bacterial vaginosis.  Supplementation with daily 4000 IU vitamin D in Hollis, et al. study with neither maternal nor neonatal side effects.  Single dose injection of vitamin D3 after delivery reduced progression of insulin resistance.

 Determining if the high dose vitamin D supplementation during pregnancy effects on post-partum glucose tolerance and insulin resistance in women with GDM and hypovitaminosis D.

 Study design: An equal randomized (1:1) controlled trial.  Time: From June 2012 till May  Place: GDM clinic of Zanjan University of Medical Sciences.

 Inclusion criteria: Women older than 16 years with singleton pregnancy in weeks of gestation, GDM diagnosis by Carpenter-Coustan criteria, vitamin D insufficiency (in intervention group).  Exclusion criteria: Known type 1 or 2 diabetes, high dose vitamin D consumption in the last 3 months assisted pregnancies, hypertension hx and untreated thyroid disorders.

 Serum vitamin D and Ca measurement  Including patients with baseline 25OHD < 30 ng/ml  Supplementation by 14 vitamin D pearls  Urinary Ca/Cr measurement after 8 th pearl consumption  Providing the routine clinical care for GDM women  Blood samples were drawn and kept at – 80 ̊ C  Providing the routine clinical care for GDM women

 At the time of delivery Recording the maternal and neonatal characteristics Sampling of the cord blood  6 – 12 weeks after delivery Determining the basal serum vitamin D in control group and exclusion the sufficient cases Post-partum tests: OGTT with 75-g glucose, serum insulin, 25 (OH) D, HbA 1 C.

VariablesGroup IGroup CP value Number4644 Age, mean (SD), years32.2 (5.5)32.5 (4.7)0.79 Pre-pregnancy BMI, mean (SD), kg/m (3.9)27.5 (3.8)0.94 Late and early pregnancy BW difference8.9 (4.5)6.9 (4.8)0.04 GA at GDM diagnosis, mean (SD), week21.4 (7.6)21.3 (7.1)0.90 Final insulin dose (units/day)21.7 (21.3)16.0 (19.2)0.19 Gravidity, n (%) 112 (26)12 (27) 0.24 ≥ 234 (74)32 (73) 25 OHD, mean (SD), ng/ml14.4 (6.5)17.4 (6.2)0.03

VariablesGroup IGroup CP value Number 42 Primary outcomes, mean (SD) 25 OHD, ng/ml32.4 (14.4)19.3 (9.6)0.00 FBS, mg/dl94 (16)89 (13)0.12 BS 2h, mg/dl115 (48)110 (36)0.56 Insulin, µu/ml8.7 (4.4)8.8 (9.7)0.99 HOMA-IR2.0 (1.3)1.8 (1.9)0.24 HbA 1 C, %5.6 (0.5)5.5 (0.5)0.58

VariablesGroup IGroup CP value Number 42 Secondary outcomes, n (%) Cesarean section20 (43)24 (54)0.29 Pre-term labor3 (6.5)5 (11)0.48* Pre-eclampsia1 (2)3 (7)0.35* Still birth1 (2) 1.00* Hypoglycemia4 (8)5 (11)0.73* Macrosomia2 (4)1 (2)1.00* Phototherapy4 (8)8 (18)0.18 Fetal and neonatal anomaly1 (2) 1.00

Serum vitamin D Time/group < 20 ng/ml ng/ml≥ 30 ng/mlP value At enrollment Intervention (%) Control (%) weeks after delivery Intervention (%) Control (%)

 High dose vitamin D supplementation during pregnancy in women with GDM and vitamin D deficiency provides an optimum serum level of vitamin D.  Vitamin D supplementation does not effect on post-partum blood glucose levels and insulin resistance.  Preterm labor incidence was more frequent in the control group.

 Yap C and associates compared the influence of daily 5000 IU v.s 400 IU vitamin D3 supplementation of pregnant mothers on glucose tolerance and insulin resistance during pregnancy.  Asemi Z, et al. reported a positive result of vitamin D and Ca co-supplementation of mild GDM women on fasting plasma glucose and insulin resistance during pregnancy.

 Proper dose of vitamin D3 supplementation.  Greater sample size compared to similar studies.  Including severe cases of GDM.  Suitable interval between supplementation and the tests.  The least case lost to follow up (6%)  Evaluation of neonatal and pregnancy outcome.

 Assessment of the same effect on pregnancy outcome a suitable sample size.  Assessment of growth and development markers in target children.