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Vitamin D and Parathyroid Hormone Status in Pregnancy: Effect on Insulin Sensitivity, β-cell Function, and Gestational Diabetes Mellitus
Abstract
Context: Previous studies have yielded conflicting findings on the relationship between vitamin D deficiency/insufficiency and gestational diabetes mellitus (GDM). We hypothesized that PTH may be an underlying factor relevant to this potential association. Objective: This study sought to evaluate the effect of vitamin D and PTH status on insulin sensitivity, β-cell function, and glycemia in pregnancy. Setting and Design: Five-hundred-twenty-four women underwent a glucose challenge test (GCT) and oral glucose tolerance test (OGTT) in late second/early third trimester. The GCT/OGTT identified 142 women with GDM, 94 with gestational impaired glucose tolerance, 163 with an abnormal GCT and normal OGTT, and 125 with normal GCT and OGTT. Main Outcomes: Glycemia was assessed by glucose tolerance status and area under the glucose curve (AUCgluc) on the OGTT. Insulin sensitivity and β-cell function were assessed by Matsuda index and Insulin Secretion-Sensitivity Index-2 (ISSI-2), respectively. Results: There were 166 women (31.7%) with vitamin D deficiency (25-OH-D < 50 nmol/L), 178 (34%) with insufficiency (25-OH-D ≥ 50 nmol/L and < 75 nmol/L), and 180 (34.3%) with sufficiency (25-OH-D ≥ 75 nmol/L). Vitamin D status was not associated with Matsuda index, ISSI-2, AUCgluc, or glucose tolerance status. In contrast, ISSI-2 decreased and AUCgluc increased across ascending tertiles of PTH (P = .06 and P = .002, respectively). Indeed, the prevalence of GDM progressively increased from the first (22.6%) to second (25.8%) to third (33.5%) tertile of PTH (P < .001). On logistic regression analyses, the third tertile of PTH was independently associated with GDM (adjusted OR = 1.82; 95% CI, 1.09–3.02; P = .022), whereas vitamin D deficiency and insufficiency were not significant predictors of GDM. Conclusions: Increased PTH, rather than vitamin D deficiency/insufficiency, is independently associated with dysglycemia in pregnancy.
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Thyroid dysfunction, including both hyperthyroidism and hypothyroidism, can induce diabetes in pregnant women.
“Thyroid dysfunction, including both hyperthyroidism”
From Exposure to per- and polyfluoroalkyl substances in early pregnancy, risk of gestational diabetes mellitus, potential pathways, and influencing factors in pregnant women: A nested case-control study (2023) · cites this paper as Kramer et al., 2014
The Discussion (page unavailable) links elevated parathyroid hormone (PTH) with gestational diabetes, but does not address thyroid dysfunction, hyperthyroidism, or hypothyroidism. Searches for those terms found no passage supporting the claim that thyroid dysfunction can induce diabetes in pregnant women. (LLM, conf=0.76)
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Metadata
- Authors
- Kramer, C. K., Swaminathan, B., Hanley, A. J., Connelly, P. W., Sermer, M., Zinman, B., & Retnakaran, R.
- Affiliations
- Mount Sinai Hospital (CA)
- St. Michael's Hospital (CA)
- University of Toronto (CA)
- Corresponding author
- Retnakaran, Ravi
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2014-12-01
- Volume
- 99
- Issue
- 12
- Pages
- 4506-4513
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2063519432
- Cited by
- 52
- References
- 1
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 9 · 2018: 10 · 2017: 4 · 2016: 6 · 2015: 4
- FWCI
- 4.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Diabetes Association (OG‐3‐11‐3300‐RR, MOP-84206)
- University of Toronto
- Canadian Institutes of Health Research (115442_1, MOP 84206)
- Ontario Ministry of Research and Innovation
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Vitamin D Research Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- vitamin D deficiency, vitamin D insufficiency, parathyroid hormone, gestational diabetes mellitus, insulin sensitivity, beta-cell function, insulin secretion, impaired glucose tolerance in pregnancy, glycemia, Matsuda index, oral glucose tolerance test, glucose challenge test, 25-hydroxyvitamin D
- MeSH terms
- Adult, Blood Glucose, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Nutritional Status, Parathyroid Hormone, Pregnancy, Vitamin D, Vitamin D Deficiency, Cohort Studies, Diabetes, Gestational, Insulin-Secreting Cells
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