The DALI vitamin D randomized controlled trial for gestational diabetes mellitus prevention: No major benefit shown besides vitamin D sufficiency. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Corcoy, Rosa; Mendoza, Lilian C.; Simmons, David; Desoye, Gernot; Adelantado, J.M.; Chico, Ana; Devlieger, Roland; van Assche, Andre; Galjaard, Sander; Timmerman, Dirk; Lapolla, Annunziata; Dalfra, Maria G.; Bertolotto, Alessandra; Harreiter, Jürgen; Wender-Ozegowska, Ewa; Zawiejska, Agnieszka; Kautzky-Willer, Alexandra; Dunne, Fidelma P.; Damm, Peter; Mathiesen, Elisabeth R.; Jensen, Dorte M.; Andersen, Lise Lotte T.; Tanvig, Mette; Hill, David J.; Jelsma, Judith G.; Snoek, Frank J.; Köfeler, Harald; Trötzmüller, Martin; Lips, Paul; van Poppel, Mireille N.M.
• Is Part Of: Clinical nutrition. Volume 39:Issue 3(2020)
• Page Start: 976
• Page End: 984
• Publication Date: 2020-03
• Subjects: Vitamin D supplementation -- Vitamin D sufficiency -- Pregnancy -- Fasting plasma glucose -- Fasting plasma insulin -- Gestational diabetes mellitus; GDM gestational diabetes mellitus -- FPG fasting plasma glucose -- BMI body mass index -- 25(OH)D 25-hydroxyvitamin D -- GWG gestational weight gain -- OGTT oral glucose tolerance test -- LC–MS/MS liquid chromatography–mass spectrometry/mass spectrometry -- DEQAS vitamin D external quality assessment scheme -- HOMA-IR homeostasis model assessment of insulin resistance -- PAFs population attributable fractions; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2019.04.006
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background & aims: As vitamin D deficiency is associated with an increased risk of gestational diabetes mellitus (GDM), we aimed to test vitamin D supplementation as a strategy to reduce GDM risk (evaluated after fasting plasma glucose (FPG), insulin resistance and weight gain) in pregnant overweight/obese women. Methods: The DALI vitamin D multicenter study enrolled women with prepregnancy body mass index (BMI) ≥ 29 kg/m 2, ≤19 + 6 weeks of gestation and without GDM. Participants were randomized to receive 1600 IU/day vitamin D3 or placebo (each with or without lifestyle intervention) on top of (multi)vitamins supplements. Women were assessed for vitamin D status (sufficiency defined as serum 25-hydroxyvitamin D (25(OH)D) ≥ 50 nmol/l), FPG, insulin resistance and weight at baseline, 24–28 and 35–37 weeks. Linear or logistic regression analyses were performed to assess intervention effects. Results: Average baseline serum 25(OH)D was ≥50 nmol/l across all study sites. In the vitamin D intervention arm ( n = 79), 97% of participants achieved target serum vitamin 25(OH)D (≥50 nmol/l) at 24–28 weeks and 98% at 35–37 weeks vs 74% and 78% respectively in the placebo arm ( n = 75, p < 0.001). A small but significantly lower FPG (−0.14 mmol/l; CI95 −0.28, −0.00) was observed at 35–37 weeks with the vitamin D intervention without any additional difference in metabolic status, perinatal outcomes or adverse event rates. Conclusion: In the DALI vitamin D trial, supplementation with 1600 IU vitamin D3/day achieved vitamin D sufficiency in virtually all pregnant women and a small effect in FPG at 35–37 weeks. The potential of vitamin D supplementation for GDM prevention in vitamin D sufficient populations appears to be limited. Trial registration number: ISRCTN70595832 Highlights: Vitamin D supplementation is an attractive candidate for GDM prevention. Baseline serum 25(OH)D was unexpectedly high and partly attributable to ethnicity. 1600 IU/day vitamin D supplementation achieved sufficiency at delivery in 96% women. A small reduction in FPG was observed in the vitamin D arm at 35–37 weeks. Vitamin D potential for GDM prevention is limited in women without deficiency.