Supplementation of Vitamin D in the Postdelivery Period of Women with Previous Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis of Randomized Trials.
Study Goal
The researchers aimed to evaluate the effects of vitamin D supplementation on postpartum outcomes in women with previous gestational diabetes mellitus (GDM), including serum calcium concentration.
Results Summary
The study found no significant difference in serum calcium concentration or other metabolic outcomes between women who received vitamin D supplementation and the control group. The only notable effect was a significant increase in vitamin D concentration, but the evidence quality was rated very low.
Population
Postpartum women with a previous diagnosis of gestational diabetes mellitus (GDM).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
vitamin D supplementation | no change | postpartum period outcomes | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no difference | #1 |
vitamin D supplementation | increase | concentration of vitamin D | women diagnosed with previous gestational diabetes mellitus (GDM) | relative risk [RR]: 1.85; 95% confidence interval [CI]: 1.02-2.68 | significant increase | #2 |
vitamin D supplementation | no change | fasting blood glucose | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #3 |
vitamin D supplementation | no change | glycated hemoglobin | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #4 |
vitamin D supplementation | no change | serum calcium concentration | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #5 |
vitamin D supplementation | no change | homeostatic model assessment of insulin resistance (HOMA-IR) | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #6 |
vitamin D supplementation | no change | quantitative insulin sensitivity check index (QUICKI) | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #7 |
vitamin D supplementation | no change | parathyroid hormone (PTH) | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #8 |
vitamin D supplementation | no change | body mass index (BMI) | women diagnosed with previous gestational diabetes mellitus (GDM) | - | no significance | #9 |
OBJECTIVE: To evaluate the effects of vitamin D supplementation in the postpartum period of women with previous gestational diabetes mellitus (GDM). METHODS: Randomized clinical trials of pregnant women with GDM of any chronological, gestational age and parity, with no history of previous disease who received vitamin D supplementation in the prenatal and/or postpartum period and were evaluated in the postpartum period were included. The PubMed, EMBASE, Cochrane, and LILACS databases were consulted until July 2019. Serum vitamin D concentration (25-hydroxyvitamin D in nmol/L), fasting blood glucose, glycated hemoglobin, serum calcium concentration, homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), parathyroid hormone (PTH) and body mass index (BMI) were evaluated. Similar results in at least two trials were plotted using the RevMan 5; Cochrane Collaboration, Oxford, Reino Unido. The quality of the evidence was generated according to the classification, development, and evaluation of the classification of the recommendations. RESULTS: Four studies were included in the present review (200 women). The findings indicate that there is no difference in the postpartum period in women diagnosed with previous GDM who received vitamin D supplementation in the prenatal and/or in the postpartum period, showing only that there was a significant increase in the concentration of vitamin D (relative risk [RR]: 1.85; 95% confidence interval [CI]: 1.02-2.68). CONCLUSION: This increase in the concentration of vitamin D should be interpreted with caution, since the assessment of the quality of the evidence was very low. For the other analyzed outcomes, there was no significance between the intervention and control groups, and the outcomes, when analyzed in their strength of evidence, were considered very low and low in their evaluation. OBJETIVO: Avaliar os efeitos da suplementação de vitamina D no pós-parto de mulheres com diabetes mellitus gestacional (DGM) anterior. MéTODOS: Foram incluídos ensaios clínicos randomizados com gestantes com GDM de qualquer idade cronológica, gestacional e paridade, sem história de doença prévia, que receberam suplementação de vitamina D no pré-natal e/ou no pós-parto e foram avaliadas no pós-parto. As bases de dados consultadas foram PubMed, EMBASE, Cochrane e LILACS, até julho de 2019. Foram avaliados concentração sérica da vitamina D (25-hidroxivitamina D em nmol/L), glicemia de jejum, hemoglobina glicada, concentração sérica de cálcio, modelo de avaliação da homeostase de resistência à insulina (HOMA-IR, na sigla em inglês), índice qualitativo RESULTADOS: Quatro estudos foram incluídos na presente revisão (200 mulheres). Os achados indicam que não há diferença no período pós-parto em mulheres com diagnóstico prévio de DMG que receberam suplementação de vitamina D no período pré-natal e/ou pós-parto, mostrando apenas que houve um aumento significativo na concentração de vitamina D (risco relativo [RR]: 1,85; IC [intervalo de confiança] 95%: 1,02–2,68). CONCLUSãO: Este aumento na concentração de vitamina D deve ser interpretado com cautela, uma vez que a avaliação da qualidade das evidências foi muito baixa. Para os demais desfechos analisados, não houve significância entre os grupos intervenção e controle, e os desfechos, quando analisados em sua força da evidência, foram considerados muito baixa e baixa em sua avaliação. PROSPERO: CRD42018110729.