CONTEXT: Gestational diabetes mellitus (GDM) is a common pregnancy complication, particularly in women undergoing assisted reproductive technology (ART). An association of GDM with vitamin D in women conceiving naturally has been described; however, studies have yielded heterogeneous results. OBJECTIVE: To analyze the association between prepregnancy total and free vitamin D and GDM incidence in women undergoing ART. METHODS: Post hoc analysis of a prospective study at the Reproductive and Genetic Hospital of CITIC-Xiangya in Changsha, China. Total and free vitamin D were measured 1 day before embryo transfer. The patients were screened for GDM using the oral glucose tolerance test. RESULTS: A total of 1593 women were included in the study, among whom 256 (16.1%) developed GDM. According to international guidelines for total 25-hydroxyvitamin D [25(OH)D], 47 (2.9%) patients had sufficient (≥30 ng/mL) levels, while 696 (43.7%) were insufficient (20 to <30 ng/mL) and 850 (54.4%) were deficient (<20 ng/mL). Comparing GDM and non-GDM patients, there was no significant difference in total nor free vitamin D levels (P = .340 and .849). Similarly, analysis of GDM rates by quintiles of total and free 25(OH)D showed no significant association in one-way ANOVA (P = .831 and .799). Multivariate logistic regression, considering age, BMI, and fasting glucose, also did not show a significant influence of the 2 vitamin D forms on GDM incidence (P = .266 and .123 respectively). CONCLUSION: In this relatively vitamin D deficient/insufficient ART cohort, the degree of neither total nor free vitamin D deficiency before pregnancy was associated with the occurrence of GDM.

2nd Faculty of Medicine Charles University 150 06 Prague Czech Republic

5th Department of Medicine University Medical Centre Mannheim University of Heidelberg 68167 Mannheim Germany

Department of Clinical Science Reproductive and Genetic Hospital of CITIC Xiangya Changsha 410008 China

Institute of Medical Diagnostics IMD 12247 Berlin Germany

Institute of Pharmacy Freie Universität Berlin 14195 Berlin Germany

Key Laboratory of Stem Cells and Reproductive Engineering Ministry of Health Changsha 410017 China

Medical Faculty of Charité Universitätsmedizin Berlin 10117 Berlin Germany

School of Basic Medical Science Institute of Reproductive and Stem Cell Engineering Central South University Changsha 410017 China

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Karras  S, Paschou  SA, Kandaraki  E, et al.  Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review. Eur J Clin Nutr. 2016;70(9):979‐986. PubMed

Xiao  JP, Zang  J, Pei  JJ, Xu  F, Zhu  Y, Liao  XP. Low maternal vitamin D status during the second trimester of pregnancy: a cross-sectional study in Wuxi, China. PLoS One. 2015;10(2):e0117748. PubMed PMC

Gao  C, Sun  X, Lu  L, Liu  F, Yuan  J. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis. J Diabetes Investig. 2019;10(1):154‐162. PubMed PMC

Ashrafi  M, Gosili  R, Hosseini  R, Arabipoor  A, Ahmadi  J, Chehrazi  M. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol. 2014;176:149‐152. PubMed

Wang  J, Liu  Q, Deng  B, Chen  F, Liu  X, Cheng  J. Pregnancy outcomes of Chinese women undergoing IVF with embryonic cryopreservation as compared to natural conception. BMC Pregnancy Childbirth. 2021;21(1):39. PubMed PMC

Schafer-Graf  UM, Gembruch  U, Kainer  F, et al.  Gestational diabetes Mellitus (GDM)—diagnosis, treatment and follow-up. Guideline of the DDG and DGGG (S3 level, AWMF registry number 057/008, February 2018). Geburtshilfe Frauenheilkd. 2018;78(12):1219‐1231. PubMed PMC

von Websky  K, Hasan  AA, Reichetzeder  C, Tsuprykov  O, Hocher  B. Impact of vitamin D on pregnancy-related disorders and on offspring outcome. J Steroid Biochem Mol Biol. 2018;180:51‐64. PubMed

Tsuprykov  O, Chen  X, Hocher  CF, Skoblo  R, Lianghong  Y, Hocher  B. Why should we measure free 25(OH) vitamin D?  J Steroid Biochem Mol Biol. 2018;180:87‐104. PubMed

Tsuprykov  O, Buse  C, Skoblo  R, Haq  A, Hocher  B. Reference intervals for measured and calculated free 25-hydroxyvitamin D in normal pregnancy. J Steroid Biochem Mol Biol. 2018;181:80‐87. PubMed

Rizzo  G, Garzon  S, Fichera  M, et al.  Vitamin D and gestational diabetes Mellitus: is there a link?  Antioxidants (Basel). 2019;8(11):511. PubMed PMC

Cai  S, Li  J, Zeng  S, et al.  Impact of vitamin D on human embryo implantation-a prospective cohort study in women undergoing fresh embryo transfer. Fertil Steril. 2021;115(3):655‐664. PubMed

Chen  H, Li  J, Cai  S, et al.  Blastocyst transfer: a risk factor for gestational diabetes Mellitus in women undergoing in vitro fertilization. J Clin Endocrinol Metab. 2022;107(1):e143‐e152. PubMed PMC

Holick  MF, Binkley  NC, Bischoff-Ferrari  HA, et al.  Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911‐1930. PubMed

Amrein  K, Scherkl  M, Hoffmann  M, et al.  Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020;74(11):1498‐1513. PubMed PMC

Zeng  S, Chu  C, Doebis  C, von Baehr  V, Hocher  B. Reference values for free 25-hydroxy-vitamin D based on established total 25-hydroxy-vitamin D reference values. J Steroid Biochem Mol Biol. 2021;210:105877. PubMed

International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger  BE, Gabbe  SG, et al.  International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(7):676‐682. PubMed PMC

Song  SJ, Zhou  L, Si  S, et al.  The high prevalence of vitamin D deficiency and its related maternal factors in pregnant women in Beijing. PLoS One. 2013;8(12):e85081. PubMed PMC

Hong-Bi  S, Yin  X, Xiaowu  Y, et al.  High prevalence of vitamin D deficiency in pregnant women and its relationship with adverse pregnancy outcomes in Guizhou, China. J Int Med Res. 2018;46(11):4500‐4505. PubMed PMC

Li  X, Wang  Y, Gao  G, Guan  X, Qin  P, Liu  C. High prevalence of vitamin D deficiency in pregnant women in south China. Int J Vitam Nutr Res. 2020;90(3-4):273‐278. PubMed

Wang  J, Yang  F, Mao  M, Liu  DH, Yang  HM, Yang  SF. High prevalence of vitamin D and calcium deficiency among pregnant women and their newborns in Chengdu, China. World J Pediatr. 2010;6(3):265‐267. PubMed

Liu  W, Hu  J, Fang  Y, Wang  P, Lu  Y, Shen  N. Vitamin D status in mainland of China: a systematic review and meta-analysis. EClinicalMedicine. 2021;38:101017. PubMed PMC

Chen  GD, Pang  TT, Li  PS, et al.  Early pregnancy vitamin D and the risk of adverse maternal and infant outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2020;20(1):465. PubMed PMC

Soheilykhah  S, Mojibian  M, Rashidi  M, Rahimi-Saghand  S, Jafari  F. Maternal vitamin D status in gestational diabetes mellitus. Nutr Clin Pract. 2010;25(5):524‐527. PubMed

Zhang  C, Qiu  C, Hu  FB, et al.  Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One. 2008;3(11):e3753. PubMed PMC

Baker  AM, Haeri  S, Camargo  CA  Jr, Stuebe  AM, Boggess  KA. First-trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case-control study. Diabetes Metab Res Rev. 2012;28(2):164‐168. PubMed PMC

Clifton-Bligh  RJ, McElduff  P, McElduff  A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med. 2008;25(6):678‐684. PubMed

Farrant  HJ, Krishnaveni  GV, Hill  JC, et al.  Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr. 2009;63(5):646‐652. PubMed PMC

Liu  Y, Hocher  JG, Chen  H, et al.  Supplementary table for: the degree of pre-pregnancy vitamin D deficiency is not associated with gestational diabetes in women undergoing ART. Figshare; 2023. doi: 10.6084/m9.figshare.24270592.v1 PubMed DOI PMC

Shang  M, Zhao  N. Early pregnancy vitamin D insufficiency and gestational diabetes mellitus. J Obstet Gynaecol Res. 2022;48(9):2353‐2362. PubMed

Wang  Y, Li  H, Zheng  M, et al.  Maternal vitamin D deficiency increases the risk of adverse neonatal outcomes in the Chinese population: A prospective cohort study. PLoS One. 2018;13(4):e0195700. PubMed PMC

Xu  C, Ma  HH, Wang  Y. Maternal early pregnancy plasma concentration of 25-hydroxyvitamin D and risk of gestational diabetes Mellitus. Calcif Tissue Int. 2018;102(3):280‐286. PubMed

Loy  SL, Lek  N, Yap  F, et al.  Association of maternal vitamin D Status with glucose tolerance and caesarean section in a multi-ethnic Asian cohort: the growing up in Singapore towards healthy outcomes study. PLoS One. 2015;10(11):e0142239. PubMed PMC

Pham  TTM, Huang  YL, Chao  JC, et al.  Plasma 25(OH)D concentrations and gestational diabetes Mellitus among pregnant women in Taiwan. Nutrients. 2021;13(8):2538. PubMed PMC

Yin  WJ, Tao  RX, Hu  HL, et al.  The association of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus: a Chinese prospective birth cohort study. Am J Clin Nutr. 2020;111(1):122‐130. PubMed

Cheng  Y, Chen  J, Li  T, et al.  Maternal vitamin D status in early pregnancy and its association with gestational diabetes mellitus in Shanghai: a retrospective cohort study. BMC Pregnancy Childbirth. 2022;22(1):819. PubMed PMC

Pre-pregnancy LDL/HDL and total Cholesterol/HDL ratios are strong predictors of gestational diabetes mellitus in women undergoing assisted reproductive technologies

The Degree of Prepregnancy Vitamin D Deficiency Is Not Associated With Gestational Diabetes in Women Undergoing ART