Date of Award

10-2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Medical Education

First Advisor

Abderrahim Oulha

Second Advisor

Fatima Al-Maskari

Third Advisor

Abdullah Shehab

Abstract

Vitamin D deficiency and Gestational Diabetes Mellitus (GDM) are common health problems among pregnant women in the Middle East region including the United Arab Emirates. However, a few prospective studies have investigated the association between vitamin D deficiency and the risk of GDM.

We estimated the incidence of GDM and examined the association of vitamin D status in early pregnancy and the development of GDM in Emirati pregnant women. In addition, we studied the association of diet, low physical activity and other covariates with the risk of GDM.

We conducted a prospective cohort study on Emirati pregnant women who visited eight primary healthcare clinics for antenatal care. A cohort of 563 women was selected that included women aged 18 - 45 years, ≤ 15 weeks pregnant and was free of GDM. The primary exposure was vitamin D deficiency (25(OH) D < 12 ng/ml) and vitamin D insufficiency (25(OH) D = 12 – 20 ng/l) as per Institute of Medicine Criteria. Secondary exposure variables were levels of physical activity (low, moderate and high as per WHO recommendations) and dietary intake. The physical activity was measured by using the Global Physical Activity Questionnaire (GPAQ) and dietary intake was determined by using a validated Food Frequency Questionnaire (FFQ). The outcome variable was GDM that was diagnosed by using fasting and 75 g 2-hour postprandial Oral Glucose Tolerance Test (OGTT) in 24 – 28 weeks of gestation. The data on socio-demographic characteristics, personal and family medical history, physical activity, dietary intake, blood pressure and anthropometric indices were collected at baseline. In addition, fasting blood samples were taken to measure fasting blood glucose and 25(OH) D levels. The participants revisited antenatal clinics in their 24 - 28 weeks of gestation for the screening of GDM. The status of GDM was confirmed by reviewing medical records of mothers or by telephonic interview.

Overall, 58.3% of pregnant women had vitamin D deficiency and 26.4% had insufficiency. The overall incidence of GDM was 15.2%. The incidence of GDM was 16% in vitamin D deficient women, 16.1% in vitamin D insufficient women and 10.7% in women with normal vitamin D. Adjusted logistic regression analysis showed that vitamin D concentration (Adjusted Odds Ratio [AOR]: 0.99, 95% Confidence Interval [CI]: 0.95 – 1.02, p = 0.450), vitamin D insufficiency (AOR: 2.11, 95% CI: 0.81 – 5.64, p = 0.101) and deficiency (AOR: 1.94, 95% CI: 0.88 – 5.32, p = 0.118) were not associated with GDM. Low (AOR: 1.09, 95% CI: 0.43 – 2.79, p = 0.850) and moderate (AOR: 0.78, 95% CI: 0.45 – 1.34, p = 0.372) physical activity levels were not significantly associated with increased odds of GDM. The Daily consumption of red meat (AOR: 6.16, 95% CI: 1.31 - 28.92, p = 0.021) and dates (AOR: 1.86, 95% CI: 1.03 - 6.49, p = 0.043), family history of diabetes (AOR: 1.93, 95% CI: 1.02 - 3.62, p = 0.043) and Body Mass index (BMI) before pregnancy (AOR: 1.07, 95% CI: 1.02 - 1.11, p = 0.003) were significantly associated with GDM

Vitamin D deficiency and physical activity were not associated with GDM, while daily intake of red meat and dates, increasing BMI before pregnancy and positive family history was positively associated with GDM. These findings are congruent with some previous studies in the Middle East region and elsewhere and provide guidelines to health stakeholders and healthcare providers for improving the screening, prevention and management of GDM in Emirati women.

Comments

يعتبر سكري الحمل حالة مرضية مهمة، حيث تعاني منه الكثير من النساء في دولة الإمارات العربية المتحدة . تشير الدراسات غلى ان نسبة الإصابة بسكري الحمل في دولة الإمارات العربية المتحدة 7.9%- 24.9 % ، كما يعتبر سكري الحمل عامل خطورة بالنسبة للا والجنين حيث أنه يؤدي إلى مضاعفات لكليهما ويعزز الإصابة بالنوع الثاني السكري.

أثبتت بعض الدراسات أن نقص فيتامين دله دور كبير في الإصابة بسكري الحمل، كما أن العوامل المرتبطة بذمط الحيا كالتغذية وارياضة تلعبان دورا مهما في علاج المرض والسيطرة عليه

صممت هذ الدراسة لتشمل 563 حامل إماراتية في مدينة رأس الخيمة في دولة الإمارات العربية المتحدة، وللكشف عن وجود علاقة بين نقص فيتامين د وتأثير عوامل نمط الحياة كالتغذية والرياضة، بالإضافة غلى التاريخ العائلي للاصابة بالسكري ومنسب كتلة الجسم وعلاقة هذه العوامل بالإصابة بسكري الحمل.

لم نتمكن من الحصول على علاقة واضحة وقوية بين نقص فيتامين د ولنشاط الرياضي للحوامل والإصابة بسكري الحمل، إلاأنه كانت هناك علاقة قوية بين تناول اللحم الأحمر، التمر من الناحية الغذائية و الإصابة بسكري الحمل بافضضافة إلى التاريخ العئلي للاصابة بالسكري ومنسب كتلة الجسم اللذان كانا العوامل التي لها دور كبير للاصابة بسكري الحمل

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