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Increased levels of PTH during pregnancy linked to dyslipidemia, gestational diabetes
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An elevated level of parathyroid hormone rather than vitamin D status appears to be associated with dyslipidemia during pregnancy, according to recent findings.
The extent of this correlation was such that women in the highest tertile of parathyroid hormone (PTH) had an 82% increased risk of developing gestational diabetes, the researchers wrote.
In the cross-sectional study, researchers evaluated 524 women enrolled in an ongoing, prospective antepartum gestational diabetes mellitus screening cohort. Participants were screened for gestational diabetes late in the second trimester using a 50 g glucose challenge test (GCT). Those with abnormal GCT results were referred for a diagnostic oral glucose tolerance test (OGTT). Additionally, all participants underwent a 3-hour 100 g OGTT, regardless of GCT results, to determine their gestational glucose tolerance status. Based on these tests, the researchers stratified the participants into the following glucose tolerance groups: gestational diabetes (n=142), gestational impaired glucose tolerance (n=94), abnormal GCT with normal OGTT (n=163) and normal GCT and OGTT (n=125).
The researchers measured serum 25-hydroxyvitamin D (25-(OH)D) and PTH by competitive electrochemiluminescent immunoassay.
The researchers determined glycemia based on glucose tolerance status and area-under-the-glucose-curve (AUGgluc) as tested on the OGTT, Matsuda index was used to evaluate insulin sensitivity and beta-cell function was measured using the Insulin Secretion-Sensitivity Index 2 (ISSI-2).
The researchers found that 166 (31.7%) of the women were 25-(OH)D deficient (<50 nmol/L), 178 (34%) had 25-(OH)D insufficiency (≥50 nmol/L and <75 nmol/L) and 180 (34.3%) were 25-(OH)D sufficient (≥75 nmol/L). There was no association between vitamin D status and Matsuda Index, ISSI-2, AUCgluc or glucose tolerance status.
Conversely, participants in the higher tertiles of PTH were found to have decreased ISSI-2 (P=.06) and increased AUCglu (P=.002). Additionally, the researchers found a progressive increase in the rates of gestational diabetes across the tertiles of PTH, with the first tertile having a 22.6% prevalence, the second a 25.8% prevalence and the third a 33.5% prevalence (P<.001).
Logistic regression analysis revealed an association between the third tertile of PTH and gestational diabetes (adjusted OR=1.82; 95% CI, 1.09-3.03). Vitamin D deficiency and insufficiency, however, were not found to be significant predictors of gestational diabetes in this cohort.
According to the researchers, the study’s cross-sectional design did not allow for anaylsis of the causality of the relationship between PTH and gestational diabetes.
“However, owing to the paucity of data on this topic, we believe that our findings yield novel insight pertaining to PTH and glucose metabolism in pregnancy that should lead to further studies, including longitudinal investigations,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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