Relationship Among Pathophysiology of Gestational Diabetes, Preeclampsia, Vitamin D Level, and Immunomodulation: A Narrative Review

Abstract

Context: Preeclampsia is among the major causes of maternal, fetal, and neonatal morbidity and mortality, worldwide. It is characterized by an increase in blood pressure and proteinuria (Systolic BP≥140 or Diastolic BP ≥90 mmHg). The serum level of 25-hydroxy vitamin D deficiency has long been suspected as a risk factor for gestational diabetes mellitus (GDM) and preeclampsia, and perhaps 1, 25-dihydroxy vitamin D has a role in the regulation of the immune system. Inflammatory markers, including cytokines, angiogenic factors, leukocytes, interleukins, and acute phase reactants, are involved in the pathophysiology of preeclampsia and gestational diabetes mellitus. Objective: This review article was performed with the aim to assess the relationship among pathophysiology of gestational diabetes, preeclampsia, vitamin D level, and immunomodulation. Evidence Acquisition: Databases of Cochrane (2000Cochrane ( -2016, Embase (2000Embase ( -2016, Pubmed/Medline (1995-2016, and Google Scholar (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) were searched to find the related references with keywords of gestational diabetes mellitus, preeclampsia, vitamin D, regulation of the immune system. The contents of the articles were exactly and repeatedly studied and analyzed. Results: Vitamin D deficiency is more prevalent in patients with gestational diabetes mellitus and preeclampsia than normal pregnant women are, so vitamin D supplementation may control glucose levels and blood pressure and improve the outcome of pregnancy. Conclusion: Several studies, materials provided in this study, and clinical evidence confirm that both preeclampsia and gestational diabetes unbalance the maternal immune system; in addition, evidence from casecontrol studies show that vitamin D levels are significantly lower in patients with preeclampsia and diabetes than normal people.