Gestational diabetes mellitus (GDM) has been recognized for decades; however as America continues to embrace high carbohydrate high sugar high processed diets physicians should pay closer attention to the ever-increasing signs and outcomes of GDM. Currently GDM is thought to affect up to 18 percent of all pregnancies in the United States however new diagnostic standards aimed at more rigorously identifying GDM risks would nearly triple the current rate of prevalence. This follows recent concerns regarding the long-term effects of GDM and the more recent revelation that even the slightest sign of impaired glucose regulation could lead to adverse outcomes.

It is well-known that GDM carries significant increases in perinatal risks and pregnancy complications including large for gestational age infants cesarean delivery neonatal hypoglycemia fetal hyperinsulinemia premature delivery preeclampsia hyperbilirubinemia and others. Equally concerning is the fact that women with a history of GDM are more likely to develop type 2 diabetes later in life while infants born to GDM mothers carry increased risk factors for developing type 2 diabetes and obesity. In a nation where obesity and diabetes are already out of control and with the next generation facing the greatest risk factors to date it seems plausible to assume that taking greater control of the problem at the start of life may prove to be a significant step in the right direction.

The largest risk factor for developing GDM is maternal obesity; however steps aimed at reducing obesity after conception have proved unsatisfactory and although a global effort to curtail obesity ensues we are far from success. In light of this alternative measures to reduce the negative outcomes of GDM are being considered as physicians are presented with increasingly greater numbers of pregnant women with impaired glucose regulation. One such effort has focused on the potentially positive role of calcium and vitamin D supplementation on the metabolic status of pregnant women with GDM. A recent study published in Diabetologia looked at the outcome of 56 pregnant women with GDM given 1000 mg calcium per day and a 50000 U vitamin D3 pearl twice during the study. The results revealed that supplementation resulted in a reduction of fasting plasma glucose serum insulin levels quantitative insulin sensitivity check index (QUICKI) serum LDL-cholesterol and total cholesterol. Additionally an increase in HDL-cholesterol was noted. Such results indicated that calcium-vitamin D supplementation yielded an overall improved metabolic status. Indices of oxidative stress also showed positive results as noted by a significant increase in glutathione (GSH) and a corresponding reduction in malondialdehyde (MDA) levels among the supplemented group compared with placebo.

Previous studies have shown a strong relationship between vitamin D statuses and type 2 diabetes mellitus in both human and animal studies. Inadequate levels of vitamin D predisposed subjects to glucose intolerance and altered insulin secretion.  While pancreatic tissue does sport vitamin D receptors and vitamin D binding proteins suggesting a direct relationship between vitamin D status and insulin producing cells it has also been proposed that vitamin D could support insulin production indirectly through modulating calcium. An influx of extracellular calcium into pancreatic beta cells facilitates the release of insulin. During pregnancy calcium requirements are high due to the mineralization of the fetus developing bones and calcium deficiencies are far too frequent among today's pregnant women. Therefore in an attempt to kill two birds with one stone it seems advantageous to address both the calcium and vitamin D deficiencies together to ensure adequate glucose regulation.

In a generation where GDM is quickly becoming an unfortunate upward trend it seems reasonable to look outside the box and consider additional elements that may positively influence the outcome of this condition. Adequate amounts of calcium and vitamin D would appear to be a good place to start.