Periodontitis and gestational diabetes

Background + Aims

• Periodontitis is a chronic inflammatory disease leading to the destruction of tooth-supporting tissues and eventual tooth loss if untreated. It is highly prevalent worldwide, affecting 10–60% of populations. Beyond oral health, periodontitis contributes to systemic diseases by allowing pathogens (bacteria) and inflammatory mediators to enter the circulatory system, increasing risks for conditions like diabetes mellitus (DM), cardiovascular diseases, and adverse pregnancy outcomes.
• Periodontitis is recognised as a risk factor for DM due to its role in triggering systemic inflammation, impairing glucose metabolism, and damaging pancreatic β-cells. It has also emerged as a potential risk factor for gestational diabetes mellitus (GDM), which affects over 200,000 U.S. pregnancies annually and is linked to serious maternal and neonatal complications. Studies indicate an association between untreated periodontitis and GDM, though the mechanisms and impact of periodontal treatment during pregnancy require further investigation.
• This prospective study aims to explore GDM incidence among pregnant women with and without periodontitis and evaluate the effects of periodontal therapy in mitigating risks.

Materials + Methods

• This study recruited adult women with normal glucose levels, who were pregnant for the first time with a singleton pregnancy and diagnosed within 1-4 weeks of pregnancy. Those with systemic diseases (except hypertension) or who had taken medicines within the previous 3-months were excluded.
• Participants were divided into three groups, based on their periodontal diagnosis and willingness to receive treatment:
  • Non-periodontitis (NP)
  • Periodontitis untreated (PU)
  • Periodontitis treated (PT)
• Periodontal examination by dentists assessed plaque index, probing pocket depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP). Diagnosis followed the 2017 world workshop classification guidelines (staging and grading).
• Professional periodontal therapy in the PT group adhered to the EFP S3 guideline, including supragingival and subgingival instrumentation, and ongoing supportive care.
• Gingival crevicular fluid (GCF) and serum for key bacterial species and inflammatory mediators (e.g., CRP, TNF-α, IL-6) were collected and analyzed at 12-16 weeks.
• GDM was diagnosed at 24–28 weeks using an oral glucose tolerance tests (OGTT).
• Statistical analysis identified factors influencing GDM incidence using logistic regression and correlation tests.

Results

• This study assessed the relationship between periodontitis and GDM in 3,523 pregnant women.
• The overall GDM incidence was 6.53%, with significant differences among the groups. GDM was observed in 4.79% of the NP group, 11.21% of the PU group, and 7.32% of the PT group, indicating that periodontal therapy may have reduced GDM risk (p < .05).
• Logistic regression analysis showed the adjusted odds ratio (OR) for GDM in the PU group was 2.543, which decreased to 1.566 after periodontal treatment. Factors like BMI, chronic hypertension, and a family history of diabetes were associated with higher GDM risk (p < .05). Sensitivity analyses confirmed these findings.
• Higher prevalence of certain bacteria (e.g., P. gingivalis and F. nucleatum) and elevated serum inflammatory markers (CRP, TNF-α, IL-8) were observed in the PU group compared to NP. Periodontal treatment significantly reduced these levels (p < .05).
• Regression models identified P. gingivalis, TNF-α, and IL-8 as key mediators in the PU and GDM relationship.

Limitations