Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies

Abstract

BackgroundGestational diabetes mellitus (GDM) is glucose intolerance with first onset during pregnancy and is associated with serious maternal and fetal complications. The etiology of GDM is not well understood, but systemic inflammation effects on insulin signaling and glucose metabolism is suspected. Periodontal disease is a chronic inflammatory condition that induces local and host immune responses and has been evaluated for a potential role in development of GDM. Results from studies evaluating the association between periodontitis and GDM are mixed. We performed a systematic review and meta-analysis to summarize available data regarding the association between periodontitis and GDM.MethodsTwelve electronic databases were searched for observational studies of the association between periodontitis and GDM through March 2016. Eligible studies were assessed for quality and heterogeneity. Random effects models were used to estimate summary measures of association.ResultsWe identified 44 articles from 115 potentially relevant reports of which 10 studies met our eligibility criteria. Clinical diagnostic criteria for periodontitis and GDM varied widely among studies, and moderate heterogeneity was observed. Random effects meta-analysis of all included studies with a total of 5724 participants including 624 cases, showed that periodontitis is associated with an increased risk of GDM by 66 %, (OR = 1.66, 95 % CI: 1.17 to 2.36; p < 0.05), I2 = 50.5 %. Similar results were seen in sub-analysis restricted to data from methodologically high quality case–control studies including 1176 participants including 380 cases, (OR = 1.85, 95 % CI: 1.03 to 3.32); p < 0.05), I2 = 68.4 %. Meta-analysis of studies that adjusted for potential confounders estimated more than 2-fold increased odds of GDM among women with periodontitis (aOR = 2.08, 95 % CI: 1.21 to 3.58, p = 0.009, I2 = 36.9 %).ConclusionMeta-analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis. Robust prospective study designs and uniform definition for periodontitis and GDM definitions are urgently needed to substantiate these findings.

Association between periodontal disease and gestational diabetes mellitus—A prospective cohort study

“…A significant association between periodontal disease and occurrence of GDM has been reported by various studies with an odds ratio (95% CI) of 2.2 (1.1–4.8), 2.6 (1.2–5.6), 9.11 (1.11–74.90), 2.5 (1.2–5.3) and 3.00 (1.19–7.56) (Chokwiriyachit et al., ; Novak, Taylor, Dawson, Ferguson, & Novak, ; Offenbacher et al., ; Xiong et al., and Xiong et al., ; respectively). A meta‐analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis (Abariga & Whitcomb, ). It found a more than twofold increased risk between GDM and periodontitis (aOR = 2.08) in studies that adjusted for such described risk factors for GDM.…”

“…Periodontitis is associated with several adverse pregnancy outcomes (Kumar et al., ). The relationship between periodontal disease and GDM has been specifically examined and reviewed (Xiong et al., ; Sanz et.al., ; Abariga & Whitcomb, ). There are emerging evidences that periodontitis may predispose to the development of diabetes (Chapple et al.…”

Periodontitis and placental growth factor in oral fluids are early pregnancy predictors of gestational diabetes mellitus

“…[28][29][30] Pregnancy increases the susceptibility of periodontal tissues to develop inflammation, 13 and this was more evident in patients with GDM. 10,12,31 Indeed, women with GDM have a greater risk for developing more severe periodontal disease than normal healthy pregnant women. 10,12,31 Moreover, the prevalence of periodontitis is higher in women with GDM (44.8%) when compared with women without diabetes (13.2%), with an odds ratio of 5.33.…”

“…10,12,31 Indeed, women with GDM have a greater risk for developing more severe periodontal disease than normal healthy pregnant women. 10,12,31 Moreover, the prevalence of periodontitis is higher in women with GDM (44.8%) when compared with women without diabetes (13.2%), with an odds ratio of 5.33. 10 The evidence linking periodontitis and GDM suggests that either the presence of high levels of inflammatory mediators or periodontopathogens may play a role in the pathogenesis of GDM.…”

“…9,10 In fact, an association between periodontitis and GDM is only partially supported by recent systematic reviews because the available evidence is limited, highlighting the relevance of conducting new prospective studies based on standard definitions of periodontitis and GDM in different populations, and controlling by confounders to elucidate this association. 11,12 The potential interaction between GDM and periodontitis could be mediated by the effect of molecules of placental origin in the periodontal tissues during pregnancy, increasing blood vessel proliferation, vasodilation, and progesterone activity. Consistent with this hypothesis, pregnancy is associated with an increased gingival crevicular fluid (GCF) volume.…”