Journal of periodontology · 2025
Association between periodontitis and gestational diabetes mellitus via systemic inflammation: A prospective cohort study.
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Cheng Jing, Tao Yun, Gong Qian, Liu Juan, Wang Cheng, Li Yujuan, Luo Hong, Xi Jinmeng, Wang You, Gao Wei, Cheng Bo
Аннотация
BACKGROUND: This study aimed to investigate the association between periodontitis severity and the risk of gestational diabetes mellitus (GDM) considering pathways induced by systemic inflammation.
METHODS: Pregnant women with singleton pregnancies aged at least 18 years at 12-20 gestational weeks were enrolled in the study. Logistic and linear regression models were constructed to examine the associations between periodontal status and GDM risk and blood glucose levels. Age-stratified analyses (≥ 30 vs. < 30 years) were conducted to evaluate potential effect modification. Lastly, mediation analysis was employed to assess the proportion of the association mediated by systemic inflammatory biomarkers.
RESULTS: Out of 446 participants, the overall incidence of GDM was 26.68%. It increased with the severity of periodontal disease, reaching a 3-fold higher GDM risk among women with stages II-IV periodontitis compared to healthy controls [17.35% vs. 38.60%; odds ratio (OR) = 3.00, 95% confidence interval (95% CI): 1.38-6.67, p < 0.05]. Stratified analyses showed this association was restricted to women aged ≥ 30 years (p for interaction < 0.05), with a 4.78-fold higher GDM risk in women having stages II-IV periodontitis (OR = 4.78, 95% CI: 1.85-13.08; p < 0.05). Even women with stage I periodontitis exhibited a significant association (OR = 2.84, 95% CI: 1.25-6.92, p < 0.05). Mediation analysis revealed that systemic inflammatory markers [white blood cell (WBC), neutrophils, systemic immune inflammation index (SII), aggregate index of systemic inflammation (AISI)] partially mediated the link between stages II-IV periodontitis and GDM, with mediation proportions of 17.85%, 18.61%, 17.32%, and 11.71%, respectively.
CONCLUSION: Increasing periodontitis severity was significantly associated with a higher risk of GDM in a dose-response manner in women aged ≥ 30 years, but not in younger women. Besides, systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.
PLAIN LANGUAGE SUMMARY: The relationship between periodontitis severity and gestational diabetes mellitus (GDM) risk has not been systematically characterized, and the biological mechanisms underlying this association are not clear. Our study demonstrated a significant, dose-dependent association between periodontal disease severity and GDM risk, with a 3-fold increased likelihood among pregnant women with stages II-IV periodontitis compared to healthy controls. Notably, this association was markedly stronger among women aged ≥ 30 years. Systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.
METHODS: Pregnant women with singleton pregnancies aged at least 18 years at 12-20 gestational weeks were enrolled in the study. Logistic and linear regression models were constructed to examine the associations between periodontal status and GDM risk and blood glucose levels. Age-stratified analyses (≥ 30 vs. < 30 years) were conducted to evaluate potential effect modification. Lastly, mediation analysis was employed to assess the proportion of the association mediated by systemic inflammatory biomarkers.
RESULTS: Out of 446 participants, the overall incidence of GDM was 26.68%. It increased with the severity of periodontal disease, reaching a 3-fold higher GDM risk among women with stages II-IV periodontitis compared to healthy controls [17.35% vs. 38.60%; odds ratio (OR) = 3.00, 95% confidence interval (95% CI): 1.38-6.67, p < 0.05]. Stratified analyses showed this association was restricted to women aged ≥ 30 years (p for interaction < 0.05), with a 4.78-fold higher GDM risk in women having stages II-IV periodontitis (OR = 4.78, 95% CI: 1.85-13.08; p < 0.05). Even women with stage I periodontitis exhibited a significant association (OR = 2.84, 95% CI: 1.25-6.92, p < 0.05). Mediation analysis revealed that systemic inflammatory markers [white blood cell (WBC), neutrophils, systemic immune inflammation index (SII), aggregate index of systemic inflammation (AISI)] partially mediated the link between stages II-IV periodontitis and GDM, with mediation proportions of 17.85%, 18.61%, 17.32%, and 11.71%, respectively.
CONCLUSION: Increasing periodontitis severity was significantly associated with a higher risk of GDM in a dose-response manner in women aged ≥ 30 years, but not in younger women. Besides, systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.
PLAIN LANGUAGE SUMMARY: The relationship between periodontitis severity and gestational diabetes mellitus (GDM) risk has not been systematically characterized, and the biological mechanisms underlying this association are not clear. Our study demonstrated a significant, dose-dependent association between periodontal disease severity and GDM risk, with a 3-fold increased likelihood among pregnant women with stages II-IV periodontitis compared to healthy controls. Notably, this association was markedly stronger among women aged ≥ 30 years. Systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.