Title Periodontal Disease is a Risk Factor for the Development of Gestational Diabetes Mellitus
Clinical Question In pregnant women, does having periodontal disease increase the risk of gestational diabetes mellitus (GDM)?
Clinical Bottom Line Studies have shown that periodontal disease and its inflammatory mediators are associated with an increased risk for the development of gestational diabetes. This is based on a meta-analysis of 5,724 pregnant patients including 624 cases of GDM.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27825315Abariga/2016Females with periodontal disease Meta-Analysis
Key resultsForty-four articles were reviewed, and 10 studies met the eligibility criteria. The random effects meta-analysis of all studies included a total of 5,724 participants including 624 cases, and 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). Similar results were seen when restricting to high quality case-control studies with 1,176 participants that included 380 cases (OR = 1.85, 95% CI: 1.03 to 3.32); p < 0.05). Meta-analysis of studies that adjusted for potential confounders estimated more than 2-fold increased odds of GDM among women with periodontitis (OR = 2.08, 95% CI: 1.21 to 3.58, p = 0.009).
23075430Chokwiriyachit/201250 females diagnosed with GDMCase Control Study
Key resultsThe case-control study included 50 females with GDM and 50 females without diabetes. Fifty percent of the GDM females had periodontitis compared to only 26% of the controls. The females with GDM had significantly higher levels of attachment loss and probing depths and more bleeding on probing compared to the controls. Periodontitis was significantly associated with GDM (OR = 3.00, 95% CI: 1.19 to 7.56).
Evidence Search periodontitis and gestational diabetes
Comments on
The Evidence
Validity: Both articles included case-control studies that linked periodontal disease and its’ inflammatory mediators to an increased risk of gestational diabetes mellitus. Inflammatory mediators, IL1 and IL6, induce local and host immune responses effecting insulin signaling and glucose metabolism. Abariga/2016 used a clear research question and an extensive search, with more then one researcher selecting the studies for inclusion and extracting data from the studies. The overall sample size (5,724 pregnant patients including 624 cases of GDM) was large, and most of the included studies were rated as low risk of bias. In the meta-analysis of all included studies, heterogeneity was moderate (I2 = 50.5%.) In the meta-analysis of studies that adjusted for potential confounders, heterogeneity was also moderate (I2 = 36.9%). On the other hand, heterogeneity was substantial for the meta-analysis of high quality case-control studies (I2 = 84.8%). Perspective: The research results serve as a measure of proof that all pregnant females should maintain/have good oral hygiene. Since there is an association between periodontitis and gestational diabetes mellitus, it is recommended for all pregnant females get checked for any inflammatory oral health problems.
Applicability This subject is applicable to general practice in which females who have periodontitis may have an increased risk of gestational diabetes. Women undergoing prenatal care should be referred for dental care that includes periodontal treatment to reduce inflammatory mediators.
Specialty (General Dentistry) (Periodontics)
Keywords Periodontal disease; Gestational diabetes mellitus
ID# 3223
Date of submission 05/01/2017
E-mail Medinaay@livemail.uthscsa.edu
Author Aislen Medina
Co-author(s) e-mail
Faculty mentor Juanita Lozano-Pineda, DDS, MPH
Faculty mentor e-mail pinedaj@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available