Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes.
J Periodontol. 2018 Sep;89(9):1052-1060. doi: 10.1002/JPER.17-0497.
Gestational diabetes mellitus (GDM) affects around 7% to 10% of all pregnancies. Early detection of predisposition to GDM is the first step in developing efficacious preventive treatment. The objective of the present study was to establish the utility of placental proteins presents in oral fluids (gingival crevicular fluid [GCF] and saliva), and periodontal disease status as early pregnancy predictors of GDM.
A nested case control within a prospective cohort was conducted. Pregnant systemically healthy women, aged between 18 and 40 years at 11 to 14 weeks gestation were included. Samples of oral fluids were collected and a complete maternal/obstetric and periodontal history was obtained. The concentration of placental growth factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) were measured by enzyme-linked immunosorbent assay in a nested case control sample of the prospective cohort. Multiple logistic regression models assessed the association. The evaluation of the diagnostic accuracy of the biomarkers was performed through receiver operating characteristic (ROC) curves by calculating the area under the curve (AUC).
There were recruited 212 pregnant women at 11 to 14 weeks of pregnancy, of these, 14 women (i.e., 6.6%) developed GDM, and displayed significant greater bleeding on probing (BOP) [P = 0.0003]; periodontal probing depth (PD) [P = 0.0028]; clinical attachment level (AL) [P = 0.0008] and periodontal inflamed surface area (PISA) [P = 0.0001]. Similarly, initial glycemia and GCF-PlGF concentrations were significantly greater in women with GDM [P = 0.0012, and P = 0.0019, respectively]. When data were subjected to ROC curve analysis, the combination of initial glycemia and GCF-PlGF concentration delivered an area under the ROC curve of 0.897. Multiple logistic regression analyses demonstrate an association between glycemia (OR 1.21, 95% confidence interval [CI] 1.06 to 1.38; P = 0.005) and GCF-PlGF concentrations in women who developed GDM (OR 1.68, CI 1.05 to 2.68 P = 0.03).
Within the limitations of the present study, the results support that first trimester maternal glycemia combined with GCF-PlGF concentrations could be a surrogate biomarker for the future development of GDM in pre-symptomatic women.
妊娠糖尿病（GDM）影响约 7%至 10%的所有妊娠。早期发现 GDM 的易感性是开发有效预防治疗的第一步。本研究的目的是确定口腔液（龈沟液[GCF]和唾液）中存在的胎盘蛋白以及牙周病状况作为预测 GDM 的早期妊娠指标的效用。
在前瞻性队列中进行嵌套病例对照研究。纳入年龄在 18 至 40 岁之间，妊娠 11 至 14 周的系统健康孕妇。采集口腔液样本，并获得完整的孕产妇/产科和牙周病史。通过酶联免疫吸附试验测量嵌套病例对照样本中胎盘生长因子（PlGF）和可溶性 Fms 样酪氨酸激酶 1（sFlt-1）的浓度。多变量逻辑回归模型评估关联。通过计算曲线下面积（AUC），通过接收者操作特征（ROC）曲线评估生物标志物的诊断准确性。
共招募了 212 名妊娠 11 至 14 周的孕妇，其中 14 名孕妇（即 6.6%）发生 GDM，并且明显出现更大的探诊出血（BOP）[P=0.0003]；牙周探诊深度（PD）[P=0.0028]；临床附着水平（AL）[P=0.0008]和牙周炎表面面积（PISA）[P=0.0001]。同样，GDM 妇女的初始血糖和 GCF-PlGF 浓度明显更高[P=0.0012 和 P=0.0019]。当数据进行 ROC 曲线分析时，初始血糖和 GCF-PlGF 浓度的组合获得 ROC 曲线下面积为 0.897。多变量逻辑回归分析表明，血糖（OR 1.21，95%置信区间[CI]1.06 至 1.38；P=0.005）和 GCF-PlGF 浓度之间存在关联在发生 GDM 的妇女中（OR 1.68，CI 1.05 至 2.68；P=0.03）。
在本研究的限制范围内，结果支持在无症状妇女中，早期妊娠母亲血糖结合 GCF-PlGF 浓度可能是 GDM 未来发展的替代生物标志物。
