Stomatology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China.
Department of Stomatology, Northwest Women's and Children's Hospital, Xi'an, China.
J Clin Periodontol. 2022 Feb;49(2):164-176. doi: 10.1111/jcpe.13578. Epub 2021 Dec 14.
This study aimed to determine whether periodontitis in early pregnancy and periodontal therapy during gestation affect the incidence of gestational diabetes mellitus (GDM) through a population-based clinical study.
Subjects without periodontitis at 1-4 weeks of gestation who met our inclusion criteria were enrolled in the non-periodontitis group. Periodontitis patients who agreed or refused to receive periodontal therapy during pregnancy were separately enrolled in the periodontitis treated or untreated group. At 12-16 weeks of gestation, gingival crevicular fluid (GCF) and venous blood were collected for analyses of bacterial species and serum inflammatory mediators, respectively. At 24-28 weeks of gestation, GDM patients were identified by oral glucose tolerance tests. The association tests were performed using Chi-squared statistics and regression analyses.
The complete data of 3523 pregnant women were recorded during the study period. GDM incidence among the untreated periodontitis participants (84/749, 11.21%) was significantly higher than that among the non-periodontitis participants (108/2255, 4.79%) (p < .05), and periodontal treatment during gestation reduced the incidence from 11.21% (untreated group) to 7.32% (38/519, treated group) (p < .05). Based on multiple logistic regression analyses, it was found that periodontitis in early pregnancy was associated with GDM, and three-step regression analyses showed that Porphyromonas gingivalis (P. gingivalis) and the serum TNF-α and IL-8 levels played a role in the association between untreated periodontitis and GDM. Furthermore, Pearson's correlation test indicated that the existence of P. gingivalis in GCF was positively correlated with high serum levels of these two inflammatory mediators.
This study establishes a connection between periodontitis in early pregnancy and GDM and demonstrates that the presence of P. gingivalis is associated with high levels of inflammatory mediators in serum, and thereby may contribute to the development of GDM. In-depth mechanistic studies are needed to further support these findings.
本研究旨在通过一项基于人群的临床研究，确定早孕期牙周炎和孕期牙周治疗是否通过影响妊娠期糖尿病（GDM）的发病率。
在妊娠 1-4 周无牙周炎且符合纳入标准的受试者被纳入非牙周炎组。同意或拒绝在孕期进行牙周治疗的牙周炎患者分别纳入牙周炎治疗组和未治疗组。在妊娠 12-16 周时，分别采集龈沟液（GCF）和静脉血，用于分析细菌种类和血清炎症介质。在妊娠 24-28 周时，通过口服葡萄糖耐量试验确定 GDM 患者。采用卡方检验和回归分析进行关联检验。
在研究期间，共记录了 3523 名孕妇的完整数据。未治疗的牙周炎组（84/749，11.21%）的 GDM 发生率明显高于非牙周炎组（108/2255，4.79%）（p<0.05），孕期牙周治疗可将 GDM 发生率从 11.21%（未治疗组）降低至 7.32%（38/519，治疗组）（p<0.05）。基于多因素逻辑回归分析，发现早孕期牙周炎与 GDM 相关，且三步回归分析显示牙龈卟啉单胞菌（P. gingivalis）和血清 TNF-α、IL-8 水平在未治疗的牙周炎与 GDM 之间的关联中起作用。此外，Pearson 相关检验表明 GCF 中 P. gingivalis 的存在与这两种炎症介质的血清高浓度呈正相关。
本研究确立了早孕期牙周炎与 GDM 之间的联系，并表明 P. gingivalis 的存在与血清中炎症介质的高水平相关，可能有助于 GDM 的发生。需要进行深入的机制研究来进一步支持这些发现。
