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Jamal WZ, Khan FR, Zuberi N, Kazmi SMR, Rozi S. Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study. Sci Rep 2024; 14:9951. [PMID: 38688972 PMCID: PMC11061300 DOI: 10.1038/s41598-024-60659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2-3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3-5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.
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Affiliation(s)
- Wafa Zehra Jamal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | | | - Nadeem Zuberi
- Department of Obstetrics & Gynecology, Aga Khan University, Karachi, Pakistan
| | | | - Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Ramírez V, Weber L, Hernández M, Realini O, Bendek MJ, Busso D, Hoare A, Illanes SE, Chaparro A. Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study. Clin Oral Investig 2023; 27:5509-5518. [PMID: 37505241 DOI: 10.1007/s00784-023-05170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To evaluate the relationship between obesity and periodontitis staging compared with periodontal healthy or gingivitis in pregnant women. MATERIALS AND METHODS An analytical cross-sectional study was conducted on pregnant women between 11 and 14 weeks of pregnancy. Sociodemographic, clinical, obstetric, and periodontal variables were studied. The exposure variable was obesity (body mass index [BMI] ≥ 30), and the primary outcome was periodontitis staging versus periodontal healthy/gingivitis. Data were analysed and estimated by multinomial logistic regression models. RESULTS The present study screened 1086 pregnancies and analysed 972 women with a median age of 29 years; 36.8% were diagnosed as obese. 26.9% of patients were diagnosed as periodontal healthy or gingivitis, 5.5% with stage I periodontitis, 38.6% with stage II periodontitis, 24% with stage III periodontitis, and 5.1% with stage IV periodontitis. After identifying and adjusting for confounding variables (educational level and plaque index), obesity had a relative risk ratio (RRR) of 1.66 (95% CI: 1.05-2.64; p = 0.03) and 1.57 (95% CI: 1.09-2.27; p = 0.015) for stage III periodontitis compared to periodontal healthy/gingivitis and stage II periodontitis, respectively. CONCLUSION Besides the already known risk indicators for periodontitis (age, smoking, and educational level), our study suggests a relationship between obesity and periodontitis staging in pregnancy. CLINICAL RELEVANCE Obesity can alter host immune responses, leading to increased susceptibility to infections and overactive host immunity, which could influence the prevalence and severity of maternal periodontitis in pregnancy.
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Affiliation(s)
- Valeria Ramírez
- Department of Biomedical Sciences, Ethics, Research and Education, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Laura Weber
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Ornella Realini
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
| | - María José Bendek
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile
- PhD Program in Biomedicine, School of Medicine, Universidad de los Andes, Santiago, Chile
| | - Dolores Busso
- Laboratory of Reproductive Biology, Biomedical Research and Innovation Center, Universidad de los Andes, Santiago, Chile
| | - Anilei Hoare
- Laboratory of Oral Microbiology, Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Sebastián Enrique Illanes
- Laboratory of Reproductive Biology, Biomedical Research and Innovation Center, Universidad de los Andes, Santiago, Chile
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Alejandra Chaparro
- Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile.
- Biomedical Research and Innovation Center, Santiago, Chile.
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Yefet E, Bejerano A, Iskander R, Zilberman Kimhi T, Nachum Z. The Association between Gestational Diabetes Mellitus and Infections in Pregnancy-Systematic Review and Meta-Analysis. Microorganisms 2023; 11:1956. [PMID: 37630515 PMCID: PMC10458027 DOI: 10.3390/microorganisms11081956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/10/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
We conducted a systematic review and meta-analysis to evaluate the association between gestational diabetes mellitus and infections during pregnancy. We included cross-sectional, case-control, cohort studies and clinical trials, evaluating the frequency of infections in women with and without gestational diabetes mellitus. A search was conducted in Embase, PubMed, and Web of Science electronic databases and by manually searching references, until 23 March 2022, resulting in 16 studies being selected for review, with 111,649 women in the gestational diabetes mellitus group, and 1,429,659 in the controls. Cochrane's Q test of heterogeneity and I² were used to assess heterogeneity. Pooled odds ratio (OR) was calculated. Funnel plots and Egger test were used for assessment of publication bias. The results showed a significant association between gestational diabetes mellitus and infections (pooled-OR 1.3 95% CI [1.2-1.5]). Sub-analyses showed a significant association for urinary tract infections (pooled-OR of 1.2 95% CI [1.1-1.3]), bacterial infections (pooled-OR were 1.2 95% CI [1.1-1.4]), and SARS-CoV-2 (pooled-OR 1.5 95% CI [1.2-2.0]) but not to gingivitis or vaginal candidiasis. The results underscore the significance of acknowledging gestational diabetes mellitus as a risk factor for infections.
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Affiliation(s)
- Enav Yefet
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya 1528001, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Aviv Bejerano
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya 1528001, Israel
| | - Rula Iskander
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel (Z.N.)
| | - Tal Zilberman Kimhi
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya 1528001, Israel
| | - Zohar Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula 1834111, Israel (Z.N.)
- Rappaport Faculty of Medicine, Technion, Haifa 3109601, Israel
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Abouzaid M, Howidi N, Badran Z, Mohammed G, Mousa NA. The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications. Front Med (Lausanne) 2023; 10:1168625. [PMID: 37342498 PMCID: PMC10277493 DOI: 10.3389/fmed.2023.1168625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women's risk for each disorder.
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Affiliation(s)
- Maryam Abouzaid
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Nourhan Howidi
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Zahi Badran
- Periodontology Unit, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Ghada Mohammed
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Noha A. Mousa
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Abstract
PURPOSE OF REVIEW Epidemiological and mechanistic studies have reported relationships between blood lipids, mostly measured by traditional method in clinical settings, and gestational diabetes mellitus (GDM). Recent advances of high-throughput lipidomics techniques have made available more comprehensive lipid profiling in biological samples. This review aims to summarize evidence from prospective studies in assessing relations between blood lipids and GDM, and discuss potential underlying mechanisms. RECENT FINDINGS Mass spectrometry and nuclear magnetic resonance spectroscopy-based analytical platforms are extensively used in lipidomics research. Epidemiological studies have identified multiple novel lipidomic biomarkers that are associated with risk of GDM, such as certain types of fatty acids, glycerolipids, glycerophospholipids, sphingolipids, cholesterol, and lipoproteins. However, the findings are inconclusive mainly due to the heterogeneities in study populations, sample sizes, and analytical platforms. Mechanistic evidence indicates that abnormal lipid metabolism may be involved in the pathogenesis of GDM by impairing pancreatic β-cells and inducing insulin resistance through several etiologic pathways, such as inflammation and oxidative stress. SUMMARY Lipidomics is a powerful tool to study pathogenesis and biomarkers for GDM. Lipidomic biomarkers and pathways could help to identify women at high risk for GDM and could be potential targets for early prevention and intervention of GDM.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiong-Fei Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University
- Shuangliu Institute of Women's and Children's Health, Shuangliu Maternal and Child Health Hospital, Chengdu, China
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
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Sohail MU, Mashood F, Oberbach A, Chennakkandathil S, Schmidt F. The role of pathogens in diabetes pathogenesis and the potential of immunoproteomics as a diagnostic and prognostic tool. Front Microbiol 2022; 13:1042362. [DOI: 10.3389/fmicb.2022.1042362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Diabetes mellitus (DM) is a group of metabolic diseases marked by hyperglycemia, which increases the risk of systemic infections. DM patients are at greater risk of hospitalization and mortality from bacterial, viral, and fungal infections. Poor glycemic control can result in skin, blood, bone, urinary, gastrointestinal, and respiratory tract infections and recurrent infections. Therefore, the evidence that infections play a critical role in DM progression and the hazard ratio for a person with DM dying from any infection is higher. Early diagnosis and better glycemic control can help prevent infections and improve treatment outcomes. Perhaps, half (49.7%) of the people living with DM are undiagnosed, resulting in a higher frequency of infections induced by the hyperglycemic milieu that favors immune dysfunction. Novel diagnostic and therapeutic markers for glycemic control and infection prevention are desirable. High-throughput blood-based immunoassays that screen infections and hyperglycemia are required to guide timely interventions and efficiently monitor treatment responses. The present review aims to collect information on the most common infections associated with DM, their origin, pathogenesis, and the potential of immunoproteomics assays in the early diagnosis of the infections. While infections are common in DM, their role in glycemic control and disease pathogenesis is poorly described. Nevertheless, more research is required to identify novel diagnostic and prognostic markers to understand DM pathogenesis and management of infections. Precise monitoring of diabetic infections by immunoproteomics may provide novel insights into disease pathogenesis and healthy prognosis.
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León-Ríos X, da Silva Pires S, Gil-Montoya J. Asociación entre diabetes mellitus gestacional y enfermedad periodontal: revisión sistemática. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2022. [DOI: 10.1016/j.gine.2022.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pukkila J, Mustaniemi S, Lingaiah S, Lappalainen OP, Kajantie E, Pouta A, Kaaja R, Eriksson JG, Laivuori H, Gissler M, Vääräsmäki M, Keikkala E. Increased Oral Care Needs and Third Molar Symptoms in Women with Gestational Diabetes Mellitus: A Finnish Gestational Diabetes Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10711. [PMID: 36078430 PMCID: PMC9518339 DOI: 10.3390/ijerph191710711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/13/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
(1) Hyperglycemia and oral pathology accelerate each other in diabetes. We evaluated whether gestational diabetes mellitus (GDM) is associated with self-reported increased oral health care needs and oral symptoms, including third molar symptoms, during pregnancy. (2) Pregnant women with (n = 1030) and without GDM (n = 935) were recruited in this multicenter Finnish Gestational Diabetes study in 2009-2012. Of the women with GDM, 196 (19.0%) receiving pharmacological treatment, 797 (77.0%) receiving diet treatment and 233 (23.0%) with recurrent GDM were analyzed separately. Oral health was assessed using structured questionnaires and analyzed by multivariable logistic regression adjusted for background risk factors. (3) Women with GDM were more likely to report a higher need for oral care than controls (31.1% vs. 24.5%; odds ratio (OR) 1.39; 95% confidence interval (CI) 1.14-1.69), particularly women with recurrent GDM (38.1% vs. 24.5%; OR 1.90; 95% CI 1.40-2.58). Women with pharmacologically treated GDM (46.9%) more often had third molar symptoms than controls (36.1%; OR 1.57; 95% CI 1.15-2.15) than women with diet-treated GDM (38.0%; OR 1.47; 95% CI 1.07-2.02). (4) GDM is associated with perceived oral care needs. Third molar symptoms were associated with pharmacologically treated GDM.
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Affiliation(s)
- Jenni Pukkila
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Sanna Mustaniemi
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Shilpa Lingaiah
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Olli-Pekka Lappalainen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Eero Kajantie
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
- Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 7028 Trondheim, Norway
| | - Anneli Pouta
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Department of Government Services, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Risto Kaaja
- Internal Medicine, Institute of Clinical Medicine, Turku University Hospital, University of Turku, 20521 Turku, Finland
| | - Johan G. Eriksson
- Technology and Research, Agency for Science, Singapore Institute for Clinical Sciences, Singapore 117609, Singapore
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Young Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Folkhälsan Research Center, 00250 Helsinki, Finland
| | - Hannele Laivuori
- Adolescent and Maternal Health Research, Center for Child, Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
- Department of Obstetrics and Gynaecology, Tampere University Hospital, 33520 Tampere, Finland
- Medical and Clinical Genetics, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, 00290 Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, 104 35 Stockholm, Sweden
- Region Stockholm, Academic Primary Health Care Centre, 113 65 Stockholm, Sweden
| | - Marja Vääräsmäki
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
| | - Elina Keikkala
- PEDEGO Research Unit, Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, 90220 Oulu, Finland
- Population Health, Public Health and Welfare, Finnish Institute for Health and Welfare, 00271 Helsinki and 90220 Oulu, Finland
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Hormonal Fluctuations and Periodontal Status in Postmenopausal Women. Int J Dent 2022; 2022:9990451. [PMID: 35585960 PMCID: PMC9110255 DOI: 10.1155/2022/9990451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. While the short-term effects of hormonal events on gingival inflammation have been well described, their long-term effects on the periodontium have received less attention. Our investigation was aimed at evaluating the correlation between hormonal fluctuations and periodontal status in postmenopausal women from the profile of the Rafsanjan Cohort Study. Material and Methods. We used the data obtained from the profile of the Rafsanjan Cohort Study (RCS) as a part of the prospective epidemiological research studies in Iran (PERSIAN). The RCS includes 10,000 participants aged 35–70 years old. Among this population, the periodontal status data of 4143 women were available. Of these 4,143, the postmenopausal women were included in the study, and those who had a history of gingival treatment during the past 6 months were excluded from the study. Finally, 928 postmenopausal women were included in the present study. Periodontal status was assessed by measuring the clinical attachment loss, pocket depth, and bleeding on probing (BOP). Univariate and multivariate regression analyses were applied using three different models. Results. The results showed that 53.2% of postmenopausal women had periodontitis. There were significant differences between the participants with and without periodontitis in brushing frequency and educational status
. After adjusting for all potential confounders, no correlation was found between hormonal fluctuations and periodontal status. Conclusion. There was no correlation between hormonal fluctuations and periodontal status.
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Bunpeng N, Boriboonhirunsarn D, Boriboonhirunsarn C, Sawangpanyangkura T, Tansriratanawong K. Association between gestational diabetes mellitus and periodontitis via the effect of reactive oxygen species in peripheral blood cells. J Periodontol 2022; 93:758-769. [PMID: 34787908 DOI: 10.1002/jper.21-0455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Periodontitis (P) has emerged as a risk factor for gestational diabetes mellitus (GDM) through immune cell function alterations, elevated proinflammatory mediators, and increased reactive oxygen species (ROS). The main objective of present study was to determine associations between pregnancy with and without GDM and P. The secondary objective was to compare ROS production in peripheral blood cells (PBCs) of pregnant women with and without GDM. METHODS This cross-sectional case-control study included 128 pregnant women: 64 with and 64 without GDM. All participants were examined for clinical parameters of GDM and periodontal conditions. Associations between GDM-related periodontal data and GDM risk were evaluated by multiple logistic regression. PBCs were isolated and cultured. ROS productions in each PBCs types was investigated by flow cytometry with ROS antibodies. RESULTS P was significantly more prevalent in pregnant women with GDM than in those without GDM (57.8% versus 37.5%), with an odds ratio (OR) of 2.28, and a 95% confidence interval (CI) of 1.12 to 4.64 (P = 0.022). The OR (95% CI) was 2.59 (1.19 to 5.65) (P = 0.017) after adjusting for potential confounding factors, including diabetes mellitus (DM) family history, age ≥30 years, body mass index, and maternal age. ROS levels in all PBCs types were significantly higher in the GDM than in the non-GDM group (P < 0.05). CONCLUSION This study supported the association between P and GDM and indicated that P may be a risk factor for GDM. High levels of ROS production in the PBCs of pregnant women with GDM emphasized the association with GDM.
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Affiliation(s)
- Nattawan Bunpeng
- Department of Oral Medicine and Periodontology, Mahidol University, Bangkok, Thailand
| | - Dittakarn Boriboonhirunsarn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Teerat Sawangpanyangkura
- Department of Restorative Dentistry and Periodontology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383&set/a 912874875+940716348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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12
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State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021. [DOI: 10.3390/jcm10225383
expr 893869204 + 932072443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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13
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González-Moles MÁ, Ramos-García P. State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature. J Clin Med 2021; 10:5383. [PMID: 34830663 PMCID: PMC8618619 DOI: 10.3390/jcm10225383] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/24/2022] Open
Abstract
Diabetes mellitus (DM) is a global health problem, having recognized that in the next 20 years the number of diabetic patients in the world will increase to 642 million. DM exerts enormous repercussions on general health diabetic (especially derived from vascular, cardiac, renal, ocular, or neurological affectation). It entails in addition a high number of deaths directly related to the disease, as well as a high health care cost, estimated at $673 billion annually. Oral cavity is found among all the organs and systems affected in the course of DM. Important pathologies are developed with higher prevalence, such as periodontitis (PD), alterations in salivary flow, fungal infections, oral cancer, and oral potentially malignant disorders (OPMD). It has been proven that PD hinders the metabolic control of DM and that the presence of PD increases the possibility for developing diabetes. Despite the relevance of these oral pathologies, the knowledge of primary care physicians and diabetes specialists about the importance of oral health in diabetics, as well as the knowledge of dentists about the importance of DM for oral health of patients is scarce or non-existent. It is accepted that the correct management of diabetic patients requires interdisciplinary teams, including dentists. In this critical review, the existing knowledge and evidence-degree on the preventive, clinical, diagnosis, prognosis, and therapeutic aspects of oral diseases that occur with a significant frequency in the diabetic population are developed in extension.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18010 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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14
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Wang Y, Huang Y, Wu P, Ye Y, Sun F, Yang X, Lu Q, Yuan J, Liu Y, Zeng H, Song X, Yan S, Qi X, Yang CX, Lv C, Wu JHY, Liu G, Pan XF, Chen D, Pan A. Plasma lipidomics in early pregnancy and risk of gestational diabetes mellitus: a prospective nested case-control study in Chinese women. Am J Clin Nutr 2021; 114:1763-1773. [PMID: 34477820 DOI: 10.1093/ajcn/nqab242] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/28/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Lipid metabolism plays an important role in the pathogenesis of diabetes. There is little evidence regarding the prospective association of the maternal lipidome with gestational diabetes mellitus (GDM), especially in Chinese populations. OBJECTIVES We aimed to identify novel lipid species associated with GDM risk in Chinese women, and assess the incremental predictive capacity of the lipids for GDM. METHODS We conducted a nested case-control study using the Tongji-Shuangliu Birth Cohort with 336 GDM cases and 672 controls, 1:2 matched on age and week of gestation. Maternal blood samples were collected at 6-15 wk, and lipidomes were profiled by targeted ultra-HPLC-tandem MS. GDM was diagnosed by oral-glucose-tolerance test at 24-28 wk. The least absolute shrinkage and selection operator is a regression analysis method that was used to select novel biomarkers. Multivariable conditional logistic regression was used to estimate the associations. RESULTS Of 366 detected lipids, 10 were selected and found to be significantly associated with GDM independently of confounders: there were positive associations with phosphatidylinositol 40:6, alkylphosphatidylcholine 36:1, phosphatidylethanolamine plasmalogen 38:6, diacylglyceride 18:0/18:1, and alkylphosphatidylethanolamine 40:5 (adjusted ORs per 1 log-SD increment range: 1.34-2.86), whereas there were inverse associations with sphingomyelin 34:1, dihexosyl ceramide 24:0, mono hexosyl ceramide 18:0, dihexosyl ceramide 24:1, and phosphatidylcholine 40:7 (adjusted ORs range: 0.48-0.68). Addition of these novel lipids to the classical GDM prediction model resulted in a significant improvement in the C-statistic (discriminatory power of the model) to 0.801 (95% CI: 0.772, 0.829). For every 1-point increase in the lipid risk score of the 10 lipids, the OR of GDM was 1.66 (95% CI: 1.50, 1.85). Mediation analysis suggested the associations between specific lipid species and GDM were partially explained by glycemic and insulin-related indicators. CONCLUSIONS Specific plasma lipid biomarkers in early pregnancy were associated with GDM in Chinese women, and significantly improved the prediction for GDM.
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Affiliation(s)
- Yi Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yichao Huang
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Ping Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Ye
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengjiang Sun
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Lu
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiaying Yuan
- Department of Science and Education, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Huayan Zeng
- Nutrition Department, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
| | - Xingyue Song
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China
| | - Shijiao Yan
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China.,School of Public Health, Hainan Medical University, Haikou, Hainan, China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, West China Second Hospital, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Chun-Xia Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuanzhu Lv
- Department of Emergency, Hainan Clinical Research Center for Acute and Critical Diseases, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China.,Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, Hainan, China.,Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences, Hainan Medical University, Haikou, Hainan, China
| | - Jason H Y Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiong-Fei Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Da Chen
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou, Guangdong, China
| | - An Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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15
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Bendek MJ, Canedo-Marroquín G, Realini O, Retamal IN, Hernández M, Hoare A, Busso D, Monteiro LJ, Illanes SE, Chaparro A. Periodontitis and Gestational Diabetes Mellitus: A Potential Inflammatory Vicious Cycle. Int J Mol Sci 2021; 22:ijms222111831. [PMID: 34769262 PMCID: PMC8584134 DOI: 10.3390/ijms222111831] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
Periodontitis is a chronic inflammatory immune disease associated with a dysbiotic state, influenced by keystone bacterial species responsible for disrupting the periodontal tissue homeostasis. Furthermore, the severity of periodontitis is determined by the interaction between the immune cell response in front of periodontitis-associated species, which leads to the destruction of supporting periodontal tissues and tooth loss in a susceptible host. The persistent bacterial challenge induces modifications in the permeability and ulceration of the sulcular epithelium, which facilitates the systemic translocation of periodontitis-associated bacteria into distant tissues and organs. This stimulates the secretion of pro-inflammatory molecules and a chronic activation of immune cells, contributing to a systemic pro-inflammatory status that has been linked with a higher risk of several systemic diseases, such as type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM). Although periodontitis and GDM share the common feature of systemic inflammation, the molecular mechanistic link of this association has not been completely clarified. This review aims to examine the potential biological mechanisms involved in the association between periodontitis and GDM, highlighting the contribution of both diseases to systemic inflammation and the role of new molecular participants, such as extracellular vesicles and non-coding RNAs, which could act as novel molecular intercellular linkers between periodontal and placental tissues.
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Affiliation(s)
- María José Bendek
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile; (M.J.B.); (G.C.-M.); (O.R.); (I.N.R.)
| | - Gisela Canedo-Marroquín
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile; (M.J.B.); (G.C.-M.); (O.R.); (I.N.R.)
| | - Ornella Realini
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile; (M.J.B.); (G.C.-M.); (O.R.); (I.N.R.)
| | - Ignacio N. Retamal
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile; (M.J.B.); (G.C.-M.); (O.R.); (I.N.R.)
| | - Marcela Hernández
- Laboratory of Periodontal Biology and Department of Pathology and Oral Medicine, Faculty of Dentistry, University of Chile, Olivos 943, Independencia, Santiago 8380544, Chile;
| | - Anilei Hoare
- Laboratory of Oral Microbiology, Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Olivos 943, Independencia, Santiago 8380544, Chile;
| | - Dolores Busso
- Program in Biology of Reproduction, Centre for Biomedical Research and Innovation (CIIB), Universidad de los Andes, Santiago 8380544, Chile; (D.B.); (L.J.M.); (S.E.I.)
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8380544, Chile
| | - Lara J. Monteiro
- Program in Biology of Reproduction, Centre for Biomedical Research and Innovation (CIIB), Universidad de los Andes, Santiago 8380544, Chile; (D.B.); (L.J.M.); (S.E.I.)
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8380544, Chile
| | - Sebastián E. Illanes
- Program in Biology of Reproduction, Centre for Biomedical Research and Innovation (CIIB), Universidad de los Andes, Santiago 8380544, Chile; (D.B.); (L.J.M.); (S.E.I.)
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago 8380544, Chile
| | - Alejandra Chaparro
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Av. Plaza 2501, Las Condes, Santiago 7620157, Chile; (M.J.B.); (G.C.-M.); (O.R.); (I.N.R.)
- Correspondence: ; Tel.: +56-998376593
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16
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Zheng M, Wang C, Ali A, Shih YA, Xie Q, Guo C. Prevalence of periodontitis in people clinically diagnosed with diabetes mellitus: a meta-analysis of epidemiologic studies. Acta Diabetol 2021; 58:1307-1327. [PMID: 34028620 DOI: 10.1007/s00592-021-01738-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/06/2021] [Indexed: 12/19/2022]
Abstract
AIMS The relationship between diabetes mellitus and periodontitis has long been discussed, but the conclusion of this relationship was controversial. We conducted this meta-analysis to explore the association between diabetes mellitus and the prevalence of periodontitis. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies reporting associations of periodontitis with diabetes. Gray literature was integrated from the Open-Gray database. Prevalence estimates and odds ratios were extracted by two independent reviewers and synthesized through meta-analyses. RESULTS Twenty-seven papers met the inclusion criteria involving 3092 diabetic patients and 23,494 controls. Overall prevalence of periodontitis was 67.8% in diabetics (combined types) and 35.5% in patients without diabetes (OR, 1.85; 95%CI, 1.61-2.11). Probing depth (MD 0.23; 95% CI, 0.17-0.29; I2 = 25%) and plaque index (MD, 0.20; 95% CI, 0.18-0.23; P = 0.59; I2 = 0%) severity scores were significantly greater among the diabetic group. CONCLUSIONS The prevalence and severity of periodontitis are greater in patients with diabetes than in non-diabetic populations.
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Affiliation(s)
- Mengwen Zheng
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China
| | - Cheng Wang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Glossop Rd, Sheffield, S10 2JF, UK
| | - Yi An Shih
- School of Nursing, Peking University, Beijing, China
| | - Qinqin Xie
- Department of Stomatology, The Second Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chao Guo
- Department of Stomatology, School of Medicine, The First Affiliated Hospital, Shihezi University, Shihezi, Xinjiang, China.
- The Affiliated Hospital of Qingdao University, Qingdao,Shangdong, China.
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17
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Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Raju K, Berens L. Periodontology and pregnancy: An overview of biomedical and epidemiological evidence. Periodontol 2000 2021; 87:132-142. [PMID: 34463990 DOI: 10.1111/prd.12394] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Women are particularly susceptible to developing gingival problems during pregnancy. In addition, periodontal disease in pregnant women may lead to adverse outcomes for both mother and infant, which have serious clinical and public health implications. Both scenarios have been extensively researched, helping to bring attention to pregnant women as an important and vulnerable population as it concerns periodontal health. The increase in gingival inflammation caused by hormonal changes in pregnant women is undisputed and has been studied and documented since the 1960s, although the exact etiology is not fully understood. The relationship between periodontal disease during pregnancy and adverse pregnancy outcomes is less substantiated, because of conflicting evidence. This review of the biomedical and epidemiologic literature provides an overview of both sides of this relationship and examines the potential mechanisms for developing periodontal disease during pregnancy and the proposed mechanisms by which periodontal disease leads to adverse pregnancy outcomes.
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Affiliation(s)
- Karen Raju
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, USA
| | - Lisa Berens
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, California, USA
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19
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Yilmaz D, Altas A. Evaluation of gingival microcirculation in patients with gestational diabetes mellitus. Microvasc Res 2021; 138:104222. [PMID: 34246644 DOI: 10.1016/j.mvr.2021.104222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the possible microcircularity variations at periodontal mucous level in patients with gestational diabetes mellitus (GDM). MATERIAL AND METHODS Overall 55 periodontally healthy and non-smoker participants were enrolled in the study by whom 30 were diagnosed with GDM (26 to 34 weeks pregnant) and 25 were systemically healthy unpregnant controls. The analysis was performed in the masticatory/gingival mucosa of maxillary anterior region and by the optical probe videocapillaroscopy technique equipped with 200× lenses. The following parameters were recorded: capillary loop visibility, capillary orientation to surface, microhemorrhages, capillary density and tortuosity. RESULTS The average capillary density was significantly higher in participants with GDM (27 ± 5.46 no. loops/mm2) compared to controls (21.16 ± 3 no. loops/mm2) (P = 0.035) while increased tortuosity scores was observed in controls compared with the GDM group (P = 0.017). There was not any significantly difference between study groups among the other variables (P > 0.05). CONCLUSIONS Capillary alterations including capillary density and tortuosity were demonstrated in gingival microcirculation of patients with GDM. These microcirculatory changes could provide us new understanding on the dynamics of the relationship between GDM and periodontal tissues.
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Affiliation(s)
- Dogukan Yilmaz
- Department of Periodontology, Faculty of Dentistry, Sakarya University, Sakarya, Turkey.
| | - Ayfer Altas
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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20
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Rodrigues Amorim Adegboye A, Dias Santana D, Teixeira dos Santos PP, Guedes Cocate P, Benaim C, Trindade de Castro MB, Maia Schlüssel M, Kac G, Lilienthal Heitmann B. Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile. Nutrients 2021; 13:783. [PMID: 33673568 PMCID: PMC7997467 DOI: 10.3390/nu13030783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6-8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions' clinical benefits and cost-effectiveness is warranted.
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Affiliation(s)
- Amanda Rodrigues Amorim Adegboye
- Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK
| | - Danilo Dias Santana
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Pedro Paulo Teixeira dos Santos
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Paula Guedes Cocate
- Department of Bioscience and Physical Activity, School of Physical Education and Sports, Federal University of Rio de Janeiro, Rio de Janeiro 21941-599, Brazil;
| | - Camila Benaim
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Maria Beatriz Trindade de Castro
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Michael Maia Schlüssel
- The EQUATOR Network—UK Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Old Road, Oxford OX3 7LD, UK;
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Department of Social and Applied Nutrition, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil; (D.D.S.); (P.P.T.d.S.); (C.B.); (M.B.T.d.C.); (G.K.)
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at the Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, 2000 Frederiksberg, Denmark;
- Section for General Practice, Institute of Public Health, Copenhagen University, 1014 Copenhagen, Denmark
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21
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Kunasegaran T, Balasubramaniam VRMT, Arasoo VJT, Palanisamy UD, Ramadas A. Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031272. [PMID: 33572656 PMCID: PMC7908368 DOI: 10.3390/ijerph18031272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
A rapid increase in the prevalence of gestational diabetes mellitus (GDM) has been associated with various factors such as urbanization, lifestyle changes, adverse hyperglycemic intrauterine environment, and the resulting epigenetic changes. Despite this, the burden of GDM has not been well-assessed in Southeast Asia. We comprehensively reviewed published Southeast Asian studies to identify the current research trend in GDM in this region. Joanna Briggs Institute’s methodology was used to guide the scoping review. The synthesis of literature findings demonstrates almost comparable clinical evidence in terms of risk factors and complications, challenges presented in diagnosing GDM, and its disease management, given the similarities of the underlying population characteristics in Southeast Asia. Evidence suggests that a large proportion of GDM risk in women may be preventable by lifestyle modifications. However, the GDM burden across countries is expected to rise, given the heterogeneity in screening approaches and diagnostic criteria, mainly influenced by economic status. There is an urgent need for concerted efforts by government and nongovernmental sectors to implement national programs to prevent, manage, and monitor the disease.
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22
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Chaparro A, Realini O, Hernández M, Albers D, Weber L, Ramírez V, Param F, Kusanovic JP, Sorsa T, Rice GE, Illanes SE. Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases-8 and -9 are associated with the severity of periodontitis and the development of gestational diabetes mellitus. J Periodontol 2020; 92:205-215. [PMID: 32789908 DOI: 10.1002/jper.19-0743] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is increasing worldwide and women with a history of GDM are at risk of developing type 2 diabetes which is a risk factor for periodontitis. The aim of this study was to explore the association between the concentrations of matrix metalloproteinase (MMP)-8 and -9 in gingival crevicular fluid (GCF) during early pregnancy with the periodontal diagnosis and the risk of GDM development. METHODS A prospective cohort study, including 314 women, enrolled at 11 to 14 weeks of pregnancy was conducted. A complete maternal/obstetric and periodontal exam was performed, and GCF samples were obtained for the MMP-8 and -9 determination by Multiplex Elisa Assays. Mann-Whitney test; Spearman's correlation and log-binomial regression model estimated the association between MMPs concentration in GCF and GDM. RESULTS Fourteen percent of the pregnancies were diagnosed with GDM. An increase in the concentration of MMP-8 and -9 in women with periodontitis stage III and IV compared to periodontitis stage I was observed (99.31 ng/mL [IQR: 85.32] versus 71.95 ng/mL [IQR: 54.04], and 262.4 ng/mL [IQR: 312.55] versus 114.1 ng/mL [IQR: 184.94], respectively). Women who developed GDM showed increased concentrations of MMP-8 and -9 in GCF since the beginning of pregnancy (P = 0.0381; P = 0.0302, respectively). MMP-8 concentration in GCF was associated with GDM (RR: 1.19; P = 0.045; CI 95% 1.00 to 1.40; and RR: 1.20; P = 0.063; CI 95% 0.99 to 1.45 in the adjusted model). CONCLUSION(S) GCF concentrations of MMP-8 and -9 at early of pregnancy are increased in women with severe periodontitis and associated with the GDM development.
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Affiliation(s)
- Alejandra Chaparro
- Department of Periodontology, Center for Biomedical Research, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Ornella Realini
- Department of Periodontology, Center for Biomedical Research, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Daniela Albers
- Department of Statistics, Faculty of Dentistry, Universidad Mayor, Santiago, Chile
| | - Laura Weber
- Department of Periodontology, Center for Biomedical Research, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Valeria Ramírez
- Department of Public Health and Epidemiology, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Fernanda Param
- Department of Periodontology, Center for Biomedical Research, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile
- Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Periodontology, Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Gregory Edward Rice
- Department of Obstetrics and Gynecology, Center for Biomedical Research, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Center for Biomedical Research, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile
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Chaparro A, Zúñiga E, Varas-Godoy M, Albers D, Ramírez V, Hernández M, Kusanovic JP, Acuña-Gallardo S, Rice G, Illanes SE. Periodontitis and placental growth factor in oral fluids are early pregnancy predictors of gestational diabetes mellitus. J Periodontol 2019; 89:1052-1060. [PMID: 29790168 DOI: 10.1002/jper.17-0497] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Alejandra Chaparro
- Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Edgardo Zúñiga
- Department of Periodontology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Manuel Varas-Godoy
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
| | - Daniela Albers
- Department of Statistics, Faculty of Dentistry, Universidad Mayor, Santiago, Chile
| | - Valeria Ramírez
- Department of Public Health and Epidemiology, Faculty of Dentistry, Universidad de los Andes
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.,Dentistry Unit, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - Juan Pedro Kusanovic
- Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile.,Center of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Stephanie Acuña-Gallardo
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
| | - Gregory Rice
- Exosome Biology Laboratory, Center for Clinical Diagnostics, Royal Brisbane and Women's Hospital, University of Queensland Center for Clinical Research, Brisbane, Australia
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Laboratory of Reproductive Biology, Faculty of Medicine, Universidad de los Andes
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Mishra S, Rao CR, Bhadoria AS, Mohanty S, Kishore S, Chaudhary AS. Life-cycle approach for prevention of gestational diabetes mellitus. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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25
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Monteiro LJ, Varas-Godoy M, Monckeberg M, Realini O, Hernández M, Rice G, Romero R, Saavedra JF, Illanes SE, Chaparro A. Oral extracellular vesicles in early pregnancy can identify patients at risk of developing gestational diabetes mellitus. PLoS One 2019; 14:e0218616. [PMID: 31242249 PMCID: PMC6594608 DOI: 10.1371/journal.pone.0218616] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Aim To isolate and characterize oral extracellular vesicles from gingival crevicular fluid at 11–14 weeks and evaluate their capacity to identify patients at risk of developing gestational diabetes mellitus. Methods A case-control study was conducted, including patients who developed gestational diabetes mellitus (n = 11) and healthy pregnant controls (n = 23). Obstetric and periodontal histories were recorded at 11–14 weeks of gestation, and samples of gingival crevicular fluid obtained. Extracellular vesicles were isolated from gingival crevicular fluid by ExoQuick. Nanoparticle tracking analysis, ELISA and transmission electron microscopy were used to characterize extracellular vesicles. Results Total extracellular vesicles isolated from gingival crevicular fluid were significantly higher in patients who developed gestational diabetes mellitus later in pregnancy compared to normoglycemic pregnant women (6.3x109 vs 1.7 x1010, p value = 0.0026), and the concentration of the extracellular vesicles delivered an area under the ROC curve of 0.81. The distribution size of extracellular vesicles obtained using ExoQuick was around 148 ± 57 nm. There were no significant differences in the periodontal status between cases and controls. The exosome transmembrane protein CD63 was also detected in the extracellular vesicles of gingival crevicular fluid. Conclusion We were able to isolate extracellular vesicles from gingival crevicular fluid using a method that is suitable to be applied in a clinical setting. Our results provide an insight into the potential capacity of first trimester oral extracellular vesicles as early biomarkers for the prediction of gestational diabetes mellitus in pre-symptomatic women.
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Affiliation(s)
- Lara J. Monteiro
- Department of Obstetrics and Gynecology, Centre for Biomedical Research, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Manuel Varas-Godoy
- Department of Obstetrics and Gynecology, Centre for Biomedical Research, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Max Monckeberg
- Department of Obstetrics and Gynecology, Centre for Biomedical Research, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
| | - Ornella Realini
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | - Marcela Hernández
- Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Dentistry Unit, Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - Gregory Rice
- Department of Obstetrics and Gynecology, Centre for Biomedical Research, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
- Centre for Clinical Research, University of Queensland, Herston, Qld, Australia
| | - Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland and Detroit, United States of America
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI. Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, United States of America
| | | | - Sebastián E. Illanes
- Department of Obstetrics and Gynecology, Centre for Biomedical Research, Faculty of Medicine, Universidad de los Andes, Santiago, Chile
- * E-mail: (AC); (SEI)
| | - Alejandra Chaparro
- Department of Periodontology, Centre for Biomedical Research, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
- * E-mail: (AC); (SEI)
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Calcium and vitamin D supplementation and/or periodontal therapy in the treatment of periodontitis among Brazilian pregnant women: protocol of a feasibility randomised controlled trial (the IMPROVE trial). Pilot Feasibility Stud 2019; 5:38. [PMID: 30873290 PMCID: PMC6402123 DOI: 10.1186/s40814-019-0417-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/13/2019] [Indexed: 12/16/2022] Open
Abstract
Background Periodontitis is a common oral inflammation, which is a risk factor for adverse pregnancy outcomes. Intakes of vitamin D and calcium are inversely associated with occurrence and progression of periodontitis. This study aims to assess the feasibility of a multi-component intervention, including provision of milk powder supplemented with calcium and vitamin D and periodontal therapy (PT), for improving maternal periodontal health and metabolic and inflammatory profiles of low-income Brazilian pregnant women with periodontitis. Methods The IMPROVE trial is a feasibility randomised controlled trial (RCT) with a 2 × 2 factorial design with a parallel process evaluation. Pregnant women with periodontitis, aged 18–40 years and with < 20 gestational weeks (n = 120) were recruited and randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus PT during pregnancy, (2) placebo sachet and powdered milk plus PT during pregnancy, (3) fortified sachet (vitamin D and calcium) and powdered milk plus PT after delivery and (4) placebo sachet and powdered milk plus PT after delivery. Dentists and participants are blinded to fortification. Acceptability of study design, recruitment strategy, random allocation, data collection procedures, recruitment rate, adherence and attrition rate will be evaluated. Data on serum levels of vitamin D, calcium and inflammatory biomarkers; clinical periodontal measurements; anthropometric measurements; and socio-demographic questionnaires are collected at baseline, third trimester and 6–8 weeks postpartum. Qualitative data are collected using focus group, for analysis of favourable factors and barriers related to study adherence. Discussion Oral health and mineral/vitamin supplementation are much overlooked in the public prenatal assistance in Brazil and of scarcity of clinical trials addressing these issues in low and middle-income countries,. To fill this gap the present study was designed to assess the feasibility of a RCT on acceptability of a multi-component intervention combining conventional periodontal treatment and consumption of milk fortified with calcium-vitamin D for improving periodontal conditions and maternal metabolic and inflammation status, among Brazilian low-income pregnant women with periodontitis. Thus, we hope that this relatively low-cost and safe multicomponent intervention can help reduce inflammation, improve maternal periodontal health and metabolic profile and consequently prevent negative gestational outcomes. Trial registration NCT, NCT03148483. Registered on May 11, 2017.
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27
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Chanomethaporn A, Chayasadom A, Wara-Aswapati N, Kongwattanakul K, Suwannarong W, Tangwanichgapong K, Sumanonta G, Matangkasombut O, Dasanayake AP, Pitiphat W. Association between periodontitis and spontaneous abortion: A case-control study. J Periodontol 2018; 90:381-390. [PMID: 30367824 DOI: 10.1002/jper.18-0174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Spontaneous abortion, or miscarriage, is a complication of pregnancy which can severely affect women both physically and psychologically. We investigated the associations of periodontitis and periodontopathic bacteria with spontaneous abortion. METHODS We conducted a matched case-control study in two tertiary hospitals in Khon Kaen, Thailand. Cases were 85 women with spontaneous abortion at <20 weeks of gestation matched to 85 controls on age, gestational age, and hospital. Full-mouth periodontal examinations were performed. Periodontitis was defined as at least one site with probing depth ≥5 mm and clinical attachment level ≥2 mm at the same site. Subgingival plaque samples were collected to determine the levels of Porphyromonas gingivalis, Tannerella forsythia, and Fusobacterium nucleatum using real time polymerase chain reaction. RESULTS The cases were significantly more likely to have periodontitis (50.6%) than the controls (21.2%; P = 0.007). Conditional logistic regression revealed a crude odds ratio (OR) of 4.1 for the association between periodontitis and spontaneous abortion (95% confidence interval [CI] = 1.9-8.9, P = 0.001). The OR decreased, but was still significant, after controlling for previous miscarriage (OR = 3.3, 95% CI = 1.4-7.8, P = 0.006). There was no significant association between the levels of periodontopathic bacteria and spontaneous abortion. Increased levels of P. gingivalis and F. nucleatum were associated with periodontitis in both case and control groups. Association between increased T. forsythia levels and periodontitis was observed only in the case women. CONCLUSIONS Periodontitis was more common in women with spontaneous abortions as compared with matched controls. Levels of periodontopathic bacteria was not associated with spontaneous abortion in this population.
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Affiliation(s)
- Anchana Chanomethaporn
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Anek Chayasadom
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Nawarat Wara-Aswapati
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.,Chronic Inflammatory Diseases and Systemic Diseases Associated with Oral Health Research Group, Khon Kaen University
| | | | - Waraporn Suwannarong
- Department of Periodontology, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Oranart Matangkasombut
- Department of Microbiology and Research Unit on Oral Microbiology and Immunology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Ananda P Dasanayake
- Department of Epidemiology, New York University College of Dentistry, New York, NY, USA
| | - Waranuch Pitiphat
- Chronic Inflammatory Diseases and Systemic Diseases Associated with Oral Health Research Group, Khon Kaen University.,Department of Community Dentistry, Faculty of Dentistry, Khon Kaen University
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Kumar A, Sharma DS, Verma M, Lamba AK, Gupta MM, Sharma S, Perumal V. Association between periodontal disease and gestational diabetes mellitus—A prospective cohort study. J Clin Periodontol 2018; 45:920-931. [DOI: 10.1111/jcpe.12902] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Ashok Kumar
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Deepika S. Sharma
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Mahesh Verma
- Maulana Azad Institute of Dental Sciences New Delhi India
| | | | - Madhavi M. Gupta
- Department of Obstetrics and GynaecologyMaulana Azad Medical College New Delhi India
| | - Shashi Sharma
- Institute of Cytology and Preventive Oncology Noida Uttar Pradesh India
| | - Vanamail Perumal
- Department of Obstetrics and GynaecologyAll India Institute of Medical Sciences New Delhi India
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Graziani F, Gennai S, Solini A, Petrini M. A systematic review and meta-analysis of epidemiologic observational evidence on the effect of periodontitis on diabetes An update of the EFP-AAP review. J Clin Periodontol 2017; 45:167-187. [PMID: 29277926 DOI: 10.1111/jcpe.12837] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Abstract
AIM To update the available evidence on the impact of periodontitis on diabetes control, incidence and complications. METHODS Observational studies on the effect of periodontitis on diabetes, published after 2012, were identified through electronic databases and hand-searched journals. Findings were summarized by evidence tables, using PRISMA statement. Quality of the included studies was evaluated through the Newcastle Ottawa scale. RESULTS Healthy individuals with periodontitis exhibit a poor glycaemic control and a higher risk of developing diabetes. Individuals affected by diabetes show a deterioration of glycaemic control if also affected by periodontitis and significantly higher prevalence of diabetes-related complications. Limited evidence is available on gestational diabetes and type 1 diabetes. CONCLUSIONS Periodontitis has a significant impact on diabetes control, incidence and complications. Nevertheless, the heterogeneity and quality of the included publications suggest that caution should be exercised when interpreting the data and that there remains an important need for additional evidence.
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Affiliation(s)
- Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy.,Unit of Internal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Morena Petrini
- Department of Surgical, Medical and Molecular Pathology, Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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Jin B, Liu L, Zhang S, Cao X, Xu Y, Wang J, Sun L. Nuclear Magnetic Resonance-Assisted Metabolic Analysis of Plasma for Mild Gestational Diabetes Mellitus Patients. Metab Syndr Relat Disord 2017; 15:439-449. [PMID: 29022831 DOI: 10.1089/met.2017.0065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Bai Jin
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liping Liu
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuxuan Zhang
- Department of Obstetrics and Gynecology, The First People's Hospital of Xuzhou, Xuzhou, China
| | - Xiaohui Cao
- Department of Obstetrics, Wuxi Maternity and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi, China
| | - Yuhong Xu
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junsong Wang
- Department of Natural Medicinal Chemistry, State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Lizhou Sun
- Department of Obstetrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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31
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Esteves Lima RP, Cota LOM, Silva TA, Cortelli SC, Cortelli JR, Costa FO. Periodontitis and type 2 diabetes among women with previous gestational diabetes: epidemiological and immunological aspects in a follow-up of three years. J Appl Oral Sci 2017; 25:130-139. [PMID: 28403353 PMCID: PMC5393533 DOI: 10.1590/1678-77572016-0367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/06/2016] [Accepted: 09/22/2016] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to verify the incidence on the development of type 2 diabetes in women with previous gestational diabetes with and without periodontitis after a three-year time interval. MATERIAL AND METHODS Initial sample of this follow-up study consisted of 90 women diagnosed with gestational diabetes who underwent periodontal examination. After three years, 49 women were subjected to new periodontal examination and biological, behavioral, and social data of interest were collected. Additionally, the quantification of the C-reactive protein in blood samples was performed. Fasting glucose and glycated hemoglobin levels were requested. Saliva samples were collected for quantification of interleukin 6 and 10, tumor necrosis factor α, matrix metalloproteinase 2 and 9. RESULTS The incidence of type 2 diabetes mellitus was 18.4% and of periodontitis was 10.2%. There was no significant difference in the incidence of type 2 diabetes mellitus among women with and without periodontitis. It was observed impact of C-reactive protein in the development of type 2 diabetes mellitus. However, it was not observed impact of periodontitis on the development of type 2 diabetes mellitus among women with previous gestational diabetes. CONCLUSIONS It was not observed impact of periodontitis on the development of type 2 diabetes among women with previous gestational diabetes. The impact of C-reactive protein in the development of type 2 diabetes mellitus highlights the importance of an inflammatory process in the diabetes pathogenesis.
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Affiliation(s)
- Rafael Paschoal Esteves Lima
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | - Luis Otávio Miranda Cota
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | - Tarcília Aparecida Silva
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
| | | | | | - Fernando Oliveira Costa
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Periodontologia e Patologia, Belo Horizonte, MG, Brasil
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Abariga SA, Whitcomb BW. Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 2016; 16:344. [PMID: 27825315 PMCID: PMC5101727 DOI: 10.1186/s12884-016-1145-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational 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. METHODS Twelve 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. RESULTS We 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 %). CONCLUSION Meta-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.
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Affiliation(s)
- Samuel A Abariga
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA.
| | - Brian W Whitcomb
- Division of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, 415 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA
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Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, Oliveira da Silveira J, Martins CC, Miranda Cota LO, Costa FO. Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis. J Periodontol 2015; 87:48-57. [PMID: 26334246 DOI: 10.1902/jop.2015.150311] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To the best of the authors' knowledge, there is no systematic review of the potential association between periodontitis and gestational diabetes mellitus (GDM) in the current literature. The aim of the present systematic review and meta-analysis is to search for scientific evidence regarding the association between periodontitis and GDM. METHODS The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD2014010728) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in three electronic databases without restrictions regarding language or date of publication. From 190 studies selected, 15 underwent full-text analysis. Eight studies were eligible (five cross-sectional and three case-control studies), and seven were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI). RESULTS There was a significant association between periodontitis and GDM in the meta-analyses of four cross-sectional studies (OR 1.67, 95% CI 1.20 to 2.32) and two case-control studies (OR 2.66, 95% CI 1.52 to 4.65). However, sensitivity tests for case-control studies showed a lack of consistency in data; when including one case-control study, the significance was null (meta-analysis of three case-control studies: OR 1.69, 95% CI 0.68 to 4.21). CONCLUSIONS There was substantial clinical, methodologic, and statistical heterogeneity among the studies. The scientific evidence cannot affirm a positive association between periodontitis and GDM. Future studies with different designs in distinct populations should be conducted to investigate this association.
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Affiliation(s)
| | - Renata Magalhães Cyrino
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Carvalho Dutra
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Carolina Castro Martins
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais
| | - Luis Otávio Miranda Cota
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Fernando Oliveira Costa
- Department of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Chen HH, Chen DY, Lin SY, Lai KL, Chen YM, Chou YJ, Chou P, Lin CH, Huang N. Exposição à periodontite no intervalo de um ano antes do tratamento antidiabético e risco de artrite reumatoide em pacientes com diabete mellitus: estudo de coorte populacional. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [DOI: 10.1016/j.rbr.2014.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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