Prepregnancy Obesity and Periodontitis Among Pregnant Females With and Without Gestational Diabetes Mellitus

Excessive weight in pregnant women increases the chance of diagnosing periodontitis combined with tooth loss

BACKGROUND

Excess weight (EW), especially in women of childbearing age, those who are pregnant, as well as postpartum, is a problem worldwide. Fat accumulation deregulates the inflammatory response, contributing to the development of health problems, such as periodontitis. This study investigated the association between EW and periodontitis during pregnancy.

METHODS

A cross-sectional, multicenter study involved 1745 postpartum women in Brazil. Socioeconomic-demographic data, gestational history, lifestyle behavior, and general and oral health conditions were obtained. Pre-pregnancy body mass index (BMI) was collected from medical records with EW being the exposure. Both tooth loss and clinical attachment level (CAL) were evaluated, and the presence of periodontitis was the outcome. Logistic regression, odds ratio (OR) and 95% confidence interval (95% CI), and quantile regression, beta coefficient and 95% CI, estimated the association between EW (BMI) and periodontitis and its combined effect with tooth loss ≥3, as dichotomous and continuous variables (CAL and tooth loss), with 5% significance level.

RESULTS

The EW was 27.7% prevalent and periodontitis was 11.7%. There was a positive association between EW and periodontitis: ORadjusted:1.39; 95% CI:1.01;1.92 and between EW and periodontitis combined with tooth loss ≥3: ORadjusted:1.73; 95% CI:1.36;2.20. The adjusted association between EW and periodontitis as continuous variables was also positive, showing that for each unit of increased BMI, there was an elevation in the mean CAL (p = 0.04) and tooth loss (p < 0.01), with statistical significance.

CONCLUSIONS

There was a moderate association between EW and periodontitis during pregnancy, with an even greater association of pregnant women with EW presenting periodontitis combined with tooth loss.

Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study

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.

Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study

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.

Knowledge, attitudes and practices of undergraduate students and dentists about dental prenatal care

INTRODUCTION

Prenatal care is a fundamental moment for health promotion to be carried out, since at that moment women are more receptive to new knowledge, with the aim of providing better healthcare for the baby. This study aimed to evaluate the knowledge, attitudes and practices of undergraduate students and professionals, both from the public and from private sectors in Brazil, regarding dental prenatal care.

MATERIALS AND METHODS

This study corresponded to an online questionnaire survey, via Google Forms, consisting of 17 general questions for undergraduates (n = 103) and 16 for professionals (n = 227) for demographic and school mapping, and 18 specific questions about the importance and protocol of dental prenatal care. T-test, Mann-Whitney U-test and multiple linear regression were adopted (p < .05).

RESULTS

The average total score of the questionnaire for students and professionals was 12.40 and 15.65, respectively (p < .0001), indicating moderate knowledge. Professionals showed a higher prevalence of moderate (77%) and high (2%) knowledge of the subject when compared to undergraduate students (51% and 0% respectively). The graduation period in which the students were enrolled was a predictor of the total score of the questionnaire [F (1, 101) = 21.21; p < .0001; R²  = .165]. The female gender and the lower weekly workload were the main predictors of the total score of the questionnaire for professionals [F (3, 223) = 6.74; p < .0001; R²  = .083].

CONCLUSIONS

Although professionals have greater knowledge about dental prenatal care than students, there are still deficiencies in the knowledge and practices of them in respect of dental management during pregnancy. Higher education institutions need to change the teaching-learning plan regarding the holistic dental approach for women during pregnancy.

Is overweight associated with periodontitis in pregnant women? Systematic review and meta-analysis

This systematic review and meta-analysis aimed to generate pooled evidence for the association between excessive weight and pregnancy induced periodontitis. EMBASE, SCOPUS, PubMed/MEDLINE, Web of Science, BVS/LILACS, Cochrane Library and SCIELO databases were accessed. Eligibility criteria were: human clinical studies published between year 2000 and 2021. Newcastle-Ottawa scale was used to evaluate risk of bias of the studies. Meta-analysis was performed using MedCalc® Statistical Software. Eleven studies were included, evaluating 2152 pregnant women (743 with overweight/obesity and 1409 with normal body mass index - BMI), with a mean age of 29.62 years. Most studies had low risk of bias. A positive association between overweight/obesity and periodontitis was found, with an average of 61.04% of women with overweight/obesity and periodontitis, showing the overall random-effects relative risk and 95% CI of 2.21 (1.53–3.17) (p < 0.001). Arterial hypertension, gestational diabetes mellitus and excessive gestational weight gain were the most common adverse effects of maternal obesity that may have been linked to periodontitis induced pro-inflammatory state. In conclusion, a positive association was found between overweight/obesity and periodontitis during pregnancy. However, the high heterogeneity between the studies related to sample size, periodontal classification and the cutoff-points for BMI are the main limitation.

Obesity during pregnancy and its oral repercussions

Obesity during pregnancy and its oral repercussions: what is the current evidence?

Periodontal status and quality of life in pregnant women with both overweight/obesity and hypertension: A cross-sectional study

Background

The aim of this study was to assess the periodontal condition and quality of life of pregnant women affected with both overweight/obesity and arterial hypertension.

Material and Methods

Pregnant women were dived into three groups: with overweight/obesity and hypertension (G1 = 23), with overweight/obesity without hypertension (G2 = 31) and with normal BMI and without hypertension (G3 = 38). They were evaluated regarding: contextual variables (age, socioeconomic level and anthropometric parameters); periodontal status; and quality of life (adapted version of Oral Health Impact Profile – OHIP-14). ANOVA, Kruskal-Wallis, chi-square and binary logistic regression model were adopted (p< 0.05).

Results

There were no intergroup differences for age (p = 0.700), education level (p = 0.119) and gestational weight gain (p = 0.415), nevertheless G2 differed from G3 regarding household monthly income (p = 0.040). G2 had higher prevalence of bleeding on probing than G3 (p = 0.001), but G1 and G2 presented higher prevalence of periodontitis (p< 0.001). Household monthly income (adjusted OR = 0.71; 95% CI = 0.52 - 0.98; p = 0.038) and hypertension (adjusted OR = 3.70; 95% CI = 1.16 - 11.80; p = 0.026) remained in the final logistic regression model [X2(4) = 21.79; p = 0.0002; R2 of Nagelkerke = 0.284]. G1 showed worse impact on quality of life, mainly regarding physical pain (p< 0 .001), psychological discomfort (p< 0 .001), physical disability (p< 0 .001), social disability (p = 0.005) and handicap (p< 0 .001).

Conclusions

In conclusion, maternal excessive weight is associated with periodontitis during pregnancy. Moreover, the presence of hypertension in overweight pregnant women seems to be determinant to negatively influence their quality of life, resulting in physical, psychological and social damages.

Key words:Hypertension, obesity, overweight, periodontitis, quality of life.

Mothers' high glycemic levels and the association between periodontitis and low birth weight

BACKGROUND

Maternal hyperglycemia, periodontitis, and adverse gestational outcomes are important health problems. The present study investigated the hypothesis that periodontitis and the glycemic level of mothers may have opposing influences on birth weight (BW). This study evaluated the effect of high glycemic levels, albeit within the normal range, on the association between periodontitis and low birth weight (LBW).

METHODS

732 women took part in this case-control study; 172 were mothers of children with LBW <2,500g, and 560 were mothers of children with BW ≥2,500g. The BW of newborns was obtained from medical records, and information on socioeconomic-demographic, lifestyle behavior were obtained through interviews. Glycated hemoglobin (HbA1c) levels were evaluated, and full-mouth periodontal examination was carried out within seven days postpartum. Hierarchical and logistic regression analysis evaluated the effect of glycemic levels on the association between periodontitis and LBW by subgroups, estimating Odds Ratios (OR) with 95% confidence intervals (95%CI).

RESULTS

In the group with HbA1c levels <5.6%, a statistically significant relationship existed between periodontitis and LBW. Using the Centre for Disease Control/American Academy of Periodontics criteria, the OR_adjusted was 1.55; 95%CI: 1.04-2.31; using the Gomes-Filho et al. criteria the OR_adjusted was 1.91; 95%CI: 1.06-3.45. In the group with higher HbA1c levels but still within the normal range (≥5.6% and <6.5%), the findings showed no association between periodontitis and LBW.

CONCLUSION

Higher maternal glycemic levels within the normal range, inferior to those indicative of gestational diabetes, diabetes mellitus, or hyperglycemia, and periodontitis have opposing effects on BW, altering the association magnitude. This article is protected by copyright. All rights reserved.

Systemic Condition, Periodontal Status, and Quality of Life in Obese Women During Pregnancy and After Delivery

Objective

To evaluate the systemic condition, periodontal status, and quality of life of obese women during pregnancy and after delivery.

Methods

This prospective cohort consisted of 60 women examined in the third trimester of pregnancy (32nd-36th gestational week [T1]) and after delivery (T2) and were divided into elevated body mass index (BMI; GO = 30) and normal BMI (GN = 30) according to the World Health Organization. The variables assessed were: (1) gestational weight gain, arterial hypertension (AH), and diabetes mellitus; (2) oral hygiene behaviour (frequency of dental floss using and toothbrushing); (3) probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and dental biofilm; and (4) quality of life (Oral Health Impact Project [OHIP]-14). Analysis of variance (ANOVA), Friedman, Cochran's Q and χ² tests, and logistic regression model were adopted (P < .05).

Results

GO showed a higher frequency of AH in T1 (P < .001). Both groups decreased the frequency of dental floss use (P = .013) and toothbrushing (P < .001) and increased the percentage of dental biofilm in T2 (P < .001). GO presented a greater PPD and CAL in T1 and T2 and higher BOP in T1 (P < .001), demonstrating a negative impact in the following dimensions of Oral Health Impact Project-14 during T1 functional limitation (P = .020), physical disability (P = .020), and handicap (P = .021).

Conclusion

Obese women presented higher prevalence of AH during pregnancy and higher prevalence of periodontitis in both periods. They showed a poor quality of life in T1 regarding functional limitation, physical disability, and handicap.

Periodontal status of women with excessive gestational weight gain and the association with their newborns' health

OBJECTIVE

The aim of this study was to assess the association between high gestational weight gain and systemic and periodontal status of women between the 32nd and 36th gestational weeks of pregnancy (T1) and after delivery (T2), and the association of these factors with newborns' health.

METHODS

The sample was divided into excessive gestational weight gain (GE = 25) and normal gestational weight gain (GN = 25) and was evaluated regarding: (i) socio-economic status; (ii) systemic and periodontal status; and (iii) newborns' health. The results were analysed using the Mann-Whitney U-test, the t-test, the Friedman test, analysis of variance (ANOVA) and Cochran's Q test (P < 0.05).

RESULTS

Women with GE had lower household income (P = 0.010) and higher body mass index (BMI) at both T1 and T2. The prevalence of hypertension at T1 was higher in women with GE, but the condition resolved post-delivery (P = 0.001). Worsening in oral hygiene was observed at T2 in both groups (P < 0.001). Sixty-eight percent of women with GE and 16% of women with GN had periodontitis at T1, and 52% and 12%, respectively, had periodontitis at T2. In women with GE, the BMI of newborns was higher (P = 0.031).

CONCLUSIONS

Women with high gestational weight gain also showed a high prevalence of hypertension and periodontitis during pregnancy, and persistent periodontitis after delivery. High gestational weight gain was related to high BMI of newborns.

Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth

INTRODUCTION

Excessive weight is associated with periodontitis because of inflammatory mediators secreted by the adipose tissue. Periodontal impairments can occur during pregnancy due to association between high hormonal levels and inadequate oral hygiene. Moreover, periodontitis and excessive weight during pregnancy can negatively affect an infant's weight at birth.

OBJECTIVE

This observational, cross-sectional study aimed to evaluate the association between pre-pregnancy overweight/obesity, periodontitis during the third trimester of pregnancy, and the infants' birth weight.

METHODOLOGY

The sample set was divided into 2 groups according to the preconception body mass index: obesity/overweight (G1=50) and normal weight (G2=50). Educational level, monthly household income, and systemic impairments during pregnancy were assessed. Pocket probing depth (PPD) and clinical attachment level (CAL) were obtained to analyze periodontitis. The children's birth weight was classified as low (<2.5 kg), insufficient (2.5-2.999 kg), normal (3-3.999 kg), or excessive (≥4 kg). Bivariate analysis (Mann-Whitney U test, t-test, chi-squared test) and logistic regression (stepwise backward likelihood ratio) were performed (p<0.05).

RESULTS

G1 showed lower socioeconomic levels and higher prevalence of arterial hypertension and gestational diabetes mellitus during pregnancy than G2 (p=0.002). G1 showed higher means of PPD and CAL (p=0.041 and p=0.039, respectively) and therefore a higher prevalence of periodontitis than G2 (p=0.0003). G1 showed lower infants' birth weight than G2 (p=0.0004). Excessive maternal weight and educational levels were independent variables associated with periodontitis during the third trimester of pregnancy (X2[2]=23.21; p<0.0001). Maternal overweight/obesity was also associated with low/insufficient birth weight (X2[1]=7.01; p=0.008).

CONCLUSION

The present findings suggest an association between excessive pre-pregnancy weight, maternal periodontitis, and low/insufficient birth weight.

Systemic conditions and oral health-related quality of life of pregnant women of normal weight and who are overweight

OBJECTIVE

This study evaluated systemic and periodontal conditions and their association with quality of life in women in the third trimester of pregnancy, assisted by the Brazilian public health-care system, with excessive and normal weight.

METHODS

Fifty pregnant women were allocated into two groups according to their pre-pregnancy body mass index (BMI): excessive (GE; n = 25; BMI ≥ 25.00 kg/m² ); and normal (GN; n = 25; 18.00 ≤ BMI ≤ 24.99 kg/m² ). Thereafter, variables such as socio-economic level, anthropometric parameters (body mass index and gestational weight gain), systemic conditions, periodontal status, and oral health-related quality of life using the short version of the Oral Health Impact Profile (OHIP-14), were evaluated.

RESULTS

There was no significant difference between groups in schooling level, monthly household income and gestational weight gain (P > 0.05). The GE group showed a higher frequency of arterial hypertension (P = 0.018), sought dental services less frequently (P = 0.035), had a higher prevalence of periodontitis (P = 0.011), and had a higher OHIP-14 overall score (P = 0.004) characterised by physical and psychological impact. In the final binary logistic regression models, high maternal BMI was associated with arterial hypertension and periodontitis during pregnancy, while periodontitis was strongly associated with moderate and high impact on quality of life.

CONCLUSION

Pregnant women in the third trimester with excessive weight, assisted by the Brazilian public health-care system, presented with a higher prevalence of arterial hypertension, worse periodontal conditions and consequent high impact on quality of life.

Systemic and oral conditions of pregnant women with excessive weight assisted in a private health system

OBJECTIVE

This observational cross-sectional study aimed to evaluate systemic and oral conditions in pregnant women with excessive pre-pregnancy weight (PEW) and normal pre-pregnancy weight (PNW) who underwent follow-up in the private healthcare system during the third trimester of pregnancy.

METHODS

Fifty pregnant women were evaluated from August 2017 to February 2018 and divided into two groups: women with PEW (n = 25); and those with PNW (n = 25). Their weight and body mass index (BMI), periodontal disease status, stimulated salivary flow, and systemic condition were evaluated. Statistical analyses were conducted using t-test, Mann-Whitney test, chi-square test and binary logistic regression (P < 0.05).

RESULTS

The groups did not differ in age, educational level or monthly household income (P > 0.05). The PEW group had a higher frequency of arterial hypertension (P = 0.019) and excessive weight gain during gestation (P = 0.010), sought dental services less frequently, and had increased severity of periodontitis (P < 0.0001). Both groups presented low salivary flow, with no intergroup difference. In the final binary logistic regression models, high maternal pre-pregnancy BMI was a significant predictor of arterial hypertension and periodontitis during the third trimester of gestation; maternal excessive weight gain was also a significant predictor of periodontitis during pregnancy.

CONCLUSION

Women with PEW who underwent follow-up in a private healthcare system had a higher prevalence of arterial hypertension and worse periodontal status during the third trimester of pregnancy as compared to women with normal weight.

Systemic and periodontal conditions of overweight/obese patients during pregnancy and after delivery: a prospective cohort

OBJECTIVE

To evaluate the systemic and periodontal conditions, as well as the determinants of health in pregnant women with and without obesity/overweight during the second and third trimesters of pregnancy and after delivery.

MATERIALS AND METHODS

In the second trimester (T1), 93 pregnant women were divided into two groups with either excessive weight (G1, n = 53) or normal weight (G2, n = 40) and subsequently examined them in the third trimester of pregnancy (T2) and at least 2 months after delivery (T3). The following variables were analyzed: (a) systemic impairments during pregnancy-arterial hypertension (AH) and gestational diabetes mellitus (GDM); (b) oral hygiene behavior; (c) periodontal conditions; (d) anthropometric data and systemic health condition after pregnancy. The Mann-Whitney test, chi-squared test, ANOVA, and binary logistic regression were adopted (p < 0.05).

RESULTS

G1 showed higher frequency of GDM and AH in T1 and T2, respectively (p = 0.047; p = 0.004). Both groups had worse oral hygiene behaviors after delivery. A higher frequency of periodontitis was found in all periods for G1 (p < 0.05). G2 showed improvement of all periodontal parameters after delivery, whereas G1 showed no difference regarding these parameters between time periods.

CONCLUSION

Pregnant women with excessive weight presented worse systemic and periodontal conditions during pregnancy and after delivery.

CLINICAL RELEVANCE

Low socioeconomic level and overweight/obesity were significant predictors of periodontitis during pregnancy and after delivery.

Relationship Among Mothers' Glycemic Level, Periodontitis, and Birth Weight

BACKGROUND

The aim of this study is to determine the influence of glycemic level on the relationship between periodontitis and low birth weight (LBW).

METHODS

A case-control study was conducted with 372 females divided into cases (109 mothers of newborns with birth weight < 2,500 g) and controls (263 mothers of newborns with birth weight ≥ 2,500 g). The birth weight of children was obtained from medical records, whereas information on sociodemographic, lifestyle, and health characteristics of the participants was obtained through an interview. Glycated hemoglobin (HbA1c) levels were measured, and probing depth, clinical attachment levels, and bleeding on probing were used to determine the periodontal status. Results were analyzed using logistic regression.

RESULTS

The likelihood of having children with LBW among the mothers with periodontitis was six times greater than that observed among mothers without periodontitis (adjusted odds ratio [OR adjusted] = 6.02, 95% confidence interval [CI] = 2.47 to 15.17), even after adjustment. There was also a strong, statistically significant relationship between periodontitis and LBW in both the normal glycemic-level group (HbA1c levels < 5.6%, unadjusted odds ratio [OR unadjusted] = 8.30, 95% CI = 3.56 to 19.35) and the high glycemic-level group (HbA1c levels ≥ 5.6% and < 6.5%, OR unadjusted = 5.73, 95% CI = 1.75 to 18.70). After adjustment for confounders, the magnitude of the association continued to be strong in the normal glycemic-level group (OR adjusted = 7.59, 95% CI = 2.7 to 24.28), an increase of 25% when compared to the main association measurement. In those with high glycemic levels (OR adjusted = 4.03, 95% CI = 0.81 to 19.96), the OR decreased almost 50%, and the association lost statistical significance.

CONCLUSION

Periodontitis and glycemic levels appeared to have opposing influences on birth weight, with periodontitis being associated with LBW and the magnitude of the association being altered depending on maternal blood glucose level.

Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis

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.