Association between periodontal disease during pregnancy and gestational diabetes mellitus: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHI Pan ¹ , DANG Xiaohe ¹ , CUI Feipeng ² , BIAN Xinyi ¹ , KANG Qi ¹ , ZHA Ying ¹ , WANG Jingyu ¹ ,  ZENG Wanjiang ¹

1. Department of Obstetrics and Gynecology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, P. R. China;
2. School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, P. R. China;

Corresponding author：

ZENG Wanjiang, Email: wjzeng@tjh.tjmu.edu.cn

Keywords：

Periodontal disease; Gestational diabetes mellitus; Meta-analysis; Observational study

DOI：

10.7507/1672-2531.202112033

Video：

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Objective To systematically review the association between periodontal disease during pregnancy and the risk of gestational diabetes mellitus (GDM). Methods PubMed, Web of Science, CBM and CNKI databases were electronically searched to collect studies on periodontal disease and GDM from inception to October 23, 2021. Two researchers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 11 studies were included, involving 2 910 pregnant women. The results of meta-analysis showed that pregnant women with periodontal disease during pregnancy reported more GDM than normal pregnant women (OR=1.81, 95%CI 1.31 to 2.50, P=0.000 3). Conclusion The current evidence suggests that there is a positive association between periodontal disease during pregnancy and the risk of GDM. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： ZHI Pan, DANG Xiaohe, CUI Feipeng, BIAN Xinyi, KANG Qi, ZHA Ying, WANG Jingyu, ZENG Wanjiang. Association between periodontal disease during pregnancy and gestational diabetes mellitus: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(5): 544-549. doi: 10.7507/1672-2531.202112033 Copy

1.	Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol, 2021, 21(7): 426-440.
2.	Durnwald C. Gestational diabetes: linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome. Semin Perinatol, 2015, 39(4): 254-258.
3.	Graziani F, Gennai S, Solini A, et al. 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, 2018, 45(2): 167-187.
4.	Atègbo JM, Grissa O, Yessoufou A, et al. Modulation of adipokines and cytokines in gestational diabetes and macrosomia. J Clin Endocrinol Metab, 2006, 91(10): 4137-4143.
5.	McIntyre HD, Catalano P, Zhang C, et al. Gestational diabetes mellitus. Nat Rev Dis Primers, 2019, 5(1): 47.
6.	Schliefsteiner C, Peinhaupt M, Kopp S, et al. Human placental hofbauer cells maintain an anti-inflammatory M2 phenotype despite the presence of gestational diabetes mellitus. Front Immunol, 2017, 8: 888.
7.	Sheu A, Chan Y, Ferguson A, et al. A proinflammatory CD4 + T cell phenotype in gestational diabetes mellitus. Diabetologia, 2018, 61(7): 1633-1643.
8.	Syngelaki A, Visser GH, Krithinakis K, et al. First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation. Metabolism, 2016, 65(3): 131-137.
9.	Xiong X, Elkind-Hirsch KE, Vastardis S, et al. Periodontal disease is associated with gestational diabetes mellitus: a case-control study. J Periodontol, 2009, 80(11): 1742-1749.
10.	Nasr AAM, Mustafa FA, Nasr MG, et al. Periodontal diseases and adverse pregnancy outcomes: is there a relation. J Am Sci, 2012, 8(9): 737-744.
11.	Esteves Lima RP, Miranda Cota LO, Costa FO. Association between periodontitis and gestational diabetes mellitus: a case-control study. J Periodontol, 2013, 84(9): 1257-1265.
12.	Chokwiriyachit A, Dasanayake AP, Suwannarong W, et al. Periodontitis and gestational diabetes mellitus in non-smoking females. J Periodontol, 2013, 84(7): 857-862.
13.	Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, et al. Association between periodontitis and gestational diabetes mellitus: systematic review and meta-analysis. J Periodontol, 2016, 87(1): 48-57.
14.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
16.	Kumar A, Sharma DS, Verma M, et al. Association between periodontal disease and gestational diabetes mellitus-a prospective cohort study. J Clin Periodontol, 2018, 45(8): 920-931.
17.	Kalra M, Tangade P, Punia H, et al. Assessment of two-way relationship between periodontal disease and gestational diabetes mellitus: a case-control study. Indian J Dent Res, 2016, 27(4): 392-396.
18.	刘芬, 周志斐, 米阳, 等. 非吸烟妇女牙周炎和妊娠期糖尿病关系研究. 蚌埠医学院学报, 2021, 46(2): 179-182.
19.	Habib FA. Evaluation of periodontal status among Saudi females with gestational diabetes and its relation to glucose and lipid homeostasis in ohud hospital, Al madina Al-munwarrah. Int J Health Sci (Qassim). 2009, 3(2): 143-154.
20.	Gümüş P, Özçaka Ö, Ceyhan-Öztürk B, et al. Evaluation of biochemical parameters and local and systemic levels of osteoactive and B-cell stimulatory factors in gestational diabetes in the presence or absence of gingivitis. J Periodontol, 2015, 86(3): 387-397.
21.	Dasanayake AP, Chhun N, Tanner AC, et al. Periodontal pathogens and gestational diabetes mellitus. J Dent Res, 2008, 87(4): 328-333.
22.	Bullon P, Jaramillo R, Santos-Garcia R, et al. Relation of periodontitis and metabolic syndrome with gestational glucose metabolism disorder. J Periodontol, 2014, 85(2): e1-e8.
23.	Lao TT, Ho LF, Chan BC, et al. Maternal age and prevalence of gestational diabetes mellitus. Diabetes Care, 2006, 29(4): 948-949.
24.	Okosun IS, Chandra KM, Boev A, et al. Abdominal adiposity in U. S. adults: prevalence and trends, 1960-2000. Prev Med, 2004, 39(1): 197-206.
25.	Ornoy A, Becker M, Weinstein-Fudim L, et al. Diabetes during pregnancy: a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring: a clinical review. Int J Mol Sci, 2021, 22(6): 2965.
26.	Mirabelli M, Chiefari E, Tocci V, et al. Gestational diabetes: implications for fetal growth, intervention timing, and treatment options. Curr Opin Pharmacol, 2021, 60: 1-10.
27.	Lorenzo PI, Martín-Montalvo A, Cobo Vuilleumier N, et al. Molecular modelling of islet β-cell adaptation to inflammation in pregnancy and gestational diabetes mellitus. Int J Mol Sci, 2019, 20(24): 6171.
28.	Hegde R, Awan KH. Effects of periodontal disease on systemic health. Dis Mon, 2019, 65(6): 185-192.
29.	Bi WG, Emami E, Luo ZC, et al. Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 2021, 34(19): 3259-3268.

1. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol, 2021, 21(7): 426-440.
2. Durnwald C. Gestational diabetes: linking epidemiology, excessive gestational weight gain, adverse pregnancy outcomes, and future metabolic syndrome. Semin Perinatol, 2015, 39(4): 254-258.
3. Graziani F, Gennai S, Solini A, et al. 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, 2018, 45(2): 167-187.
4. Atègbo JM, Grissa O, Yessoufou A, et al. Modulation of adipokines and cytokines in gestational diabetes and macrosomia. J Clin Endocrinol Metab, 2006, 91(10): 4137-4143.
5. McIntyre HD, Catalano P, Zhang C, et al. Gestational diabetes mellitus. Nat Rev Dis Primers, 2019, 5(1): 47.
6. Schliefsteiner C, Peinhaupt M, Kopp S, et al. Human placental hofbauer cells maintain an anti-inflammatory M2 phenotype despite the presence of gestational diabetes mellitus. Front Immunol, 2017, 8: 888.
7. Sheu A, Chan Y, Ferguson A, et al. A proinflammatory CD4 + T cell phenotype in gestational diabetes mellitus. Diabetologia, 2018, 61(7): 1633-1643.
8. Syngelaki A, Visser GH, Krithinakis K, et al. First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation. Metabolism, 2016, 65(3): 131-137.
9. Xiong X, Elkind-Hirsch KE, Vastardis S, et al. Periodontal disease is associated with gestational diabetes mellitus: a case-control study. J Periodontol, 2009, 80(11): 1742-1749.
10. Nasr AAM, Mustafa FA, Nasr MG, et al. Periodontal diseases and adverse pregnancy outcomes: is there a relation. J Am Sci, 2012, 8(9): 737-744.
11. Esteves Lima RP, Miranda Cota LO, Costa FO. Association between periodontitis and gestational diabetes mellitus: a case-control study. J Periodontol, 2013, 84(9): 1257-1265.
12. Chokwiriyachit A, Dasanayake AP, Suwannarong W, et al. Periodontitis and gestational diabetes mellitus in non-smoking females. J Periodontol, 2013, 84(7): 857-862.
13. Esteves Lima RP, Cyrino RM, de Carvalho Dutra B, et al. Association between periodontitis and gestational diabetes mellitus: systematic review and meta-analysis. J Periodontol, 2016, 87(1): 48-57.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
16. Kumar A, Sharma DS, Verma M, et al. Association between periodontal disease and gestational diabetes mellitus-a prospective cohort study. J Clin Periodontol, 2018, 45(8): 920-931.
17. Kalra M, Tangade P, Punia H, et al. Assessment of two-way relationship between periodontal disease and gestational diabetes mellitus: a case-control study. Indian J Dent Res, 2016, 27(4): 392-396.
18. 刘芬, 周志斐, 米阳, 等. 非吸烟妇女牙周炎和妊娠期糖尿病关系研究. 蚌埠医学院学报, 2021, 46(2): 179-182.
19. Habib FA. Evaluation of periodontal status among Saudi females with gestational diabetes and its relation to glucose and lipid homeostasis in ohud hospital, Al madina Al-munwarrah. Int J Health Sci (Qassim). 2009, 3(2): 143-154.
20. Gümüş P, Özçaka Ö, Ceyhan-Öztürk B, et al. Evaluation of biochemical parameters and local and systemic levels of osteoactive and B-cell stimulatory factors in gestational diabetes in the presence or absence of gingivitis. J Periodontol, 2015, 86(3): 387-397.
21. Dasanayake AP, Chhun N, Tanner AC, et al. Periodontal pathogens and gestational diabetes mellitus. J Dent Res, 2008, 87(4): 328-333.
22. Bullon P, Jaramillo R, Santos-Garcia R, et al. Relation of periodontitis and metabolic syndrome with gestational glucose metabolism disorder. J Periodontol, 2014, 85(2): e1-e8.
23. Lao TT, Ho LF, Chan BC, et al. Maternal age and prevalence of gestational diabetes mellitus. Diabetes Care, 2006, 29(4): 948-949.
24. Okosun IS, Chandra KM, Boev A, et al. Abdominal adiposity in U. S. adults: prevalence and trends, 1960-2000. Prev Med, 2004, 39(1): 197-206.
25. Ornoy A, Becker M, Weinstein-Fudim L, et al. Diabetes during pregnancy: a maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring: a clinical review. Int J Mol Sci, 2021, 22(6): 2965.
26. Mirabelli M, Chiefari E, Tocci V, et al. Gestational diabetes: implications for fetal growth, intervention timing, and treatment options. Curr Opin Pharmacol, 2021, 60: 1-10.
27. Lorenzo PI, Martín-Montalvo A, Cobo Vuilleumier N, et al. Molecular modelling of islet β-cell adaptation to inflammation in pregnancy and gestational diabetes mellitus. Int J Mol Sci, 2019, 20(24): 6171.
28. Hegde R, Awan KH. Effects of periodontal disease on systemic health. Dis Mon, 2019, 65(6): 185-192.
29. Bi WG, Emami E, Luo ZC, et al. Effect of periodontal treatment in pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 2021, 34(19): 3259-3268.

Chinese Journal of Evidence-Based Medicine

Association between periodontal disease during pregnancy and gestational diabetes mellitus: a meta-analysis

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