Relation of Periodontitis and Metabolic Syndrome With Gestational Glucose Metabolism Disorder

• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 2, 2014, págs. 1-8
• Idioma: inglés
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• Resumen

  • Background: Gestational diabetes mellitus (GDM) and metabolic syndrome have been related to periodontitis. This study�s objective is to establish the relationship between them in pregnant women affected by gestational glucose metabolism disorder.

    Methods: In 188 pregnant women with positive O�Sullivan test (POT) results, an oral glucose tolerance test (OGTT) was performed to diagnose GDM. The mother�s periodontal parameters, age, prepregnancy weight and height and body mass index (BMI), blood pressure, gestational age, and birth weight were recorded at 24 to 28 weeks of pregnancy, as well as levels of glucose, C-reactive protein, triglycerides, glycated hemoglobin (HbA1c), and total, low-density lipoprotein, high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL) cholesterol levels.

    Results: Prepregnancy weight, prepregnancy BMI, systolic and diastolic blood pressure, VLDL cholesterol, and glucose parameters were higher in GDM compared with POT (P <0.05). VLDL cholesterol, triglycerides, and 2-hour OGTT were higher in patients with periodontitis than in patients without periodontitis (P <0.05). HbA1c, triglycerides, and 1- and 2-hour OGTT were positively related with probing depth and clinical attachment level; blood glucose was related only to bleeding on probing (P <0.05). HbA1c, basal OGTT, and 1- and 2-hour OGTT were positively related to prepregnancy BMI and blood pressure; HDL cholesterol was negatively related to prepregnancy BMI; C-reactive protein was positively related to prepregnancy BMI and diastolic blood pressure (P <0.05).

    Conclusion: These data support the relationships among periodontal disease and some biochemical parameters such as lipid and glucose data in pregnancy, and also among metabolic syndrome and biochemical parameters.

    Periodontitis is a chronic infectious disease of the supporting tissues of teeth, with multiple related factors.1 In recent years, interest has grown regarding the relationship with other systemic conditions to identify some new aspects to improve diagnostic tools and treatment outcomes.2 The bidirectional interrelationship between diabetes mellitus (DM) and periodontal disease is one of the main issues.3 The term DM describes a group of disorders characterized by elevated levels of glucose in the blood and abnormalities of carbohydrate, fat, and protein metabolism. Gestational diabetes mellitus (GDM) is defined as a type of DM first diagnosed during pregnancy.4 Incidence of GDM varies from 2% to 14% globally and is increasing.5 It is associated with the risk of perinatal morbidity and a later development of pathology in offspring and mothers. Borderline GDM has been linked with pathogenesis in the offspring of patients who are overweight and have metabolic syndrome (MeS).6 MeS consists of a combination of impaired glucose regulation, abdominal obesity, dyslipidemia, and high blood pressure.7 It is estimated that approximately one fourth of the world�s adult population is affected by MeS.8 It is generally accepted that the origin is a proinflammatory state derived from excessive calorie intake and overnutrition and other chronic inflammatory diseases. Oxidative stress has been proposed as a potential common link to explain relationships among each component of MeS and periodontitis.9 Intrauterine exposure to GDM has been associated with a small increase in adiposity at age 3, which may mediate the higher blood pressure in these children.10 MeS is a risk factor for cardiovascular disease (CVD) and for DM. Women with GDM have a markedly elevated risk (adjusted hazard ratio: 1.71) for CVD that manifests 11 years after pregnancy.11 Furthermore, population-based administrative data have shown that, by 12 years postpartum, even women with mildly abnormal antepartum glucose tolerance have an increased risk of CVD, lower than that associated with GDM but significantly higher than that of women who maintain normal glucose tolerance in pregnancy.12 Because CVD represents the clinical manifestation of a chronic pathologic process (atherosclerosis) that develops during decades, the risk factors contributing to the gradient of future cardiovascular risk associated with gestational dysglycemia are likely to be longstanding and present at the time of pregnancy or shortly thereafter. Furthermore, women with GDM are at increased risk of developing type 2 DM.13 A recent systematic review and meta-analysis concluded that women who have had GDM have at least a seven-fold increased risk of developing type 2 DM in the future compared with those who have had a normoglycemic pregnancy.14 Most pregnant women have problems with their gums, especially gingivitis.15 The association between periodontitis and GDM has been described.16 Pregnancy is often the first time the body experiences metabolic stress conditions or periodontal changes, and both diseases should be diagnosed. The associations among all the clinical and biochemical MeS parameters in gestational glucose metabolism disorder have not yet been completely studied. Therefore, the authors try to establish the relationships among these parameters and periodontal conditions in pregnant women affected by gestational glucose metabolism disorder.