Pregnant women with periodontal disease may be at an increased risk of developing gestational diabetes even if they don't smoke or drink, according to an ongoing study at New York University.
Results of the study were presented last month at the International Association for Dental Research (IADR) meeting in Miami.
Previous research has shown that pregnant women with periodontal disease are more likely to develop gestational diabetes than pregnant women with healthy gums (Journal of Dental Research, April 2008, Vol. 87, pp. 328-333).
"Periodontal disease increases the levels of inflammatory mediators such as TNFa [tissue necrosis factor-alpha] and IL_6 [interleukin-6]. These molecules are known insulin antagonists, meaning they will compete for the insulin receptor on cell membrane," said study author Ananda Dasanayake, B.D.S., a professor of epidemiology and health promotion at New York University College of Dentistry, in an interview with DrBicuspid.com. "If these levels are high in the pregnant woman, perhaps as a result of her gum disease, they can bind to the insulin receptor on the cell membrane and even if she has enough insulin, she will now not be able to allow glucose to be transported in to the cell. This can result in gestational diabetes."
This ongoing study, which is expected to be complete by June, was conducted in collaboration with the faculty of dental sciences at the University of Peradeniya in Sri Lanka. It included 190 pregnant women in Sri Lanka who did not smoke, drink, or use illicit drugs. In fact, one of the study's unique features is that it is only including nonsmokers.
"Smoking is a major confounder in studies looking at periodontal disease and pregnancy-related events," Dr. Dasanayake explained.
Seventy percent of the sample population had not seen a dentist in the last two years, and 36% self-reported having periodontal disease. The mean age of the subjects was 28.1 years.
Researchers calculated the population's mean plaque, pocket depth, bleeding on probing, and clinical attachment loss levels. The women were also given a glucose challenge test, which is used specifically to screen for gestational diabetes.
The researchers found a positive and significant correlation between the sample population's average bleeding on probing scores and glucose challenge test values.
"As the study is ongoing, it is still too early to draw meaningful conclusions. However, one-third of this nonsmoking, nonalcohol- and nonillicit drug-using Sri Lankan women who are around 30 years of age have self-reported 'gum disease,' but their actual average clinical attachment loss was less than 1 mm," the authors noted. "Whether that amount of clinical periodontal disease will actually increase the risk of GDM [gestational diabetes mellitus] remains to be evaluated upon completion of the study. Positive and significant correlation between average bleeding on probing scores and GCT [glucose challenge test] values lend credibility to the proposed association."
Dr. Dasanayake confirmed that this study is one of many that highlights the oral systemic link, and suggested dentists use this evidence to encourage pregnant women to get regular dental checkups.
"It is prudent to advise pregnant women to seek necessary dental care during pregnancy," Dr. Dasanayake concluded. "Periodontal treatment during pregnancy has been shown to be safe and effective."
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