IDF21-0173 Relationship between periodontal disease and gestational diabetes mellitus: A systematic review

Abstract

Background: The scientific evidence on the links between periodontal disease and diabetes was presented in a recent consensus report of a joint workshop by the International Diabetes Federation and the European Federation of Periodontology. For the specific case of gestational diabetes mellitus (GDM), this consensus report stated that there was still insufficient evidence of a link between the two conditions. Aim: The aim of this systematic review is to analyze the studies evaluating an association between periodontal disease and GDM. Method: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used as a guideline for the methodology of systematic reviews. A literature search was performed in January 2021 using the PubMed/MEDLINE database on articles published in the last ten years. The inclusion criteria were original clinical studies, systematic reviews or meta-analysis treating on the links between GDM and periodontal disease. A total of 16 articles have been included in a qualitative synthesis. Results: Among the 16 articles included we had 12 original studies (2 cross-sectionals, 4 case control, and 6 cohort or follow-up) and 4 systematic reviews (SR) or meta-analyses (MA). Four themes were explored: links between obesity and periodontal disease (one cross-sectional study, one cohort), links between gingivitis and GDM (two case-control studies), links between periodontitis and GDM (one cross-sectional, two case-control, two cohort studies and four SR/MA), consequences in post-partum in case of periodontal disease and GDM (three follow-up cohorts). Regarding the links between obesity and periodontal disease, both studies showed a significantly higher frequency of periodontitis for obese pregnant women and one of them find the same tendency for GDM. Regarding the links between gingivitis and GDM, both studies showed that women with GDM had more gingival inflammation and according to a study, those women presented more periodontopathogens in the oral flora and higher levels of inflammatory markers. Regarding the links between periodontitis and GDM three original studies found a significant association. Finally, regarding the post-partum consequences in patients with periodontal disease and GDM, one study found statistically significant results: C-Reactive Protein rise with glycaemia and therefore can increase the risk of developing Type 2 Diabetes Mellitus (T2DM). The included systematic-reviews and meta-analyses indicated that periodontal disease could affect glycemic control and complications of GDM and may even lead to the development of T2DM. However, larger-scale and longer-term studies are needed to confirm this. Discussion: Among the 16 studies included, size of samples was often small with cofounding factors such as age, smoking status, socio-economic level etc. In addition, many variations in diagnostic criteria depending on the country and the year of the study. Therefore, more studies with consensual criteria are necessary to evaluate the relationship between those two diseases. Multidisciplinary management could improve the care of women with periodontal disease and GDM or previous GDM to prevent the development of T2DM.