Role of Periodontal Disease in Gestational Diabetes Mellitus (GDM)

Objectives: To systematically review the literature on the association between periodontal disease and Gestational Diabetes Mellitus (GDM) and to do a meta-analysis.
Methods: A systematic review of the literature was carried out. PubMed/Medline, Embase, DOSS, CINAHL, and Web of Science were searched using an algorithm created with the help of a librarian. PRISMA statement and the Cochrane Handbook guidelines were followed. Titles and abstracts were reviewed by three investigators (RT, ANP, and APD) using pre-specified inclusion and exclusion criteria. These included data-based human studies published in the last 20 years in English language and had GDM or a related variable as the outcome and periodontal disease parameters as independent variables. Selected manuscripts were reviewed and data were abstracted by two reviewers (RT & ANP) using the third (APD) as an adjudicator.
Results: The original search resulted in 232 articles and was later reduced to 8 studies. Four studies reported a statistically significantly higher prevalence of periodontal disease among GDM women compared to non-GDM women and one study showed a non-significant but lower prevalence of periodontal disease among GDM women. Another study showed no group differences in periodontal parameters but showed significantly higher levels of vaginal T. forsythia among GDM women. Two other studies showed significantly higher plaque and gingival indices among GDM women. When the appropriate studies (N=6) were pooled, periodontal disease prevalence among 431 GDM women was 33% compared to 12% among 8,984 non-GDM women. There was a significant heterogeneity among studies (I²=66%; p=0.01) and the M-H summary Odds Ratio based on the random effects model for the pooled estimate was 1.65 (95% Confidence Interval=1.1-2.6).
Conclusions: There appears to be an association between periodontal disease and GDM. Given the known bi-directional association between periodontal disease and Type II diabetes, the observed findings are biologically plausible but needs further confirmation.