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Periodontal disease as a potential risk factor for the development of diabetes in women with a prior history of gestational diabetes mellitus



Prof. Xu Xiong, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2022, New Orleans, LA 70112, USA. Tel.: 504-988-1379; Fax: 504-988-1568; e-mail: Xu Xiong, Yiqiong Xie, and Pierre Buekens are with the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine. Karen E. Elkind-Hirsch is with the Woman's Hospital. Robert Delarosa is with the American Academy Pediatric Dentistry. Pooja Maney is with the Department of Periodontics, Louisiana State University Health Sciences Center School of Dentistry. Gabriella Pridjian is with OB/GYN, Tulane University School of Medicine.



To examine if periodontal disease is associated with later development of impaired glucose metabolism in women with a recent history of gestational diabetes (GDM).


Women with (n = 19) and without (n = 20) a history of GDM were prospectively followed at 22 months postpartum. All subjects underwent: a) a 75-gram oral glucose tolerance test (OGTT); and b) an oral examination for measuring periodontal disease. Insulin sensitivity and pancreatic β-cell secretory capacity derived from fasting (HOMA-IR) and glucose-stimulated measures (SIOGTT and IGI/HOMA-IR) were determined. Periodontitis was defined as the presence of any site with a probing depth ≥4 mm or a clinical attachment loss ≥4 mm.


Compared to women without a history of GDM, prior GDM women had significantly higher fasting glucose and insulin concentrations, increased insulin resistance and decreased β-cell function. Although not statistically significant, prior GDM women had a higher prevalence of periodontal disease (42.1%) than women without a history of GDM (25.0%). Women with periodontal disease showed greater insulin resistance and lower β-cell function. Women with both prior GDM and periodontal disease had the most impaired glucose metabolism; the insulin secretion-sensitivity index was significantly lower in women with both prior GDM and periodontal disease (208.20 ± 2.60) than in women without prior GDM and periodontal disease (742.93 ± 1.78) (P < 0.05).


Women with prior GDM show reduced insulin sensitivity and inadequate β-cell secretory function at 22 months postpartum. Periodontal disease may contribute to their impaired glucose metabolism and future risk of developing diabetes.