The Additive Effects of Gestational Diabetes and Periodontal Disease on Adverse Pregnancy Outcomes.

Abstract

This dissertation assesses the potential interaction between periodontal disease and gestational diabetes on the risk for adverse pregnancy outcomes. As chronic disease increases among women of reproductive age, understanding how chronic conditions manifest during pregnancy is of emerging public health importance. Gestational diabetes and periodontal disease are conditions associated with increased risks for adverse pregnancy outcomes. Poor glycemic control in persons with diabetes worsens periodontal disease while periodontal disease complicates glycemic control. Evidence suggests this inter-relationship between diabetes and periodontal disease extends to gestational diabetes. The independent effects of gestational diabetes and periodontal disease on adverse pregnancy outcomes have been studied but their joint effects have not. Gestational diabetes and periodontal disease increase the risk for pre-eclampsia. Gestational diabetes increases the risk for fetal macrosomia while periodontal disease increases the risk for fetal growth restriction. These maternal and infant morbidities represent clinical indications for labor induction and cesarean delivery, procedures under significant scrutiny due to their rapid increase in prevalence over the past two decades. The analyses in this dissertation are based on matched cohort data from the Oral Infection: Impact on Gestational Diabetes study conducted at the University of Kentucky Maternal-Fetal Medicine clinic. The cohort consisted of pregnant women with gestational diabetes who were matched to pregnant women without gestational diabetes. Analyses focus on infant birthweight, pre-eclampsia and the use of obstetric intervention. Based on this study population, women with both gestational diabetes and periodontal disease had the greatest risk for pre-eclampsia and obstetric intervention compared to women with only one condition or neither condition. However, periodontal disease did not yield additional risk for higher infant birthweight beyond the risk conferred by gestational diabetes. The external validity of these results is limited due to the high-risk population served by the clinic. While gestational diabetes is a recognized clinical indication for high-risk pregnancies, periodontal disease can provide an additional high-risk marker. Clinical strategies that minimize the adverse impact of gestational diabetes and periodontal disease during pregnancy may reduce the prevalence of maternal morbidities and subsequent use of obstetric intervention.