Associação entre periodontite e diabetes mellitus gestacional: estudo caso-controle

Abstract

Gestational Diabetes Mellitus (GDM) is a glucose intolerance with onset during pregnancy. Despite presenting well-established risk factors such as obesity, previous GDM, high maternal age and family history of diabetes, has been suggested the possibility of association of inflammatory and infectious processes in the pathogenesis of GDM. Thus, periodontitis may contribute to the systemic dissemination ofinflammatory mediators, microorganisms and bacterial products induce a systemic inflammatory process that can initiate and propagate a context of insulin resistance in the manifestation of the DMG. Few studies have reported the association between gestational diabetes mellitus (GDM) and periodontitis. The objective of this study was to analyze the association between periodontitis and DMG as well as to evaluate theinfluence of risk variables social, behavioral and biological characteristics associated with both diseases. The population of this case-control study comprised 360 women, 90 women with GDM and 270 women without diabetes. Social and demographic data of interest were collected using a structured questionnaire. Through the analysis of medical records were recorded gestational age, maternal weight, height, blood glucose and diagnosis of GDM. Clinical examination was completed with a record of bleeding on probing (BOP), probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined by the presence of four or more teeth with at least one site with PD . 4 mm 9 and CAL . 3 mm associated with BOP in the same place. The influence of variables of interest was tested by univariate analysis, multivariate logistic regression and multinomial. Women in the case group had significantly higher BMI, hypertension and high maternal age than women in the control group. The prevalence of periodontitis was high in the total sample, however no significant difference between groups. The diagnosis of periodontitis was performed in 40% in case group (GDM) and 46.3% in the control group. Additionally, there were no significant differences between cases and controls for BOP, percentage of sites with PD = 4 mm, 5-6 mm and > 7 mm. When the group was stratified by levels of glucose (96 and 105 mg / dl, 106-125 mg / dl and . 126 mg / dl) to analyze the prevalence and periodontal status was not significantly different between the groups in relation to all periodontal clinical parameters analyzed. There was a lack of statistically significant association between DMG and periodontitis (OR = 1.29, CI = 0.80 to 2.10) in logistic regression analysis and multinomial. In multivariate logistic regression model remained significant for the DMG variables maternal age (OR = 2.65, CI = 1.97 to 3.56, p <0.001), hypertension (OR = 3.16, CI = 1.35 - 7.42, p = 0.008) and BMI (OR = 1.99, CI = 1.41 to 2.81, p <0.001). A high prevalence of periodontitis was found in cases and controls, with no association between periodontitis and DMG. Increased maternal age and high BMI was significantly related to DMG. The limited number of studies of the association between periodontal disease and GDM and their conflicting results point to a need for additional studies on this association.