The study drew a large cohort of 5,283 women in the age group of 20 to 44 years, drawn from NHANES III and NHANES 2009–2014 data sets. These subjects were categorized based on their diabetes status as non-diabetes, diabetes mellitus (DM), and gestational diabetes mellitus (GDM). Periodontal status of the participants was measured by both categorical diagnosis of periodontitis as well as continuous variables such as clinical attachment level (CAL).
Multivariate logistic regression analyses were utilized to compare the associations between periodontal measures and status of diabetes. Linear regression models were applied to examine associations with hemoglobin A1c (HbA1c). Mediation analysis was also used to evaluate if inflammatory biomarkers such as white blood cell count (WBC), monocyte count, and monocyte-lymphocyte ratio (MLR) were mediators of the relationship between periodontitis and GDM.
Key Findings
• Women with periodontitis had 1.68 times the risk of having GDM as women without periodontitis (OR = 1.68, 95% CI: 1.14–2.50).
• Increased clinical attachment level (CAL) was correlated with a 50% increased risk of GDM with every 1-mm increase (OR = 1.50, 95% CI: 1.25–1.81).
• HbA1c was positively correlated with both periodontitis (Beta = 0.19, SE = 0.06, p < 0.01) and CAL (Beta = 0.06, SE = 0.03, p < 0.001).
• White blood cell count mediated 5.02%
• Monocyte count mediated 5.88%
• Monocyte-lymphocyte ratio mediated 5.20%
The research concluded that periodontitis was highly related to gestational diabetes mellitus risk among women of childbearing age. Systemic inflammation, as indicated by heightened white blood cell count, monocyte count, and monocyte-lymphocyte ratio, seemed to partially mediate this relationship. The findings are in favor of incorporating periodontal screening in prenatal care to possibly eliminate the risk of GDM through early detection and intervention of oral inflammation.
Reference:
Cheng, J., Jiang, Q., Liu, Y. et al. Mediating role of systemic inflammation on the association between periodontitis and gestational diabetes mellitus: a cross-sectional study. BMC Oral Health 25, 1179 (2025).https://doi.org/10.1186/s12903-025-06541-x
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