Mediating role of systemic inflammation on the association between periodontitis and gestational diabetes mellitus: a cross-sectional study.

Abstract

Objectives: This study aimed to explore the relationship between periodontitis and gestational diabetes mellitus (GDM) and to ascertain the role of systemic inflammation in mediating this association.

Methods: Data from 5,283 women of reproductive age ranging from 20 to 44 years were retrieved from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 2009-2014 cycles. The female participants were categorized into three groups: non-diabetes, DM, and GDM. Multivariate logistic and linear regression models were employed to assess the correlations between periodontal variables and diabetes status. Additionally, a mediation analysis was performed to explore the role of systemic inflammatory biomarkers.

Results: Compared to non-periodontitis, women with periodontitis have a 1.68 times higher risk of having GDM (OR = 1.68, 95% CI: 1.14-2.50). Clinical attachment level (CAL), the continuous periodontal parameter, also presented a significant association with GDM risk (OR = 1.50, 95% CI: 1.25-1.81 per 1-mm increase). Linear regression analyses further revealed that hemoglobin A1c (HbA1c) levels were positively associated with periodontitis (Beta = 0.19, SE = 0.06, p < 0.01) and CAL (Beta = 0.06, SE = 0.03, p < 0.001), respectively. The association between periodontitis and GDM risk was found to be mediated by white blood cell count (WBC), monocyte count, and monocyte-lymphocyte ratio (MLR), with mediation proportions of 5.02%, 5.88%, and 5.20%, respectively. Similar mediation effects were observed for the CAL-GDM association.

Conclusions: The present study indicated that periodontitis was associated with GDM among women of childbearing age, with systemic inflammation potentially serving as a partial mediator of this association.