Volume 85 • Number 7

Prepregnancy Obesity and Periodontitis Among Pregnant Females With and Without Gestational Diabetes Mellitus Yiqiong Xie,* Xu Xiong,* Karen E. Elkind-Hirsch,† Gabriella Pridjian,‡ Pooja Maney,§ Robert L. Delarosa,i and Pierre Buekens*

Background: This study explored whether there is an association between prepregnancy obesity and periodontitis among pregnant females. Methods: A retrospective cohort study was conducted by using data from a previous case-control study at Woman’s Hospital, Baton Rouge, Louisiana. One hundred fifty-nine pregnant females were recruited at their prenatal care visits. Periodontal status was assessed through dental examinations performed at an average of 31 weeks gestation. Periodontitis was defined as the presence of one or more sites exhibiting probing depth ‡4 mm or clinical attachment level ‡4 mm. A Poisson regression with robust error variance was used to estimate risk ratio (RR) and 95% confidence interval (CI). Results: Prepregnancy obesity was statistically significantly associated with periodontitis during pregnancy, with obese females at 1.7 times higher risk compared with under/normal-weight females (RR = 1.7, 95% CI = 1.2 to 2.3, P 50%, especially among economically disadvantaged females.5,7-10 Periodontal disease has been associated with an increased risk of systemic diseases, such as atherosclerotic cardiovascular disease, rheumatoid arthritis, and gestational diabetes mellitus (GDM).11-16 There has also been growing evidence of an association between periodontal disease and adverse pregnancy outcomes, such as preterm birth and low birth weight,8 although this is debated.17,18 Obesity is a major public health problem in both developed and developing countries. The most recent national data on obesity prevalence show that more than one third of adults (35.7%) were doi: 10.1902/jop.2013.130502

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Xie, Xiong, Elkind-Hirsch, et al.

J Periodontol • July 2014

obese in the United States in 2009 to 2010.19 Obesity has been recognized as a proinflammatory state.20 Studies have shown increases of acute-phase proteins, proinflammatory cytokines, and leukocyte counts in obese individuals, including tumor necrosis factor-a (TNF-a), interleukin-6, and C-reactive protein.21-26 Previous studies have found that obesity is a significant risk factor for a number of conditions, such as hypertension, coronary heart disease, type 2 diabetes, and osteoarthritis.27,28 Some studies have associated obesity with periodontal disease in both animals and human adult populations.29-31 In animal studies, one early investigation30 found that obese rats with periodontitis had higher level of alveolar bone loss than nonobese rats. In human studies, Saito et al.32 reported an association between obesity and periodontitis in a group of the Japanese population aged 20 to 59 years in 1998, and a follow-up study33 suggested that increased abdominal adiposity was an important factor. Saito34 then found that obesity was associated with low-threshold periodontitis in a group of Western European males aged >60 years. Other studies from Japan,35 Great Britain,36 and Brazil 37also found that obesity was associated with periodontitis. In the United States, studies based on National Health and Nutrition Examination Survey III (NHANES III) data also found a significant correlation between body mass index (BMI) and periodontal disease, especially among those aged 18 to 34 years.38-40 A meta-analysis reported a significant association between obesity and periodontal disease (fixed-effects summary odds ratio [OR] = 1.35; Shore-corrected 95% confidence interval [CI] = 1.23 to 1.47).29 However, the authors pointed out that most studies were cross-sectional in design, and thus there was an inability to distinguish the temporal ordering between obesity and periodontitis.29 Despite the studies conducted among the general population, a few studies have examined obesity and periodontal disease specifically among pregnant females. The objective of this study is to examine whether prepregnancy obesity is associated with periodontitis among pregnant females. MATERIALS AND METHODS A retrospective cohort study was conducted by using data from a previous case-control study that was designed to examine the association between periodontal disease and GDM.15 Pregnant females were enrolled during their prenatal visits at the obstetric clinic at Woman’s Hospital in Baton Rouge, Louisiana, from June 2007 to December 2008.15 Woman’s Hospital is a state-of-the-art tertiary medical center for females, delivering >8,700 babies each year. Pregnant females were asked to participate if they

met all of the following criteria: 1) completed a GDM screening at gestational age of 24 to 30 weeks; 2) were ‡18 years of age; 3) were English speaking; and 4) agreed to sign a consent form. Exclusion criteria included the following: 1) known pregestational type 1 or type 2 diabetes; 2) having not undergone laboratory screening for GDM; 3) having taken insulin and other antidiabetic drugs before this pregnancy; 4) having

Prepregnancy obesity and periodontitis among pregnant females with and without gestational diabetes mellitus.

This study explored whether there is an association between prepregnancy obesity and periodontitis among pregnant females...
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