Periodontitis and placental growth factor in oral fluids are early pregnancy predictors of gestational diabetes mellitus

Gestational Diabetes Mellitus (GDM) affects around 7-10% of all pregnancies. Early detection of predisposition to GDM is the first step in developing efficacious preventive treatment. The objective of the present study was to establish the utility of placental proteins presents in oral fluids (gingival crevicular fluid [GCF] and saliva), and periodontal disease status as early pregnancy predictors of GDM. A nested case control within a prospective cohort was conducted. Pregnant systemically healthy women, aged between 18 and 40 years at 11-14 weeks gestation were included. Samples of oral fluids were collected and a complete maternal/obstetric and periodontal history was obtained. The concentration of Placental Growth Factor (PlGF) and soluble Fms-like tyrosine kinase 1 (sFlt-1) were measured by ELISA assay in a nested case control sample of the prospective cohort. Multiple logistic regression models assessed the association. The evaluation of the diagnostic accuracy of the biomarkers was performed through ROC curves by calculating the area under the curve (AUC). There were recruited 212 pregnant women at 11-14 weeks of pregnancy, of these, 14 women (i.e. 6.6%) developed GDM, and displayed significant greater bleeding on probing (BOP) [p = 0.0003]; periodontal probing depth (PPD) [p = 0.0028]; clinical attachment level (CAL) [p = 0.0008] and periodontal inflamed surface area (PISA) [p = 0.0001]. Similarly, initial glycaemia and GCF-PlGF concentrations were significantly greater in women with GDM [p = 0.0012, and p = 0.0019, respectively]. When data were subjected to ROC curve analysis, the combination of initial glycaemia and GCF-PlGF concentration delivered an area under the ROC curve of 0.897. Multiple logistic regression analyses demonstrate an association between glycaemia [OR 1.21, 95% CI 1.06-1.38; p = 0.005] and GCF-PlGF concentrations in women who developed GDM [OR 1.68, CI 1.05-2.68 p = 0.03]. Within the limitations of the present study, the results support that first trimester maternal glycaemia combined with GCF-PlGF concentrations could be a surrogate biomarker for the future development of GDM in pre-symptomatic women. This article is protected by copyright. All rights reserved.