Skip to main content

Advertisement

SpringerLink
Log in

Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the relationship between obesity and periodontitis staging compared with periodontal healthy or gingivitis in pregnant women.

Materials and methods

An analytical cross-sectional study was conducted on pregnant women between 11 and 14 weeks of pregnancy. Sociodemographic, clinical, obstetric, and periodontal variables were studied. The exposure variable was obesity (body mass index [BMI] ≥ 30), and the primary outcome was periodontitis staging versus periodontal healthy/gingivitis. Data were analysed and estimated by multinomial logistic regression models.

Results

The present study screened 1086 pregnancies and analysed 972 women with a median age of 29 years; 36.8% were diagnosed as obese. 26.9% of patients were diagnosed as periodontal healthy or gingivitis, 5.5% with stage I periodontitis, 38.6% with stage II periodontitis, 24% with stage III periodontitis, and 5.1% with stage IV periodontitis. After identifying and adjusting for confounding variables (educational level and plaque index), obesity had a relative risk ratio (RRR) of 1.66 (95% CI: 1.05–2.64; p = 0.03) and 1.57 (95% CI: 1.09–2.27; p = 0.015) for stage III periodontitis compared to periodontal healthy/gingivitis and stage II periodontitis, respectively.

Conclusion

Besides the already known risk indicators for periodontitis (age, smoking, and educational level), our study suggests a relationship between obesity and periodontitis staging in pregnancy.

Clinical relevance

Obesity can alter host immune responses, leading to increased susceptibility to infections and overactive host immunity, which could influence the prevalence and severity of maternal periodontitis in pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data are available upon request.

Notes

  1. Stata Statistical Software: Release 16.1, StataCorp, LLC, College Station, TX

References

  1. World Health Organization (2021) Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed April 7th 2022

  2. Chooi YC, Ding C, Magkos F (2019) The epidemiology of obesity. Metabolism 92:6–10. https://doi.org/10.1016/j.metabol.2018.09.005

    Article  PubMed  Google Scholar 

  3. Teufel F, Seiglie JA, Geldsetzer P et al (2021) Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adults. The Lancet 398:238–248. https://doi.org/10.1016/S0140-6736(21)00844-8

    Article  Google Scholar 

  4. Wozniak SE, Gee LL, Wachtel MS, Frezza EE (2009) Adipose tissue: the new endocrine organ? A review article. Dig Dis Sci 54:1847–1856. https://doi.org/10.1007/s10620-008-0585-3

    Article  PubMed  Google Scholar 

  5. Catalano PM, Shankar K (2017) Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 356:j1. https://doi.org/10.1136/bmj.j1

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mamun AA, Mannan M, O’Callaghan MJ et al (2013) Association between gestational weight gain and postpartum diabetes: evidence from a community based large cohort study. PLOS One 8:e75679. https://doi.org/10.1371/journal.pone.0075679

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ludwig DS, Rouse HL, Currie J (2013) Pregnancy weight gain and childhood body weight: a within-family comparison. PLoS Med 10:e1001521. https://doi.org/10.1371/journal.pmed.1001521

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hidayat K, Zou S-Y, Shi B-M (2019) The influence of maternal body mass index, maternal diabetes mellitus, and maternal smoking during pregnancy on the risk of childhood-onset type 1 diabetes mellitus in the offspring: systematic review and meta-analysis of observational studies. Obes Rev 20:1106–1120. https://doi.org/10.1111/obr.12858

    Article  PubMed  Google Scholar 

  9. Kassebaum NJ, Smith AGC, Bernabé E et al (2017) Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 96:380–387. https://doi.org/10.1177/0022034517693566

    Article  PubMed  Google Scholar 

  10. Monsarrat P, Blaizot A, Kémoun P et al (2016) Clinical research activity in periodontal medicine: a systematic mapping of trial registers. J Clin Periodontol 43:390–400. https://doi.org/10.1111/jcpe.12534

    Article  PubMed  Google Scholar 

  11. Marcenes W, Kassebaum NJ, Bernabé E et al (2013) Global burden of oral conditions in 1990–2010: a systematic analysis. J Dent Res 92:592–597. https://doi.org/10.1177/0022034513490168

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kassebaum NJ, Bernabé E, Dahiya M et al (2014) Global burden of severe periodontitis in 1990–2010: a systematic review and meta-regression. J Dent Res 93:1045–1053. https://doi.org/10.1177/0022034514552491

    Article  PubMed  PubMed Central  Google Scholar 

  13. Figuero E, Han YW (2000) Furuichi Y (2020) Periodontal diseases and adverse pregnancy outcomes: mechanisms. Periodontol 83:175–188. https://doi.org/10.1111/prd.12295

    Article  Google Scholar 

  14. Raju K, Berens L (2021) Periodontology and pregnancy: an overview of biomedical and epidemiological evidence. Periodontol 2000 87(1):132–142. https://doi.org/10.1111/prd.12394

    Article  PubMed  Google Scholar 

  15. Balan P, Chong YS, Umashankar S et al (2018) Keystone species in pregnancy gingivitis: a snapshot of oral microbiome during pregnancy and postpartum period. Front Microbiol 9:2360. https://doi.org/10.3389/fmicb.2018.02360

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tilakaratne A, Soory M, Ranasinghe AW et al (2000) Periodontal disease status during pregnancy and 3 months post-partum, in a rural population of Sri-Lankan women. J Clin Periodontol 27:787–792. https://doi.org/10.1034/j.1600-051x.2000.027010787.x

    Article  PubMed  Google Scholar 

  17. Wu M, Chen S-W, Jiang S-Y (2015) Relationship between gingival inflammation and pregnancy. Mediators Inflamm 2015:623427. https://doi.org/10.1155/2015/623427

    Article  PubMed  PubMed Central  Google Scholar 

  18. Teles F, Wang Y, Hajishengallis G, Hasturk H, Marchesan JT (2021) Impact of systemic factors in shaping the periodontal microbiome. Periodontol 2000 85(1):126–160. https://doi.org/10.1111/prd.12356

    Article  PubMed  Google Scholar 

  19. Ye C, Kapila Y (2021) Oral microbiome shifts during pregnancy and adverse pregnancy outcomes: hormonal and Immunologic changes at play. Periodontol 2000 87:276–281. https://doi.org/10.1111/prd.12386

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bobetsis YA, Graziani F, Gürsoy M, Madianos PN (2020) Periodontal disease and adverse pregnancy outcomes. Periodontol 2000 83:154–174. https://doi.org/10.1111/prd.12294

    Article  PubMed  Google Scholar 

  21. Chokwiriyachit A, Dasanayake AP, Suwannarong W et al (2013) Periodontitis and gestational diabetes mellitus in non-smoking females. J Periodontol 84:857–862. https://doi.org/10.1902/jop.2012.120344

    Article  PubMed  Google Scholar 

  22. Xiong X, Elkind-Hirsch KE, Vastardis S et al (2009) Periodontal disease is associated with gestational diabetes mellitus: a case-control study. J Periodontol 80:1742–1749. https://doi.org/10.1902/jop.2009.090250

    Article  PubMed  PubMed Central  Google Scholar 

  23. Abariga SA, Whitcomb BW (2016) Periodontitis and gestational diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Pregnancy Childbirth 16:344. https://doi.org/10.1186/s12884-016-1145-z

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bobetsis YA, Ide M, Gürsoy M, Madianos PN (2023). Periodontal diseases and adverse pregnancy outcomes. Present and future. Periodontol 2000 1-28. https://doi.org/10.1111/prd.12486

  25. Huang EY, Devkota S, Moscoso D et al (2013) The role of diet in triggering human inflammatory disorders in the modern age. Microbes Infect 15:765–774. https://doi.org/10.1016/j.micinf.2013.07.004

    Article  PubMed  Google Scholar 

  26. Kershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2548–2556. https://doi.org/10.1210/jc.2004-0395

    Article  PubMed  Google Scholar 

  27. Buduneli N, Bıyıkoğlu B, Ilgenli T et al (2014) Is obesity a possible modifier of periodontal disease as a chronic inflammatory process? A case-control study. J Periodontal Res 49:465–471. https://doi.org/10.1111/jre.12125

    Article  PubMed  Google Scholar 

  28. Dalla Vecchia CF, Susin C, Rösing CK et al (2005) Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 76:1721–1728. https://doi.org/10.1902/jop.2005.76.10.1721

    Article  PubMed  Google Scholar 

  29. Genco RJ, Grossi SG, Ho A et al (2005) A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 76:2075–2084. https://doi.org/10.1902/jop.2005.76.11-S.2075

    Article  PubMed  Google Scholar 

  30. Saito T, Shimazaki Y, Koga T et al (2001) Relationship between upper body obesity and periodontitis. J Dent Res 80:1631–1636. https://doi.org/10.1177/00220345010800070701

    Article  PubMed  Google Scholar 

  31. Saxlin T, Ylöstalo P, Suominen-Taipale L et al (2011) Association between periodontal infection and obesity: results of the Health 2000 Survey. J Clin Periodontol 38:236–242. https://doi.org/10.1111/j.1600-051X.2010.01677.x

    Article  PubMed  Google Scholar 

  32. Suvan J, D’Aiuto F, Moles DR et al (2011) Association between overweight/obesity and periodontitis in adults. A systematic review. Obes Rev 12:e381-404. https://doi.org/10.1111/j.1467-789X.2010.00808.x

    Article  PubMed  Google Scholar 

  33. Suvan JE, Finer N, D’Aiuto F (2018) Periodontal complications with obesity. Periodontol 2000 78:98–128. https://doi.org/10.1111/prd.12239

    Article  PubMed  Google Scholar 

  34. Tegelberg P, Saxlin T, Tervonen T et al (2021) Association of long-term obesity and weight gain with periodontal pocketing: results of the Northern Finland Birth Cohort 1966 study. J Clin Periodontol 48:1344–1355. https://doi.org/10.1111/jcpe.13524

    Article  PubMed  Google Scholar 

  35. Pamuk F, Kantarci A (2022) Inflammation as a link between periodontal disease and obesity. Periodontol 2000 90:186–196. https://doi.org/10.1111/prd.12457

    Article  PubMed  Google Scholar 

  36. Carneiro DO, Gomes-Filho IS, da Cruz SS et al (2022) Obesity in young women is positively associated with periodontitis. Clin Oral Invest 26:6139–6149. https://doi.org/10.1007/s00784-022-04563-1

    Article  Google Scholar 

  37. Çetin MB, Sezgin Y, Önder C, Bakirarar B (2022) The relationship between body mass index and stage/grade of periodontitis: a retrospective study. Clin Oral Invest 26:1937–1945. https://doi.org/10.1007/s00784-021-04172-4

    Article  Google Scholar 

  38. Costa SA, Nascimento GG, Colins PMG et al (2022) Investigating oral and systemic pathways between unhealthy and healthy dietary patterns to periodontitis in adolescents: a population-based study. J Clin Periodontol 49:580–590. https://doi.org/10.1111/jcpe.13625

    Article  PubMed  Google Scholar 

  39. Caracho RA, Foratori-Junior GA, dos Santos Fusco N et al (2020) Systemic conditions and oral health-related quality of life of pregnant women of normal weight and who are overweight. Int Dental J 70:287–295. https://doi.org/10.1111/idj.12547

    Article  Google Scholar 

  40. Chapper A, Munch A, Schermann C et al (2005) Obesity and periodontal disease in diabetic pregnant women. Braz Oral Res 19:83–87. https://doi.org/10.1590/s1806-83242005000200002

    Article  PubMed  Google Scholar 

  41. Foratori-Junior GA, da Silva BM, da Silva Pinto AC et al (2020) Systemic and periodontal conditions of overweight/obese patients during pregnancy and after delivery: a prospective cohort. Clin Oral Investig 24:157–165. https://doi.org/10.1007/s00784-019-02932-x

    Article  PubMed  Google Scholar 

  42. Lee H-J, Ha J-E, Bae K-H (2016) Synergistic effect of maternal obesity and periodontitis on preterm birth in women with preeclampsia: a prospective study. J Clin Periodontol 43:646–651. https://doi.org/10.1111/jcpe.12574

    Article  PubMed  Google Scholar 

  43. Lee H-J, Jun J-K, Lee S-M et al (2014) Association between obesity and periodontitis in pregnant females. J Periodontol 85:e224-231. https://doi.org/10.1902/jop.2014.130578

    Article  PubMed  Google Scholar 

  44. Piscoya MDB de V, Ximenes RA de A, Silva GM da et al (2012) Periodontitis-associated risk factors in pregnant women. Clinics (Sao Paulo) 67:27–33.https://doi.org/10.6061/clinics/2012(01)05

  45. Xie Y, Xiong X, Elkind-Hirsch KE et al (2014) Prepregnancy obesity and periodontitis among pregnant females with and without gestational diabetes mellitus. J Periodontol 85:890–898. https://doi.org/10.1902/jop.2013.130502

    Article  PubMed  Google Scholar 

  46. Eremenko M, Pink C, Biffar R et al (2016) Cross-sectional association between physical strength, obesity, periodontitis and number of teeth in a general population. J Clin Periodontol 43:401–407. https://doi.org/10.1111/jcpe.12531

    Article  PubMed  Google Scholar 

  47. von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology 18:800–804. https://doi.org/10.1097/EDE.0b013e3181577654

    Article  Google Scholar 

  48. Chapple ILC, Mealey BL, Van Dyke TE et al (2018) Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 89(Suppl 1):S74–S84. https://doi.org/10.1002/JPER.17-0719

    Article  PubMed  Google Scholar 

  49. Löe H (1967) The gingival index, the plaque index and the retention index systems. J Periodontol 38:610–616. https://doi.org/10.1902/jop.1967.38.6.610

    Article  Google Scholar 

  50. Chaparro A, Monckeberg M, Realini O et al (2021) Gingival crevicular placental alkaline phosphatase is an early pregnancy biomarker for preeclampsia. Diagnostics 11:661. https://doi.org/10.3390/diagnostics11040661

    Article  PubMed  PubMed Central  Google Scholar 

  51. Chaparro A, Realini O, Hernández M et al (2021) Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases-8 and -9 are associated with the severity of periodontitis and the development of gestational diabetes mellitus. J Periodontol 92:205–215. https://doi.org/10.1002/JPER.19-0743

    Article  PubMed  Google Scholar 

  52. Caton JG, Armitage G, Berglundh T et al (2018) A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Clin Periodontol 45(Suppl 20):S1–S8. https://doi.org/10.1111/jcpe.12935

    Article  PubMed  Google Scholar 

  53. World Health Organization (2010) A healthy lifestyle - WHO recommendations: fact sheets. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi. Accessed May 18th 2022

  54. Textor J, van der Zander B, Gilthorpe MS et al (2016) Robust causal inference using directed acyclic graphs: the R package “dagitty.” Int J Epidemiol 45:1887–1894. https://doi.org/10.1093/ije/dyw341

    Article  PubMed  Google Scholar 

  55. GBD (2017) DALYs and HALE Collaborators (2018) Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1859–1922. https://doi.org/10.1016/S0140-6736(18)32335-3

    Article  Google Scholar 

  56. Dandona P, Weinstock R, Thusu K et al (1998) Tumor necrosis factor-alpha in sera of obese patients: fall with weight loss. J Clin Endocrinol Metab 83:2907–2910. https://doi.org/10.1210/jcem.83.8.5026

    Article  PubMed  Google Scholar 

  57. Dandona P, Aljada A, Bandyopadhyay A (2004) Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol 25:4–7. https://doi.org/10.1016/j.it.2003.10.013

    Article  PubMed  Google Scholar 

  58. Kern PA, Ranganathan S, Li C et al (2001) Adipose tissue tumor necrosis factor and interleukin-6 expression in human obesity and insulin resistance. Am J Physiol Endocrinol Metab 280:E745-751. https://doi.org/10.1152/ajpendo.2001.280.5.E745

    Article  PubMed  Google Scholar 

  59. Garvey WT, Mechanick JI, Brett EM et al (2016) American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 22(Suppl 3):1–203. https://doi.org/10.4158/EP161365.GL

    Article  PubMed  Google Scholar 

  60. Dobner J, Kaser S (2018) Body mass index and the risk of infection - from underweight to obesity. Clin Microbiol Infect 24:24–28. https://doi.org/10.1016/j.cmi.2017.02.013

    Article  PubMed  Google Scholar 

  61. Falagas ME, Kompoti M (2006) Obesity and infection. Lancet Infect Dis 6:438–446. https://doi.org/10.1016/S1473-3099(06)70523-0

    Article  PubMed  Google Scholar 

  62. Virto L, Cano P, Jiménez-Ortega V et al (2018) Obesity and periodontitis: an experimental study to evaluate periodontal and systemic effects of comorbidity. J Periodontol 89:176–185. https://doi.org/10.1902/jop.2017.170355

    Article  PubMed  Google Scholar 

  63. Hajishengallis G, Chavakis T (2021) Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol 21:426–440. https://doi.org/10.1038/s41577-020-00488-6

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to express their gratitude to Clínica Dávila, Hospital Parroquial de San Bernardo and Agencia Nacional de Investigación y Desarrollo (ANID) FONDECYT REGULAR ID1211471, Ministerio de Ciencia y Tecnología. Chile, ANID-Basal funding for Scientific and Technological Center of Excellence, IMPACT, #FB210024 and ANID Doctorado Nacional grant 2019-21190319.

Funding

The present study was funded by the Chile Science and Technology minister. Agencia Nacional de Investigación y Desarrollo (ANID). GRANT FONDECYT REGULAR ID1211471.

Author information

Authors and Affiliations

  1. Department of Biomedical Sciences, Ethics, Research and Education, Faculty of Dentistry, Universidad de Los Andes, Santiago, Chile

    Valeria Ramírez

  2. Department of Pathology and Conservative Dentistry, Faculty of Dentistry, Universidad de Los Andes, Av. Plaza 2501, Las Condes, 7620157, Santiago, Chile

    Laura Weber, Ornella Realini, María José Bendek & Alejandra Chaparro

  3. Department of Pathology, Faculty of Dentistry, Universidad de Chile, Santiago, Chile

    Marcela Hernández

  4. PhD Program in Biomedicine, School of Medicine, Universidad de los Andes, Santiago, Chile

    María José Bendek

  5. Laboratory of Reproductive Biology, Biomedical Research and Innovation Center, Universidad de los Andes, Santiago, Chile

    Dolores Busso & Sebastián Enrique Illanes

  6. Laboratory of Oral Microbiology, Department of Pathology and Oral Medicine, Faculty of Dentistry, Universidad de Chile, Santiago, Chile

    Anilei Hoare

  7. Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de Los Andes, Santiago, Chile

    Sebastián Enrique Illanes

  8. Biomedical Research and Innovation Center, Santiago, Chile

    Alejandra Chaparro

Authors
  1. Valeria Ramírez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcela Hernández
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ornella Realini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María José Bendek
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dolores Busso
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anilei Hoare
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sebastián Enrique Illanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alejandra Chaparro
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.CH, S.I, M.H, and V.R contributed to the study design, recruited patients, provided all clinical aspects of the work, wrote the draft, and gave final review and approval of the manuscript to be published. V.R and L.W also worked in all statistical analysis and interpretation of data, initial and final drafting of the work. O.R, D.B, M.J.B, and A.H were involved in the study design and served as the examiner of the data and final reviewal of the manuscript.

Corresponding author

Correspondence to Alejandra Chaparro.

Ethics declarations

Ethical approval and consent to participate

The Ethical Committee boards of the Universidad de Los Andes FDF2018002, CEC2021021) approved the study, Clínica Dávila and Hospital Parroquial de San Bernardo, Santiago, Chile. Written informed consent was obtained from all study participants and reviewed and approved by the Ethical Committee boards.

Conflict interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramírez, V., Weber, L., Hernández, M. et al. Obesity is related to maternal periodontitis severity in pregnancy: a cross-sectional study. Clin Oral Invest 27, 5509–5518 (2023). https://doi.org/10.1007/s00784-023-05170-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-023-05170-4

Keywords

Search

Navigation