UKY DENTAL COBRE: ORAL INFECTIONS: IMPACT ON GESTATIONAL DIABETES

英国牙科 COBRE：口腔感染：对妊娠糖尿病的影响

• 批准号: 6972172
• 负责人: Karen F. Novak
• 金额: $ 21.65万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-23 至 2005-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6972172
• 关键词: clinical research; cytokine; disease /disorder proneness /risk; enzyme linked immunosorbent assay; gestational diabetes mellitus; human subject; immune response; inflammation; oral bacteria; periodontitis; postpartum; pregnancy

The National Agenda for Action: The National Public Health Initiative on Diabetes and Women's Health has developed an action plan to "mobilize the nation to address diabetes as a growing health concern." It calls for expanding community based education programs, promoting risk assessment, supporting quality care and self-management for diabetes and its complications and encouraging research into the factors that influence diabetes and women's health. This proposal is timely in addressing this issue as related to gestational diabetes mellitus (GDM) and maternal and fetal health. GDM occurs in approximately 5% of pregnant women with onset during pregnancy, and subsiding after parturition. Importantly nearly 5o% of women with GDM will eventually develop type 2 diabetes mellitus within 3-5 years post-partum. Moreover, acute and chronic neonatal morbidity and mortality have been described in neonates delivered by women with GDM. Substantial evidence is available documenting that the severity of periodontal disease is increased in patients with type 2 diabetes but no data are available on the effects of GDM on periodontal health. In addition, substantial data is accruing to support earlier observations that the infection and inflammation associated with periodontal disease may have a negative impact on the period of gestation and on fetal growth leading to the birth of preterm, low birth weight infants. Our GENERAL HYPOTHESIS is that women with GDM are at higher risk for developing more severe periodontal disease than women without GDM and that the combination of GDM and periodontal disease will be associated with an increased negative impact on maternal and fetal health. The following Specific Aims are designed to address this question. Specific Aim 1: to characterize the prevalence, extent and severity of periodontitis and associations between periodontitis and adverse maternal and fetal outcomes in women who develop GDM compared to women who don't develop GDM. Specific Aim 2: will characterize the subgingival microbial ecology in women with GDM and periodontal disease and determine if specific microbial characteristics are associated with adverse pregnancy and fetal outcomes. Specific Aim 3: will determine if patients with GDM and periodontitis have elevated levels of circulating inflammatory mediators compared to women with GDM and no periodontitis and the non-GDM controls. The innovative aspects of the project include conducting seminal studies to document a link between periodontitis, GDM and negative maternal and/or fetal outeomes. We will use prospective clinical studies correlated with basic science laboratory evaluations to provide insight into the pathogenic mechanisms contributing to negative maternal and fetal outcomes associated with inflammatory, periodontal disease and GDM. The results obtained from this: study will provide the groundwork for future clinical trials designed to evaluate the impact of non-surgical, interventional periodontal therapy on the control of GDM and its related negative outcomes.

国家行动议程：国家糖尿病和妇女健康公共卫生倡议制定了一项行动计划，以“动员全国解决糖尿病这一日益严重的健康问题”。它呼吁扩大基于社区的教育计划，促进风险评估，支持糖尿病及其并发症的优质护理和自我管理，并鼓励对影响糖尿病和妇女健康的因素进行研究。该提案及时解决了与妊娠糖尿病 (GDM) 以及孕产妇和胎儿健康相关的问题。 GDM 发生于大约 5% 的孕妇，在怀孕期间发病，分娩后消退。重要的是，近 5o% 的 GDM 女性最终会在产后 3-5 年内患上 2 型糖尿病。此外，已描述了由新生儿出生的急性和慢性新生儿发病率和死亡率。 患有 GDM 的女性。大量证据表明 2 型糖尿病患者牙周病的严重程度有所增加，但尚无关于 GDM 对牙周健康影响的数据。此外，越来越多的数据支持早期的观察结果，即与牙周病相关的感染和炎症可能对妊娠期和胎儿生长产生负面影响，导致早产、低出生体重婴儿的出生。我们的一般假设是，与没有 GDM 的女性相比，患有 GDM 的女性患更严重牙周病的风险更高，并且 GDM 和牙周病的结合将增加对孕产妇和胎儿健康的负面影响。以下具体目标旨在解决这个问题。具体目标 1：与未患 GDM 的女性相比，描述患 GDM 的女性牙周炎的患病率、范围和严重程度，以及牙周炎与母婴不良结局之间的关系。具体目标 2：将描述患有 GDM 和牙周病的女性的龈下微生物生态学特征，并确定特定的微生物特征是否与不良妊娠和胎儿结局相关。具体目标 3：将确定与患有 GDM 但没有牙周炎的女性和非 GDM 对照相比，患有 GDM 和牙周炎的患者的循环炎症介质水平是否升高。该项目的创新之处包括开展开创性研究，以记录牙周炎、妊娠期糖尿病和母体和/或胎儿阴性结果之间的联系。我们将利用与基础科学实验室评估相关的前瞻性临床研究来深入了解与炎症、牙周病和 GDM 相关的导致母婴不良结局的致病机制。由此获得的结果：研究将为未来的临床试验奠定基础，这些临床试验旨在评估非手术、介入性牙周治疗对控制 GDM 及其相关负面结果的影响。