UKY DENTAL COBRE: ORAL INFECTIONS: IMPACT ON GESTATIONAL DIABETES

国家行动议程：关于糖尿病和妇女健康的国家公共卫生倡议制定了一项行动计划，以“动员全国将糖尿病作为一个日益严重的健康问题来解决”。它呼吁扩大以社区为基础的教育项目，促进风险评估，支持糖尿病及其并发症的高质量护理和自我管理，并鼓励对影响糖尿病和妇女健康的因素进行研究。这项建议在解决与妊娠期糖尿病(GDM)和孕产妇和胎儿健康有关的问题方面是及时的。妊娠期糖尿病发生在大约5%的孕妇中，在怀孕期间起病，分娩后消退。重要的是，近50%患有妊娠期糖尿病的妇女最终会在产后3-5年内患上2型糖尿病。此外，已描述了通过以下方式分娩的新生儿的急性和慢性新生儿发病率和死亡率 患有妊娠期糖尿病的女性。有大量证据表明，2型糖尿病患者牙周疾病的严重程度增加，但没有关于妊娠期糖尿病对牙周健康影响的数据。此外，正在积累大量数据支持早先的观察，即与牙周病相关的感染和炎症可能对妊娠期和导致早产、低出生体重婴儿出生的胎儿生长产生负面影响。我们的一般假设是，患有妊娠期糖尿病的妇女比非妊娠期糖尿病的妇女患更严重的牙周病的风险更高，而且妊娠期糖尿病和牙周病的结合将与对母婴健康的负面影响增加相关。以下是为解决这个问题而设计的具体目标。具体目标1：与未患妊娠期糖尿病的妇女相比，研究妊娠期糖尿病妇女牙周炎的患病率、严重程度和严重程度以及牙周炎与不良母婴结局之间的关系。具体目标2：将表征患有妊娠期糖尿病和牙周病的女性的牙龈下微生物生态，并确定特定的微生物特征是否与不良妊娠和胎儿结局有关。具体目标3：将确定GDM和牙周炎患者的循环炎症介质水平是否高于GDM和无牙周炎的女性和非GDM对照组。该项目的创新方面包括进行开创性研究，以证明牙周炎、妊娠期糖尿病和阴性母体和/或胎儿外体之间的联系。我们将使用与基础科学实验室评估相关的前瞻性临床研究，以深入了解与炎症、牙周病和妊娠期糖尿病相关的不良母婴结局的致病机制。由此得出的结果：这项研究将为未来的临床试验提供基础，旨在评估非手术、介入牙周治疗对妊娠期糖尿病控制的影响及其相关的负面结果。

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.