NYU Dental Researchers Find Evidence of Periodontal Disease Leading to Gestational Diabetes
March 24, 2008
The findings, published in the April 2008 issue of the Journal of Dental Research, underscore how important it is for expectant mothers to maintain good oral health
March 24, 2008 (EurekAlert) - A study by a New York University dental research team has discovered evidence that pregnant women with periodontal (gum) disease are more likely to develop gestational diabetes mellitus than pregnant women with healthy gums.
The study, led by Dr. Ananda P. Dasanayake, a professor of epidemiology & health promotion at the NYU College of Dentistry, followed 256 women at New York’s Bellevue Hospital Center through their first six months of pregnancy. Twenty-two women developed gestational diabetes. Those women had significantly higher levels of periodontal bacteria and inflammation than the other women in the study.
The findings, published in the April 2008 issue of the Journal of Dental Research, underscore how important it is for expectant mothers to maintain good oral health.
“In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant,” says Dasanayake. “Treating gum disease during pregnancy has been shown to be safe and effective in improving women’s oral health and minimizing potential risks.”
“In the future,” he added, “we can expect to see more research on the link between these two conditions involving other high risk groups, such as Asian and Native American women.”
Gestational diabetes is characterized by an inability to transport glucose -- the main source of fuel for the body -- to the cells during pregnancy. The condition usually disappears when the pregnancy ends, but women who have had gestational diabetes are at a greater risk of developing the most common form of diabetes, known as Type 2 diabetes, later in life. Hispanics, Asians, and Native Americans are at the highest risk for developing gestational diabetes. Eighty percent of the women in the NYU study were Hispanic.
Inflammation associated with periodontal disease is believed to play a role in the onset of gestational diabetes, perhaps by interfering with the normal functioning of insulin, the hormone that regulates glucose metabolism.
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Sleep Apnea Increases Risk of Diabetes and Hypertension in Pregnant Women
May 23, 2007
May 23, 2007 (EurekAlert) —Sleep apnea is associated with a greatly increased incidence of pregnancy-induced diabetes and high blood pressure, according to a study presented at the American Thoracic Society 2007 International Conference, on Wednesday, May 22.
The study found that when the women’s weight was taken into account, sleep apnea was associated with a doubling of the incidence of gestational diabetes and a fourfold increase in the risk of pregnancy-induced hypertension.
In obstructive sleep apnea, the upper airway narrows, or collapses, during sleep. Periods of apnea end with a brief partial arousal that may disrupt sleep hundreds of times a night. Obesity is a major risk factor for sleep apnea.
The most effective treatment for sleep apnea is an apparatus called nasal CPAP, for contin¬u¬ous posi¬tive airway pres¬sure, which delivers air through a mask while the patient sleeps, keeping the airway open.
The researchers analyzed data from all pregnancies associated with sleep apnea, gestational diabetes (women who developed diabetes during pregnancy) and pregnancy-induced high blood pressure nationwide in 2003. Out of almost 4 million deliveries, 452 had sleep apnea. Of the 167,227 women who had gestational diabetes, 67 had sleep apnea. Of the 200,902 pregnancies with pregnancy-induced high blood pressure, 166 had sleep apnea.
“The repetitive decrease in oxygen that occurs during the night in someone with sleep apnea heightens the body’s ‘fight or flight’ state, which can raise blood pressure,” explains researcher Hatim Youssef, D.O. of UMDNJ-Robert Wood Johnson Medical School. “The body also secretes more hormones such as cortisol and epinephrine, and the body responds by producing more glucose coupled with a decreased sensitivity to insulin, which can lead to diabetes.”
Pregnancy can worsen sleep apnea, especially during the third trimester when a woman’s weight is greatest, Dr. Youssef explains. “When a mother’s oxygen level drops at night, it may also affect the oxygen level of the fetus, and we don’t know what the long-term effects are. That’s why it’s important for a pregnant woman with sleep apnea to be treated with CPAP during her pregnancy.”
It is not yet known whether CPAP treatment can reduce the risk of diabetes and hypertension during pregnancy, he says. “In the non-pregnant population, research has shown that treating sleep apnea will reduce the risk of diabetes and hypertension. In the future, we want to follow pregnant women whose sleep apnea is well-controlled to see if treatment prevents them from developing these conditions, or makes it less severe.”
He recommended that pregnant women who are obese, hypertensive or diabetic be closely evaluated for the presence of sleep apnea.
If sleep apnea is present, treatment in the form of nasal CPAP should be used and her blood pressure and blood sugar should be closely monitored, Dr. Youssef says.
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History of Gestational Diabetes Raises Lifelong Diabetes Risk in Mother and Child
April 25, 2006
Lifestyle Changes Can Prevent Or Delay Later Diabetes
April 25, 2006 (NIH News) - "It's Never Too Early to Prevent Diabetes", the latest diabetes prevention campaign message by the National Diabetes Education Program (NDEP), is spreading the word about the risk for type 2 diabetes faced by women with a history of gestational diabetes mellitus (GDM) and their offspring. On April 25th the NDEP joined Deputy Surgeon General, RADM Kenneth P. Moritsugu and Griffin P. Rodgers, M.D., acting director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one of the National Institutes of Health (NIH), in Washington to announce this latest message in an ongoing national public awareness effort. The NDEP is jointly sponsored by the NIH and the Centers for Disease Control and Prevention, agencies of the U.S. Department of Health and Human Services.
"It's Never Too Early to Prevent Diabetes" is the latest addition to NDEP's campaign, "Small Steps. Big Rewards. Prevent type 2 Diabetes", the nation's first comprehensive multicultural type 2 diabetes prevention campaign. The campaign offers materials that can help women with a history of GDM take steps to prevent or delay type 2 diabetes and help their children lower their risk for the disease. Available campaign materials include a tip sheet in English and Spanish for women who have had GDM, a tip sheet in English and Spanish for children at risk for type 2 diabetes, and a booklet for adults to help women and their families make healthy food choices and be more physically active to prevent or delay type 2 diabetes. These materials are available on the NDEP website at www.ndep.nih.gov.
"Mothers who've had GDM need to know that they and their children have an increased lifelong risk for developing type 2 diabetes," explained Moritsugu. "The risk doesn't go away. By making modest lifestyle changes to lose a small amount of weight, usually by making healthy food choices and being more physically active, women can help prevent or delay the disease. Children can lower their risk for type 2 diabetes by not becoming overweight or obese."
GDM is a form of glucose intolerance that occurs during pregnancy. GDM affects about 7 percent of all U.S. pregnancies annually, resulting in approximately 200,000 cases a year. After pregnancy, 5 to 10 percent of women who had GDM continue to have type 2 diabetes. Women with a history of GDM have a 20 to 50 percent chance of developing diabetes in the future, and their children are at increased risk for obesity and diabetes during childhood and adolescence compared to other children.
The Diabetes Prevention Program (DPP), an NIDDK-funded clinical trial, found that people at increased risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight through increased physical activity and a low fat, low calorie eating plan. The DPP included several hundred women with a history of GDM, and the powerful reduction in risk of diabetes demonstrated in the study -- up to 58 percent -- was found in all subgroups including this group of women.
"Diabetes prevention is proven, possible, and powerful," said Dr. Rodgers. "Small steps like eating fresh fruits and vegetables and whole grains, taking the stairs instead of the elevator, and playing with your kids in the park can yield a lifetime of healthy rewards for the entire family."
Recent reports have shown high or increasing rates for GDM in various parts of the country, including:
-- Washington, D.C, where in 2003 the GDM prevalence rate in Hispanic women was 12 percent -- close to the highest rate of 14 percent seen in some American Indian women.
-- New York City, where the GDM prevalence rate increased 46 percent from 1990 to 2002 -- with the highest increase found among Asian women.
-- Colorado, where the GDM prevalence rate increased 95 percent from
1994 to 2002 -- with the highest among Hispanic women.
-- Northern California, where the number of new cases each year increased 35 percent from 1991 to 2000.
These regional GDM prevalence rates raise concern that the increase may reflect the ongoing pattern of increasing obesity and contribute to the upsurge in cases of diabetes in the U.S.
The NDEP has materials for health care professionals and people at risk for diabetes -- including older adults, American Indians and Alaska Natives, Hispanics/Latinos, African Americans, and Asian Americans and Pacific Islanders. For more information about the NDEP or to obtain a copy of the new "It's Never Too Early to Prevent Diabetes" and "Nunca es muy temprano para prevenir la diabetes" tip sheets and other "Small Steps. Big Rewards." diabetes prevention materials, visit www.ndep.nih.gov or call 1-800-438-5383.
The U. S. Department of Health and Human Services' National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.
The National Institutes of Health (NIH) -- "The Nation's Medical Research Agency" -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.ndep.nih.gov.
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