{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T20:56:14Z","timestamp":1791665774674,"version":"4.3.4"},"reference-count":58,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["210972476"],"award-info":[{"award-number":["210972476"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study aimed to investigate the association between periodontitis severity and the risk of gestational diabetes mellitus (GDM) considering pathways induced by systemic inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pregnant women with singleton pregnancies aged at least 18 years at 12\u201320 gestational weeks were enrolled in the study. Logistic and linear regression models were constructed to examine the associations between periodontal status and GDM risk and blood glucose levels. Age\u2010stratified analyses (\u2265 30 vs.\u00a0&lt;\u00a030 years) were conducted to evaluate potential effect modification. Lastly, mediation analysis was employed to assess the proportion of the association mediated by systemic inflammatory biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 446 participants, the overall incidence of GDM was 26.68%. It increased with the severity of periodontal disease, reaching a 3\u2010fold higher GDM risk among women with stages II\u2013IV periodontitis compared to healthy controls [17.35%\u00a0vs. 38.60%; odds ratio (OR)\u00a0=\u00a03.00, 95% confidence interval (95% CI): 1.38\u20136.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05]. Stratified analyses showed this association was restricted to women aged \u2265 30 years (\n                      <jats:italic>p<\/jats:italic>\n                      for interaction\u00a0&lt;\u00a00.05), with a 4.78\u2010fold higher GDM risk in women having stages II\u2013IV periodontitis (OR\u00a0=\u00a04.78, 95% CI: 1.85\u201313.08;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). Even women with stage I periodontitis exhibited a significant association (OR\u00a0=\u00a02.84, 95% CI: 1.25\u20136.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.05). Mediation analysis revealed that systemic inflammatory markers [white blood cell (WBC), neutrophils, systemic immune inflammation index (SII), aggregate index of systemic inflammation (AISI)] partially mediated the link between stages II\u2013IV periodontitis and GDM, with mediation proportions of 17.85%, 18.61%, 17.32%, and 11.71%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Increasing periodontitis severity was significantly associated with a higher risk of GDM in a dose\u2013response manner in women aged \u2265 30 years, but not in younger women. Besides, systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Plain language summary<\/jats:title>\n                    <jats:p>The relationship between periodontitis severity and gestational diabetes mellitus (GDM) risk has not been systematically characterized, and the biological mechanisms underlying this association are not clear. Our study demonstrated a significant, dose\u2010dependent association between periodontal disease severity and GDM risk, with a 3\u2010fold increased likelihood among pregnant women with stages II\u2013IV periodontitis compared to healthy controls. Notably, this association was markedly stronger among women aged \u2265 30 years. Systemic inflammation may partially mediate this association, suggesting a biological link between periodontal health and glucose metabolism during pregnancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.70026","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T15:34:24Z","timestamp":1761406464000},"page":"945-959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between periodontitis and gestational diabetes mellitus via systemic inflammation: A prospective cohort study"],"prefix":"10.1002","volume":"97","author":[{"given":"Jing","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Stomatology Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Stomatology Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1755-8524","authenticated-orcid":false,"given":"Yujuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinmeng","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Stomatology Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Gao","sequence":"additional","affiliation":[{"name":"Medical Science Research Center Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1916-0410","authenticated-orcid":false,"given":"Bo","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Stomatology Zhongnan Hospital of Wuhan University  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jper.24\u20100638"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdent.2022.104253"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00784\u2010023\u201005408\u20101"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12486"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010018\u20101191\u20107"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0707943"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2013.10.012"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(09)60731\u20105"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc10\u20101354"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ15\u20100350"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12884"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12902"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13578"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jper.21\u20100455"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms222111831"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.1.21"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.exphem.2020.10.001"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.4183\/aeb.2023.441"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad336"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12946"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2011.03351.x"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892\u2010015\u20100699\u2010x"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1087994"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41432\u2010025\u201001110\u20101"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2013.130319"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010023\u201003659\u20108"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178234"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.3290\/j.ohpd.a45355"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108044"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13271"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2009.02845.x"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479\u2010828X.2011.01292.x"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/cimb45080416"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.2337\/db08\u20101651"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/1753\u20100407.12481"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/MED.0b013e32834c800d"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjhyper.2005.07.001"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/15592294.2025.2541248"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/ger.70003"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archoralbio.2016.08.012"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1002\/jper.19\u20100124"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2010.100508"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2020.1843620"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.preghy.2019.04.004"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.2337\/db17\u20100313"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010022\u201031317\u20100"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1038\/ni.2260"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl\u20102022\u2010328406"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/jper.23\u20100260"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab657"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13683"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.00702"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1601114"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1590\/1414\u2010431\u00d72024e14097"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/cm9.0000000000003236"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/aji.70069"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2012.120350"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24\u2010S002"}],"container-title":["Journal of Periodontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jper.70026","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jper.70026","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jper.70026","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:51:11Z","timestamp":1781513471000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/jper.70026"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,25]]},"references-count":58,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/jper.70026"],"URL":"https:\/\/doi.org\/10.1002\/jper.70026","archive":["Portico"],"relation":{},"ISSN":["0022-3492","1943-3670"],"issn-type":[{"value":"0022-3492","type":"print"},{"value":"1943-3670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,25]]},"assertion":[{"value":"2025-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}