One could suggest that based upon the findings of this article and other previously published studies that a challenge by certain oral pathogens associated with periodontal disease and locally elevated levels of pro-inflammatory cytokines can have a systemic impact during pregnancy. Women who harbor plaque biofilm-associated T. forsythia may be at risk for the spreading of this pathogen to both vaginal and cervical locations. Further, one can speculate that women who develop GDM have an increased incidence of chorioamnionitis and premature rupture of membranes, which are clinical conditions associated with elevated pro-inflammatory cytokines and oxidative stress that can occur with GDM and T. forsythia colonization. These clinical data support previous human studies that demonstrate extra-oral dissemination of T. forsythia to coronary vessels, artheromatous plaques, and occluded vessels.

It is important to note that periodontal disease is known to have periods of exacerbation and remission that are often not easy to identify solely by monitoring clinical parameters such as probing depths. An assessment of biochemical markers of disease activity, such as local cytokine, enzyme or bone breakdown product levels, may be necessary to truly assess risk relative to active periodontal disease. Elevated levels of pro-inflammatory cytokines, such as IL-1, IL-6 and TNF, have been associated with insulin resistance and an increased risk for developing diabetes.

The data also suggest that an additional challenge of oral infection and inflammation may compound existing risk factors, such as an elevated body mass index (BMI), a previous history of gestational diabetes, and an at-risk ethnic background, further promoting the development of insulin resistance and subsequent gestational diabetes. Since 50% of all women presenting with gestational diabetes will become women with Type II diabetes within 10 years, the oral status of those with a history of gestational diabetes becomes extremely important.