Maternal Periodontitis and Prematurity. Part I: Obstetric Outcome of Prematurity and Growth Restriction

Abstract

Oral Conditions and Pregnancy (OCAP) is a 5-year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full-mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3-level disease classification (health, mild, moderate-severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW < 2,500 g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA < 28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate-severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate-severe disease (n = 45) by pair-wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P < 0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW < 1000 g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate-severe periodontal disease (P = 0.0006 and P < 0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction.

Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar

“…This is consistent with the literature that shows a reduction in SBP from the beginning until half of the pregnancy (24 weeks), and elevation from the second half until term, when pre-gestational levels are reached, whereas DBP remains reduced by 10% until term 15,16 .…”

Periodontal Disease and Preterm Birth, is There any Relationship?

“…In a 5-year prospective study titled "Oral Conditions and Pregnancy (OCAP)" Offenbacher et al [11], demonstrated that both antepartum maternal periodontal disease and incidence/progression of periodontal disease based on full mouth periodontal examination are associated with preterm birth and growth restriction. Regarding the potential mechanism behind this relationship is that premature birth and periodontal disease share a common pathological pathway, inflammation [12][13][14][15][16].…”

“…The current best practices for diagnosing periodontal disease is based on a set of clinical and radiographic evaluations. Some studies investigating this relationship have used PD, BOP, and CAL as an indicators of periodontal disease [11,[18][19][20][21]. Radiographic evaluation was not possible within the hospital setting and in consideration of the patient's comfort.…”

Can Oral Anaerobic Bacteria cause Adverse Pregnancy Outcomes?/ Дали Оралните Анаеробни Бактерии Можат Да Доведат До Лоши Опстетрички Исходи?

“…Offenbacher and his group in 1996 reported a sevenfold increased risk of a mother with periodontal disease delivering a PTLBW baby [15]. This observation was difficult to ignore and since then many studies have been completed but with varying results [16,17].…”