Periodontal Pathogens and Preterm Birth: Current Knowledge and Further Interventions

Abstract

Preterm labor is defined as a birth before 37 weeks of gestation and occurs in 5–20% of pregnancies. Preterm labor, as multifactorial entity associated with a high risk of neonatal morbidity and mortality, is influenced by maternal, fetal and environmental factors. Microbiological studies suggest that infectious pathogens may account for 25–40% of preterm birth. Infections of different sites, like genital, urinary tract infections, and pneumonia, are linked to the preterm labor. The most recent epidemiological studies consistently report that maternal periodontal disease is associated with preterm delivery, as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes. On the other hand, some previously published papers found periodontal bacteria in placentas of term pregnancies. In spite of a huge research done on the topic, both experimental and clinical, there are many controversial opinions about the role of periodontal infections in preterm birth. Thus, this comprehensive review addresses this very important topic and evaluates novel strategies of preventive and therapeutic approaches.

The Role of Genital Mycoplasmas in Preterm Labor

“…PTB is a multifactorial disorder and its relationship to pyrogenic bacterial infection, bacterial vaginosis, and periodontal disorder has been considered ( 1 ). The importance of genital Mycoplasma in this regard is questionable ( 16 ).…”

“…Preterm birth (PTB) is the live birth before 37 completed weeks of gestation since the first day of last menstrual period (LMP) of the woman ( 1 ). Approximately, 15 million babies are born preterm annually and this rate is increasing.…”

“…Bacterial surface antigens, such as PAMP, can be detected by toll like receptors (TLRs) available in the surface of innate immune system cells and they stimulate immune cells such as macrophages or monocytes. This reaction increases the level of inflammatory cytokines and chemokines such as IL1, IL6, IL8, and TNFα; these factors lead to the production of metalloproteinase and prostaglandins which eventually cause pre-term labor ( 1 , 11 , 12 ). In order to determine the role of genital Mycoplasma in preterm labor, the frequency of four species of genital Mycoplasmas in pregnant women with preterm and term labor was examined and compared in this study.…”

Antifungal Susceptibility of Candida albicans Isolated from Tongue and Subgingival Biofilm of Periodontitis Patients

“…Due to the fact that the epithelium of periodontal pockets is inflamed and ulcerated, microorganisms from periodontal pockets may easily enter the bloodstream [ 11 ]. In immunocompromised patients, the spreading of microorganisms from the oral mucosa and periodontal pockets can lead to a severe systemic infection with a high mortality rate [ 12 ], such as cardiovascular diseases including endocarditis, diabetes bacterial pneumonia, pre-term birth and low birth weight [ 13 , 14 , 15 , 16 ]. Lately, there has even been growing concern about the potential role of yeasts originating from the oral cavity in the etiopathogenesis of fungal bacterial endocarditis [ 17 ].…”

Effect of Oral Prophylactic Measures on the Occurrence of Pre-Eclampsia (OP-PE) in High-Risk Pregnant Women: A Cluster Randomized Controlled Trial

“…PD is a chronic, multifactorial, non-communicable disease and inflammatory disease of polymicrobial origin resulting from an increase in pathobionts in the microbiota [ 14 ]. Maternal periodontopathogens may be linked to placental damage and premature pathogenesis [ 15 ], as well as the association between the presence of pathogenic oral bacteria in the placenta and adverse pregnancy outcomes [ 16 ]. PD may lead to systemic complications including pregnancy complications [ 17 ].…”