Prediction of Preterm and Low Birth Weight Delivery by Maternal Periodontal Parameters: Receiver Operating Characteristic (ROC) Curve Analysis

Abstract

In this study we used receiver-operating characteristic (ROC) analysis to comparatively evaluate maternal periodontal parameters to predict preterm (PB) delivery and low birth weight (LBW) delivery among Jordanian women. A total of 277 pregnant women (20 weeks of gestation or less) had periodontal examination at baseline and followed up until delivery. Gestational age and birth weight were retrieved from their medical records. ROC curve analyses were used to examine the overall discriminatory power of the studied periodontal parameters to predict PB, LBW, and PB or LBW. For the three outcome variables, the area under curve (AUC) ranged from 0.84 to 0.87 for average clinical attachment level (CAL), 0.78-0.86 for percent of sites with CAL ≥ 5 mm, 0.63-0.74 for percent of sites with CAL ≥ 6 mm, and 0.71-0.82 for number of missing teeth indicating that they had high discriminating power to predict adverse pregnancy outcomes. All other parameters had AUC less than 0.60 and thus had low discriminating power. Average CAL performed the best in predicting the studied adverse pregnancy outcomes because it has the highest AUC. The severity and extent of periodontal disease as measured by CAL can be used to predict the occurrence of adverse pregnancy outcomes.

Increased infection with key periodontal pathogens during gestational diabetes mellitus

“…Indeed, it has even been suggested that periodontal disease severity may predict adverse pregnancy outcome (Al Habashneh et al. ).…”

Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes – systematic review

“…However, potential covariates were not accounted for in the performed analysis. Vogt et al (2010) Habashneh et al (2012) examined (at 20 weeks' gestation) and followed outcomes for 277 Jordanian women. Univariate analysis showed that women with LBW had higher levels of attachment loss, but no differences in terms of probing depths, and this was also confirmed in models accounting for a range of demographic, medical and pregnancy history variables.…”

“…Al Habashneh et al (2012) examined at 20 weeks' gestation 277 Jordanian women and followed their pregnancy outcomes. Univariate analysis showed that women with preterm birth had higher levels of attachment loss, but no differences in terms of probing depths, and this was confirmed in models allowing for a range of demographic, medical and pregnancy history variables.…”

The effects of periodontal treatment on pregnancy outcomes

“…More recently, Al Habashneh et al. () reported that preterm birth cases and controls differed significantly in terms of mean clinical attachment loss (CAL) and the percentage of sites with CAL ≥5 mm and ≥6 mm, but not in terms of probing depth (PD) measures or the extent of CAL at lower thresholds. Given these equivocal findings, it is not possible to identify from the existing literature a disease definition that is consistently and strongly associated with preterm birth risk and that could be used to define eligibility in future RCTs.…”