Serum Inflammatory Mediators in Pregnancy: Changes After Periodontal Treatment and Association With Pregnancy Outcomes

Abstract

Objective To determine: 1) if periodontal treatment in pregnant women before 21 weeks of gestation alters levels of inflammatory mediators in serum; and 2) if changes in these mediators are associated with birth outcomes. Methods 823 pregnant women with periodontitis were randomly assigned to receive scaling and root planing before 21 weeks of gestation or after delivery. Serum obtained between 13 weeks and 16 weeks 6 days (study baseline) and 29–32 weeks gestation was analyzed for C-reactive protein, prostaglandin E2, matrix metalloproteinase-9, fibrinogen, endotoxin, interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α. Cox regression, multiple linear regression, t-tests, chi-square and Fisher’s exact tests were used to examine associations between the biomarkers, periodontal treatment, and gestational age at delivery and birthweight. Results 796 women had baseline serum data; 620 had baseline and follow-up serum and birth data. Periodontal treatment did not significantly alter the level of any biomarker (P>0.05). Neither baseline levels nor change from baseline in any biomarker was significantly associated with preterm birth or infant birthweight (P>0.05). In treatment subjects, change in endotoxin was negatively associated with change in probing depth (P<0.05). Conclusions Non-surgical mechanical periodontal treatment in pregnant women delivered before 21 weeks of gestation did not reduce systemic (serum) markers of inflammation. In pregnant women with periodontitis, levels of these markers at 13–17 weeks and 29–32 weeks gestation were not associated with risk for preterm birth or with infant birthweight.

Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case–control studies

“…This led to the hypothesis of a potential link between periodontal diseases and obstetrical complications like preterm birth, as Offenbacher and his colleagues [14] first demonstrated in 1996. Other authors suggested that such link may be related to systemic changes induced by inflammation and immune response [15][16][17].…”

Periodontitis, cardiovascular disease and pregnancy outcome – focal infection revisited?

“…Again, studies of varying size and quality have been carried out in a range of geographical locations, and these have not all reported the same pattern of results. While it has been established that periodontal treatment in pregnancy can improve oral health 111,112 and be matched by beneficial changes in oral microbiological status, 113 the majority of large well executed studies have failed to show any effect of nonsurgical periodontal treatment on the incidence of adverse pregnancy outcomes, [112][113][114][115][116][117] and this has been supported by systematic reviews. 118,119 It is unclear why treatment has failed to show improvements even though other data suggest that it may be expected to do so.…”

Design, Operation, and Interpretation of Clinical Trials

“…However, "biomarkers" such as biochemical components of gingival crevicular fluid and venous blood [e.g., prostaglandins (PGE 2 ), interleukins IL1β, IL6, IL8, IL12, TNFα, Creactive protein, fibrinogen, interferonγ] are commonly included as outcome measures in clinical trials (i.e., Machtei and Younis, 2008;Michalowicz et al, 2009;Renvert et al, 2009;Vidal et al, 2009). Those who design, conduct, and evaluate the results of such trials must carefully consider the significance of biomarker findings, because they may or may not be consistent with clinically mean ingful endpoints.…”