The potential role of the gingival crevicular fluid biomarkers in the prediction of pregnancy complications

Abstract

Early and minimally invasive methods are required to predict the risk of multiple adverse pregnancy outcomes. A potential technique with growing interest utilizes the gingival crevicular fluid (GCF), a physiological serum exudate found in the healthy gingival sulcus and in the periodontal pocket in inflammatory conditions. Analysis of biomarkers in the GCF is a minimally invasive method that can be feasible and cost-effective. The potential use of GCF biomarkers along with other clinical indicators in early pregnancy may provide reliable predictors of several adverse pregnancy outcomes, therefore, reducing both maternal and fetal morbidities. Various studies have reported that increased or decreased concentrations of different biomarkers in GCF are associated with a high risk of developing pregnancy complications. In particular, such associations have been commonly demonstrated with gestational diabetes, pre-eclampsia, and pre-term birth. However, limited evidence is available regarding other pregnancy complications such as preterm premature rupture of membranes, recurrent miscarriage, small for gestational age, and hyperemesis gravidarum. In this review, we discuss the reported association between individual GCF biomarkers and common pregnancy complications. Future research is required to provide more solid evidence of the predictive value of those biomarkers in estimating women’s risk for each disorder.

Localized microbially induced inflammation influences distant healthy tissues in the human oral cavity

“…Such a nonlocalized response within the human oral cavity is further supported by prior observations regarding improved health parameters in distant tooth sites when subgingival plaque is removed from diseased sites within periodontitis patients ( 20 ). Furthermore, it has been well established that the systemic changes associated with pregnancy results in a constant influence of hormonal, metabolic, and immunological factors, which are suspected drivers influencing the subgingival microbiome composition (pregnancy-induced gingivitis) ( 38 – 40 ).…”

The Impact of Periodontal Disease on Preterm Birth and Preeclampsia

“…Moreover, Matevosyan et al, in a 2011 meta-analysis of 125 randomized trials, patient-control studies, and prospective studies (total sample: 992 births), revealed that women with preeclampsia exhibited poorer periodontal health across both intervention and control groups (OR 1.94-2.9). Elevated attachment loss (OR 2.76) was associated with increased preeclampsia incidence (RR 2.75), even after stratification for factors like gestational age, smoking, medical visits, and anemia [32].…”

“…The potential link between preeclampsia and an unidentified microbial factor, combined with evidence that periodontitis can alter microbiota and heighten risks of cardiovascular disease, atheromatous plaques, and endothelial damage, spurred scientific investigation into a potential correlation between periodontitis and preeclampsia. The literature suggests a clear association between periodontitis and increased preeclampsia risk [25,[30][31][32][33]. Sgolastra et al, in a 2013 meta-analysis, found that periodontal disease elevates preeclampsia risk by 117% (OR 2.17) [31,34].…”

“…Although the association of periodontitis with pregnancy complications is weaker compared to other factors, such as paternity, gestational age, and medical history [32], elevated levels of CRP and fetal tyrosine kinase increase preeclampsia risk [32]. Periodontitis raises systemic CRP levels [15].…”