Periodontal disease is a neglected bacterial infection that causes destruction of the periodontium in pregnant women. Yet its impact on the occurrence of adverse pregnancy outcomes has not systematically evaluated and there is no clear statement on the relationship between periodontal disease and preterm low birth weight. The objective of this study was to summarize the evidence on the impact of periodontal disease on preterm low birth weight.
Methods
We searched the following data bases from January 2005 to December 2015: CINAHL (cumulative index to nursing and allied health literature), MEDLINE, AMED, EMBASE (excerpta medica database), Cochrane library and Google scholar. Only case-control studies with full text in English were eligible. Critical appraisal of the identified articles was done by two authors independently to provide the possible relevance of the papers for inclusion in the review process. The selected Case control studies were critically appraised with 12 items structured checklist adapted from national institute of health (NIH). Odds ratio (OR) or risk ratios (RR) were extracted from the selected studies. The two reviewers who selected the appropriate studies also extracted the data and evaluated the risk of bias.
Results
Of 229 articles, ten studies with a total of 2423 participants with a mean age ranged from 13 to 49 years were met the inclusion criteria. The studies focused on preterm birth, low birth weight and /or preterm low birth weight and periodontitis. Of the selected studies, 9 implied an association between periodontal disease and increased risk of preterm birth, low birth weight and /or preterm low birth weight outcome (ORs ranging from 2.04 to 4.19) and only one study found no evidence of association.
Conclusion
Periodontal disease may be one of the possible risk factor for preterm low birth weight infant. However, more precise studies with randomized clinical trial with sufficient follow-up period must be done to confirm the association.
Periodontal diseases are common among world population. Systemic conditions often are influenced by periodontal diseases. Recently there have been many studies that have associated periodontal diseases with adverse pregnancy outcomes. The various adverse outcomes include pregnancy gingivitis, preterm low birth weight, preeclempsia etc. Out of these preterm low birth weight poses a major threat to community health. PTLBW remains an alarming concern for health care providers.
The goal of this paper is to review the literature regarding periodontal diseases and pre-term low birth weight, and provide oral health care providers with resources to educate their patients.
The present literature review was based on findings extracted from online search of PMC indexed journals, Google scholar, MEDLINE and CINAHL databases from the year 2000 onwards.
Only case-control studies written and published in English language were included. Study subjects with mean age from 15-45 years met the inclusion criteria.
Any case control study reported earlier to 2000 were excluded. Reports in languages other than English were excluded from the review. The search keywords were pregnancy gingivitis, periodontal disease, low birth weight, oral health, and preterm delivery.
Of 300 articles, 10 studies with a total of 5358 participants with a mean age ranged from 15 to 45 years were met the inclusion criteria. The studies focused on preterm birth, low birth weight and /or preterm low birth weight and periodontitis. The findings from the selected case control studies were summarised in a tabulated form.
Periodontal disease is a high risk factor for preterm low birth weight babies. However, more precise studies with randomized clinical trial with long term follow-up period must be carried out to affirm the relationship between periodontitis and pre term low birth weight.
Periodontal diseases are one of the most common oral inflammatory diseases affecting world population. They are a group of inflammatory diseases that affect the periodontal attachment apparatus. Periodontal disease is initiated by overgrowth of certain bacterial species, with a majority of Gram-negative, anaerobic bacteria growing in sub gingival sites. The host response to periodontal pathogens causes persistent inflammation and the destruction of periodontal tissues that support teeth, leading to clinical manifestations of periodontal disease. In recent years, periodontal diseases have been associated with a number of systemic diseases such as rheumatoid arthritis, cardiovascular disease, diabetes mellitus, chronic respiratory diseases and adverse pregnancy outcomes including pre-term low birth weight (PTLBW) and pre-eclampsia [1]. Birthweight of “<2500g” finalized in 1976 as the definition of low-birth weight by 29th World health assembly. Preterm birth is defined as birth before 37weeks of gestation. PTLBW considered as significant cause of infant morbidity and mortality whereas, pre-eclampsia is the common disorder associated with PTLBW. Improving periodontal health before or during pregnancy may prevent or reduce the occurrences of these adverse pregnancy outcomes and, therefore, reduce the maternal and prenatal morbidity and mortality [2]. Hence, this article is an attempt to review the correlation between periodontal disease and adverse pregnancy outcome.
An electronic database search for relevant case- controlled studies published in English was conducted from 2000-2018 on the following databases: PMC indexed journals, Google scholar, MEDLINE and CINAHL. The search keywords were pregnancy gingivitis, periodontal disease, low birth weight, oral health, and preterm delivery.
The search from the databases and manual search from Google retrieved 300 articles, after removal of duplicates. A total of 10 articles were considered for the review (
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| Pitiphat/2006 [3] | United States | 101 Women | C-reactive protein levels increases during pregnancy due to periodontal disease. |
| Lopez/2002[4] | Chile | 639 Women | Positive association between periodontal disease and pre-term low birth weight babies |
| Jeffcoat/2001[5] | United States | 1313 women | Positive association between periodontal disease and pre-term birth |
| Boggess/2005[6] | United States | 850 women | Periodontitis increases foetal inflammation and immune changes |
| Santo-Pereira/2007 [7] | Brazil | 124 women | Periodontitis more prevalent in women who had preterm labour as compared to term labour. |
| Offenbacher/2006[8] | United States | 1020 women | Periodontitis serves as increased risk factor for preterm less than 32 weeks |
| Michalowicz BS/2006[9] | United States | 164 women | Prevalence of oral pathogens higher in women who had preterm labour. |
| Lopez/2005[10] | Chile | 870 women | Treatment significantly reduced PTLBW |
| Buduneli/2005[11] | Turkey | 181 women | PTB vs LBW No significant difference between cases and controls |
| Holbrook/2004[12] | Iceland | 96 women | No association was found between periodontal disease and PTLBW. |
Primary predictors of spontaneous PTB are black race, young mother, domestic violence, low socio-economic status, stress or depression, cigarette smoking, cocaine or heroin use, low-body mass index, low maternal weight gain before pregnancy, previous preterm birth or second trimester pregnancy loss, previous induced abortion, family history/ inflammatory gene polymorphisms, chronic lung disease, chronic hypertension, diabetes, renal disease [9].
Secondary predictors of spontaneous preterm birth are no or inadequate prenatal care, in-vitro fertilization, low maternal weight gain late in pregnancy, iron-deficiency anemia, preeclampsia, elevated fetal fibronectin, α-fetoprotein, alkaline phosphatase, or granulocyte colony-stimulating factor (G-CSF), early contractions, vaginal bleeding in first or second trimester, short cervical length, bacterial vaginosis, especially early in pregnancy, chorioamnionitis, placental abruption, placenta previa, hydramniosis, pre-eclampsia, multiple fetuses [9].
In the United States, the rate of preterm birth among black women is twice as high, and the rate of recurrent preterm birth is four times as high, as the rate among white women.
Bacteria attack choriodecidual space by releasing exotoxins and endotoxins, they activates the fetal membranes and decidua to create a different number of cytokines, including tumor necrosis factor α, interleukin-1α (IL-1α), IL-1β, IL-6 and G-CSF.7-19 Furthermore, cytokines, exotoxins, and endootoxins stimulate prostaglandin synthesis and also initiate neutrophil chemotaxis, activation, and infiltration, reaching to the synthesis and release of metalloproteases. The prostaglandins initiate uterine contractions whereas the metalloproteases forcefully attack the chorioamniotic membranes, guiding to rupture. The metalloproteases also alter the collagen in the cervix [13].
Randomized controlled clinical trials testing the effects of periodontal therapy on the adverse outcomes of pregnancy have shown that scaling and root planning can lower the risk of preterm births in mothers who are infected by periodontitis. Periodontal intervention resulted in a significantly decreased incidence for preterm delivery. Pregnancy without periodontal treatment was associated with significant increases in probing depths, plaque scores, GCF IL-1β, and GCF IL-6 levels. Intervention resulted in significant improvements in clinical status (attachment level, probing depth, plaque, gingivitis, and bleeding on probing scores) and significant decreases in levels of Prevotella nigrescens and Prevotella intermedia, serum IL-6sr, and GCF IL-1β.
A significant positive effect of non-surgical periodontal treatment of periodontal status and its beneficial impact on pregnancy outcomes in women diagnosed with gingivitis and periodontitis was demonstrated by
In a case-control study,
Periodontal disease is a high risk factor for preterm low birth weight babies. However, more precise studies with randomized clinical trial with long term follow-up period must be carried out to affirm the relationship between periodontitis and pre term low birth weight.
Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 342(20), 2000, 1500-7
Mercer BM, Goldenberg RL, Das A, Moawad AH, Iams JD, Meis PJ, et al. The preterm prediction study: A clinical risk assessment system. Am J ObstetGynecol 174(6), 1996, 1885-93.
PitiphatW,Joshipura KJ, Gillman MW, et al. Maternal periodontitis and adverse pregnancy outcomes, Community Dent Oral Epidemiol. 36(1), 2008, 3-11.
Lopez NJ, Smith PC, Gutierrez J. Higher risk of preterm birth and low birth weight in women with periodontal disease. J Dent Res. 81(1), 2002, 58-63.
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg R and Hauth JC. Periodontal infection and preterm birth:Results of a prospective study. J Am Dent Assoc. 132(7), 2001, 875-880.
Boggess KA, Lieff S, Murtha AP, Moss K, Beck J, Offenbacher S. Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol. 101(2), 2003, 227–31.
Santos-Pereira SA, Giraldo PC, Saba-Chujfi E et al: Chronic periodontitis and pre-term labour in Brazilian pregnant women: an association to be analysed. J ClinPeriodontol. 34(3), 2007, 208-13.
Offenbacher S, Boggess KA, Murtha AP, et al. Progressive periodontal disease and risk of very preterm delivery. Obstet Gynecol. 107(1), 2006, 29-36. 45.
Michalowicz BS, Hodges JS, Di Angelis AJ, et al. Treatment of periodontal disease and the risk of preterm birth. NEngl J Med. 355(18), 2006, 1885-94.
Lopez NJ, Da Silva I, Ipinza J, Gutierrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol. 76(11), 2005, 2144-53.
Buduneli N, Baylas H, Buduneli E, Turkoglu O, Kose T, Dahlen G. Periodontal infections and pre-term low birth weight: a case-control study. J ClinPeriodontol. 32(2), 2005, 174-81.
Holbrook WP, Oskarsdottir A, Fridjonsson T, Einarsson H, Hauksson A, Geirsson RT. No link between low-grade periodontal disease and preterm birth: a pilot study in a healthy Caucasian population. ActaOdontol Scand. 62(3), 2004, 177-9.
Winkler M, Fischer DC, Hlubek M, van de Leur E, Haubeck HD, Rath W. Interleukin-1beta and interleukin-8 concentrations in the lower uterine segment during parturition at term. ObstetGynecol 91(6), 1998, 945-9.