Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies.
ABSTRACT Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case-control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case-control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case-control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.
SourceAvailable from: Bruno Bueno-Silva[Show abstract] [Hide abstract]
ABSTRACT: The association between periodontitis and some of the problems with pregnancy such as premature delivery, low weight at birth, and preeclampsia (PE) has been suggested. Nevertheless, epidemiological data have shown contradictory data, mainly due to differences in clinical parameters of periodontitis assessment. Furthermore, differences in microbial composition and immune response between aggressive and chronic periodontitis are not addressed by these epidemiological studies. We aimed to review the current data on the association between some of these problems with pregnancy and periodontitis, and the mechanisms underlying this association. Shifts in the microbial composition of the subgingival biofilm may occur during pregnancy, leading to a potentially more hazardous microbial community. Pregnancy is characterized by physiological immune tolerance. However, the infection leads to a shift in maternal immune response to a pathogenic pro-inflammatory response, with production of inflammatory cytokines and toxic products. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the fetus-placenta unit. In severe periodontitis patients, the infection agents and their products are able to activate inflammatory signaling pathways locally and in extra-oral sites, including the placenta-fetal unit, which may not only induce preterm labor but also lead to PE and restrict intrauterine growth. Despite these evidences, the effectiveness of periodontal treatment in preventing gestational complications was still not established since it may be influenced by several factors such as severity of disease, composition of microbial community, treatment strategy, and period of treatment throughout pregnancy. This lack of scientific evidence does not exclude the need to control infection and inflammation in periodontitis patients during pregnancy, and treatment protocols should be validated.Frontiers in Public Health 01/2014; 2:290. DOI:10.3389/fpubh.2014.00290
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ABSTRACT: There is growing evidence showing that a number of complex human diseases are caused or are at least influenced by periodontal diseases. Such diseases include cardiovascular diseases, respiratory diseases, diabetes mellitus, and osteoporosis. Aim: The aim of the present study was to evaluate periodontal diseases as a risk factor for preterm low birth weight infants. Methods: A case-control study with a selection ratio of 1:1 was performed using 150 cases and 150 controls, who delivered their babies at Vanivilas Hospital, Bangalore, India, over a 3-months period from January 2012-March 2012. Cases were defined as mothers delivering an infant weighing less than 2,500 gms and born before 37-weeks gestation. Controls were mothers delivering an infant weighing more than 2,500 gms and born after 38-weeks gestation. Patients were evaluated for age, socioeconomic status, obstetric risk, nutritional status, maternal morbidity, infections, toxic exposure, antenatal care, infant characters, through hospital records and personal questionnaire by incharge team members. Oral examination was performed using Extent and severity index, Sulcus Bleeding Index. Results: Cases and controls did not reveal any significant difference when compared for age, socioeconomic status, obstetric risk, nutrition, maternal morbidity, and antenatal care. Periodontal disease was more severe and extensive in cases when compared with control and the difference was statistically significant (P<0.001). Bleeding index scores were higher in cases as compared to control and was statistically significant (P<0.001). Conclusion: Within the limits of this study, it is concluded that a poor periodontal health status of the mother may be a potential risk factor for a preterm low birth weight.09/2014; 3(2):88-92. DOI:10.4103/2278-960X.140045
Volume 3 issue 2 edited by Uchenna nwagha, 07/2014; Medknow-Wolters Kluwer Health.