It’s easy to imagine what germs and germ wasteproducts can do when they get into the body of a pregnant mom.

First, there’s a direct attack on the fetus through the placenta.  A direct effect of both the germs and their toxins.

Secondarily, the whole immune system is turned upside down and starts generating all sorts of hormones, particularly amniotic prostaglandins, that can trigger many problems.   PGE2 is most commonly associated with these effects.

Some effects may be seen due to higher levels of serum fibrinogen, cytokines, and CRP thanks to generalized immune system stimulus of chronic infection thanks to periodontal incursion.

Pre-term and low Birthweight

Most commonly with gingival inflammation, we see pre-term births.  And when a baby is born prematurely, they’re always at risk for many more diseases, lung problems and difficulties of brain development.  And some of these issues can be with them for life.  [less than 2500g at birth and less than 37 completed gestational weeks.]

Pre-term, low birthweight babies are FORTY TIMES  MORE LIKELY TO DIE neonatally.

Other factors could include smoking, very high or low maternal age, multi-fetal pregnancy, hypertension, diabetes, genitourinary tract infection.   BUT…gingival infection is the strongest predictor for these problems–stronger than smoking, vaginosis or even a previous pre-term birth. Treating gingivitis (“bleeding, inflamed gums”) led to over a 3X improvement in PTLBW statistics.  See Lopez et al J. Periodontology 2005.

Women with deeper gum disease (“periodontitis”) have a four to eight times odds ration of pre-term, low birthweight baby.

Women who had no treatment for their periodontitis during their pregnancy had FIVE TIMES the chance of PTLBW baby than those who did have treatment.   See Lopez et al J. Periodontology 2002.

And, yes, it is safe to do periodontal treatment during pregnancy.  Michalowicz, New Eng J Med 2006

Some medical insurance plans, notably CIGNA, are providing additional coverage for pregnant females to enhance pregnancy outcomes.

The Bottom Line

*Women of childbearing age should have regular, thorough dental and gum examinations.

*They should establish and maintain their gum health even before becoming preganant, and especially throughout the pregnancy.

*We feel it is imperative for the physician to request dental examination at the earliest stages of pregnancy or even pre-pregnancy.  Referral is critical medico-legally, as well.

*If you don’t know how to find a dental practitioner, try calling the local office of the American Dental Association.  Another suggestion: call a local oral surgeon and see who they would send their family to.

*It is probably better NOT sending the expectant patient directly to a periodontal specialist.  That referral is best managed and coordinated by the general dentist.


Gestational Diabetes

Bacteria and toxins getting into the bloodstream can throw off many parts of the whole body.  Researchers from New York University have shown that women with deep gum disease are more likely to have hyperglycemia.  This can make for babies over ten pounds at birth.  How long will it take glucose levels to return to normal after delivery?  How much damage is done during the hyperglycemic period?  How much long-term compromise is there for the newborn?


Dental Care Can Reduce Risk of Preterm Birth By Nearly 50 Percent

WEBWIRE – Friday, October 03, 2008

Columbia University College of Dental Medicine and Aetna presented findings at international Dental Research Institute conference

According to a study conducted by Aetna (NYSE: AET) and Columbia University College of Dental Medicine, women who received dental care before or during their pregnancy had a lower risk of giving birth to a preterm or low birth weight baby than pregnant women who didn’t seek dental care at all. The study, conducted between January 1, 2003 and September 30, 2006, reviewed medical and dental insurance data for 29,000 pregnant women who each had medical and dental coverage with Aetna to determine if there was an association between dental treatment and the likelihood of experiencing either birth outcome.

“Further studies need to be done but our findings show that dental treatment had a protective effect on adverse birth outcomes in women who sought dental treatment” said David A. Albert, DDS, MPH, Director, Division of Community Health, College of Dental Medicine, Columbia University.

When comparing the group who did not receive any dental treatment to the groups that received gum treatment and dental cleaning, the study found:

* The preterm birth rate was 11.0 percent for those not receiving dental treatment, and 6.4 percent for those receiving treatment
* The low birth weight rate was 5.4 percent for those not receiving dental treatment and 3.6 percent or lower among the groups receiving treatment

The Institute of Medicine of the National Academies determined that premature births, meaning babies born at less than 37 weeks of pregnancy, cost at least $26 billion a year and represented 12.5 percent of births in the U.S. in 2005.

“The results of this study send a strong message about the importance of dental care for women who want to start a family” said Dr. Mary Lee Conicella, DMD, FAGD, National Director of Clinical Operations, Aetna Dental. “We are seeing evidence that supports the role of routine preventive dental care in helping to protect the health of the newborn and the mother and contributing to lower associated medical costs.”

Aetna provides educational information about the importance of good oral health to women who are planning to become pregnant, as identified in responses to its Health Risk Assessment tool. Aetna also provides a dental/medical integration (DMI) program to pregnant women and at-risk members with diabetes and cardiovascular diseases who have both Aetna dental and medical coverage. The program is comprised of enhanced benefits, including an extra cleaning, full coverage for certain periodontal services and a variety of outreach methods to at-risk members who are not currently seeking dental care. As a result of various outreach methods during a two-year pilot with 500,000 Aetna members, 63 percent of those at-risk members who had not been to the dentist in 12 months sought dental care.  “The findings from this latest study we conducted continue to show that members with certain conditions who are engaged in seeking preventive care, such as regular dental visits, can improve their overall health and quality of life” said Alan Hirschberg, head of Aetna Dental.  

Aetna Dental launched its DMI program last fall following a published research analysis it conducted with Columbia University College of Dental Medicine which found that high-risk individuals that sought earlier dental care lowered the risk or severity of their condition and subsequently, lowered their overall medical costs.

 


Research Presented Today Provides Further Evidence on the Importance of Good Oral Health in Pregnant Women

Studies have shown that women with periodontal disease may be up to seven times more likely to deliver a preterm low birth weight baby

WASHINGTON, D.C. – May 7, 2000 – The more of the mouth affected with periodontal disease, the more likely a woman is to deliver a premature baby, according to an ongoing study of more than 2,000 pregnant women. The results point to further evidence that periodontal disease may be a significant risk factor for preterm births.

Past studies have shown that women with periodontal disease may be up to seven times more likely to deliver a preterm low birth weight baby. Today at the American Academy of Periodontology’s Specialty Conference on Periodontal Medicine in Washington, D.C., preliminary research was presented for the first time suggesting that the risk for women who have generalized periodontal disease (meaning it affects at least 30 percent of their mouth) is even higher.

“We were amazed by these findings,” said Marjorie Jeffcoat, D.M.D, the study’s lead researcher and chair of Periodontics at the University of Alabama at Birmingham School of Dentistry. However, women with only a couple of sites in their mouths affected by periodontal disease aren’t off the hook. “While there is a definite dose response, the trend for preterm birth was observed in women with as little as two sites with attachment loss (a measure of periodontal disease),” said Jeffcoat.

The women in the study had no other major risk factors for preterm birth,including genitourinary infections, tobacco use, and alcohol consumption. In the United States, about 25 percent of preterm births occur without any known risk factors.

“Low birth weight is a major public health problem in our country,” said Jack Caton, D.D.S., M.S., president of the American Academy of Periodontology. “It’s important that we continue to try to identify risk factors and preventable or treatable conditions that can help reduce the rate of premature births. Continued research into the link between periodontal disease and preterm births will help the medical and dental community provide the best possible care for mothers-to-be.”

Jeffcoat also introduced a second component of her research, an intervention trial to look at what happens when periodontal disease is treated in pregnant women. She expects to complete this study next year. “Initial data tells us the best advice continues to be that women considering pregnancy have a periodontal screening and get any problems with their oral health under control before becoming pregnant,” said Jeffcoat. However, women who are already pregnant should not shy away from dental care. “I advise periodontists to perform scaling and root planing, along with any supportive therapy, in the second trimester for pregnant patients with periodontal disease,” said Jeffcoat.       American Academy of Periodontology.

Journal of Periodontology August 2003, Vol. 74, No. 8, Pages 1214-1218 (doi:10.1902/jop.2003.74.8.1214)


Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study Dr. Marjorie K. Jeffcoat

Background: Previous case-control and prospective studies have shown an association between the presence of periodontitis and the risk of preterm birth (PTB). The goal of this pilot trial was to determine the feasibility of conducting a trial to determine whether treatment of periodontitis reduces the risk of spontaneous preterm birth (SPTB).

Methods: Three hundred sixty-six (366) women with periodontitis between 21 and 25 weeks’ gestation were recruited and randomized to one of three treatment groups with stratifi- cation on the following two factors: 1) previous SPTB at <35 weeks and 2) body mass index <19.8 or bacterial vaginosis as assessed by gram stain. The treatment groups consisted of: 1) dental prophylaxis plus placebo capsule; 2) scaling and root planing (SRP) plus placebo capsule; and 3) SRP plus metronidazole capsule (250 mg t.i.d. for one week). An additional group of 723 pregnant women meeting the same criteria for periodontitis and enrolled in a prospective study served as an untreated reference group.

Results: The rate of PTB at <35 weeks was 4.9% in the prophylaxis group, compared to 3.3% in the SRP plus metronidazole group and 0.8% in the SRP plus placebo group (P = 0.75 and 0.12, respectively). The rate of PTB at <35 weeks was 6.3% in the reference group.

Conclusions: This trial indicates that performing SRP in pregnant women with periodontitis may reduce PTB in this population. Adjunctive metronidazole therapy did not improve pregnancy outcome. Larger trials will be needed to achieve statistical significance, especially at less than 35 weeks gestational age.


Dental Visits May Help Your Baby Arrive on Schedule

Periodontal therapy may reduce the risk of delivering a preterm low birth weight baby

CHICAGO–May 1, 2007– There is good news today for pregnant women: a study in this month’s issue of the Journal of Periodontology (JOP) showed that periodontal therapy may significantly reduce the risk of delivering a preterm low birth weight baby for women with periodontal disease. Study Abstract *

The study looked at 328 pregnant women with periodontal disease and 122 periodontally healthy women. Periodontal treatment was performed during the second trimester of pregnancy on 266 of the women with periodontal disease. Sixty-two women dropped out of treatment. Postpartum follow up on all 450 subjects showed that 79% of the women with untreated periodontal disease had delivered a preterm low birth weight baby compared to only 7.5% of the periodontally treated women and 4.1% of the healthy women.

“Our study showed that performing periodontal therapy on pregnant women who have periodontal disease may reduce the risk of preterm delivery to equal that of periodontally healthy women,” explained study author Catia M. Gazolla, DDS. “These are important findings that we hope all pregnant women will take to their dental professionals when discussing their periodontal health.”

“These findings are interesting, as they come on the heels of another study appearing in the May issue of the JOP that showed the effects of high levels of periodontal bacteria during pregnancy on increased risk for preterm delivery,” said Preston D. Miller, DDS and AAP president. “These studies and others continue to strengthen the idea that women should consider a periodontal evaluation as part of their prenatal care.”

To asses your oral health, take the AAP’s online test to assess your gum disease risk.    [from http://www.perio.org:80/consumer/pregnancy-therapy07.htm?rss]


Abstract Journal of Periodontology 2007, Vol. 78, No. 4, Pages 670-676

Evidence of Periopathogenic Microorganisms in Placentas of Women With Preeclampsia

Shlomi Barak,* ­Orit Oettinger-Barak, ­Eli E. Machtei, ­Hannah Sprecher,§ and ­Gonen Ohel*­

Background: Periodontal disease is a chronic inflammatory infectious disease that may act as a focus of infection. Preeclampsia is a pregnancy-specific hypertensive disorder that often leads to maternal morbidity and mortality. Acute atherosis, the placental lesion of preeclampsia, shares many histopathological features with atherosclerosis. Recently, chronic infection was linked to the initiation of atherosclerosis. Oral pathogens have been detected in atherosclerotic plaques, where they may play a role in the development and progression of atherosclerosis. The purpose of the present study was to explore the possibility that periopathogenic bacteria may translocate into the placental tissues of women with preeclampsia.

Methods: Samples were taken from 16 placentas obtained from cesarean sections of women with preeclampsia and from 14 age-matched healthy pregnant women. Polymerase chain reaction was used to detect Actinobacillus actinomycetemcomitans, Fusobacterium nucleatum ssp.,Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythensis, and Treponema denticola.

Results: Eight of the 16 (50%) placenta specimens were positive for one or more periopathogenic bacteria in the preeclampsia group, compared to only two of the 14 samples (14.3%) from controls. Bacterial counts were statistically significantly higher in the preeclampsia groupfor all of the periopathogenic bacteria examined (P ≤0.0055). Although all of the target periopathogenic bacteria were found in the preeclampsia group, only three (P. gingivalis, T. forsythensis, and T. denticola) were found in the control group.

Conclusion: The significant presence of periopathogenic microorganisms or their products in human placentas of women with preeclampsia may suggest a possible contribution of periopathogenic bacteria to the pathogenesis of this syndrome.


Gum disease linked with gestational diabetes risk

 

NEW YORK (Reuters Health) – Pregnant women with gum disease may be more likely to develop gestational diabetes than those with healthy gums, researchers have found.

Gestational diabetes arises during pregnancy and usually resolves after the baby is born, but it can raise a woman’s risk of developing type 2 diabetes later on. It can also contribute to problems during pregnancy and delivery, including maternal high blood pressure and a larger-than-normal baby, which may necessitate a cesarean section.

The new findings, published in the Journal of Dental Research, suggest that gum disease may be a treatable risk factor for gestational diabetes. Among pregnant women researchers followed, the 8 percent who developed gestational diabetes had higher levels of gum-disease-causing bacteria and inflammation.

Gum disease can trigger an inflammatory response not only in the gums, but throughout the body. It’s possible that such inflammation may exacerbate any pregnancy-related impairment in blood sugar control, contributing to gestational diabetes in some women, the researchers speculate.

Past studies have also linked gum disease to a higher risk of premature birth, with one theory being that systemic inflammation is involved.  Of the 265 women in the study, 83 percent were Hispanic, a group that is at higher-than-average risk of both gestational diabetes and type 2 diabetes. The women who developed gestational diabetes were also significantly more likely to be heavier before they became pregnant, have had gestational diabetes before, and higher C reactive protein levels, a marker for inflammation and cardiovascular disease.

In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant,” Dr. Ananda P. Dasanayake, the lead researcher on the study, said in a statement. “Treating gum disease during pregnancy has been shown to be safe and effective in improving women’s oral health and minimizing potential risks,” added Dasanayake, a professor at the New York University College of Dentistry.

Future studies, Dasanayake noted, should investigate the link between gum disease and gestational diabetes in other high-risk groups, such as Asian and Native American women. SOURCE: Journal of Dental Research, April 2008.


Abstract Journal of Periodontology 2007, Vol. 78, No. 11, Pages 2095-2103 (doi:10.1902/jop.2007.060388)
Effect of Periodontal Therapy on Pregnancy Outcome in Women Affected by Periodontitis

Fouzia Tarannum* and ­Mohamed Faizuddin*­

Background: There is convincing evidence to suggest that infections affecting the mother during pregnancy may produce alterations in the normal cytokine- and hormone-regulated gestation, which could result in preterm labor, premature rupture of membranes, and preterm birth (PTB). Studies in the late 1990s associated periodontitis with preterm low birth weight (PLBW) deliveries, and this may have similar pathogenic mechanisms as other maternal infections. This study determined the effect of non-surgical periodontal therapy on pregnancy outcome.

Methods: A total of 200 pregnant women with periodontitis were randomly assigned to treatment and control groups. Detailed data about previous and current pregnancies were obtained. All women received a full-mouth periodontal examination, including oral hygiene index-simplified, bleeding index, and clinical attachment level. The women in the treatment group received non-surgical periodontal therapy during the gestational period, and those in the control group received periodontal treatment after delivery. Periodontal therapy included plaque control instructions and scaling and root planing performed under local anesthesia. The outcome measures assessed were gestational age and birth weight of the infant. PTB was recorded when delivery occurred at <37 weeks of gestation, and low birth weight (LBW) was recorded when the infant weighed <2,500 g.

Results: There were 53 PTBs in the treatment group and 68 PTBs in the control group. Twenty-six LBW infants were recorded in the treatment group, and 48 LBW infants were noted in the control group. The mean gestational ages were 33.8 ± 2.8 weeks and 32.7 ± 2.8 weeks in the treatment and control groups, respectively. The difference was statistically significant at P <0.006. The mean birth weight was 2,565.3 ± 331.2 g in the treatment group and 2,459.6 ± 380.7 g in the control group, with the difference being statistically significant at P <0.044. A multiple regression model showed a significant effect of periodontal treatment on birth outcomes.

Conclusions: Non-surgical periodontal therapy can reduce the risk for preterm births in mothers who are affected by periodontitis. Additional multicentered, randomized, controlled clinical trials are required to confirm this link between periodontitis and PLBW.


Journal of Periodontology 2007, Vol. 78, No. 7, Pages 1249-1255 (doi:10.1902/jop.2007.060368)
Detection of Porphyromonas gingivalis in the Amniotic Fluid in Pregnant Women With a Diagnosis of Threatened Premature Labor Rubén León,* ­Nora Silva, ­Alfredo Ovalle, ­Alejandra Chaparro,§ ­Alexis Ahumada,§ ­Marta Gajardo, ­Maria Martinez, and ­Jorge Gamonal§­

Background: Epidemiologic and randomized controlled studies have shown that periodontal diseases may be associated with preterm labor and delivery of infants with low birth weights. The purpose of the present study was to determine the presence of microbial invasion of the amniotic cavity by periodontopathic bacteria in pregnant women with a diagnosis of threatened premature labor.

Methods: A periodontal examination and collection of amniotic fluid and subgingival plaque samples were performed on women identified as having threatened premature labor (preterm premature rupture of membranes without clinical infection or labor and preterm labor with intact membranes) and a gestational age ranging between 24 and 34 weeks. Samples collected from amniotic fluid and from the four deepest periodontal pockets in each patient were pooled in prereduced transport fluid and cultured. Porphyromonas gingivalis was identified primarily by colony morphology under stereoscopic microscope and rapid biochemical tests. Amniotic fluid or plaque samples were homogenized, DNA was extracted, and polymerase chain reaction (PCR) amplification of 16S rRNA with specific and universal primers was carried out.

Results: Twenty-six women with threatened premature labor were included: eight with preterm premature rupture of membranes and 18 with preterm labor with intact membranes. Eight women presented with gingivitis, 12 with chronic periodontitis, and six without periodontal disease. Microbial invasion of the amniotic cavity as detected by P. gingivalis PCR was 30.8% (eight of 26 patients). In these eight patients, P. gingivalis was present in both the subgingival samples and the respective amniotic fluid sample.

Conclusion: The presence of microbial invasion of the amniotic cavity by P. gingivalis could indicate a role for periodontal pathogenic bacteria in pregnant women with a diagnosis of threatened premature labor.


Periodontal Bacteria Found In Amniotic Fluid

ScienceDaily (July 6, 2007) — A study appearing in the July issue of the Journal of Periodontology found bacteria commonly found in the mouth and associated with periodontal diseases in the amniotic fluid of some pregnant women.

The study, which evaluated 26 pregnant women with a diagnosis of threatened premature labor, found the presence of periodontal bacteria, P. Gingivalis, in both the oral cavity and amniotic fluid in 30% of the women. Amniotic fluid is a liquid that surrounds an unborn baby during pregnancy. Any disruptions in the amniotic fluid, such as a bacterial infection, could potentially be dangerous to both the mother and baby.

“We evaluated women who were at risk of premature labor,” said study author Gorge Gamonal, Faculty of Dentistry, University of Chile. “We know that there are many reasons a woman can be diagnosed with threatened premature labor, including bacterial infection. Past research has shown a relationship between adverse pregnancy outcomes and periodontal disease, a chronic bacterial infection.”

“While this study’s findings do not show a direct causal relationship between periodontal diseases and adverse pregnancy outcomes, it is still important for women to pay special attention to their oral health during pregnancy,” explained Preston D. Miller, Jr., DDS, President of the American Academy of Periodontology. “Woman who are pregnant or considering becoming pregnant should speak with their dental and health care professionals about their oral health during pregnancy.”


1: Am J Obstet Gynecol. 2006 Oct;195(4):1025-30.

A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery.

OBJECTIVE: Matrix metalloproteinase-8 (MMP-8) is an enzyme that is released during neutrophil activation. MMP-8 amniotic fluid concentrations are elevated not only in patients with intra-amniotic infection, but also in patients with negative amniotic fluid cultures who deliver preterm neonates. The objective of this study was to determine whether the results of a rapid MMP-8 bedside test predict imminent preterm delivery.

This test can be performed in 15 minutes and without laboratory equipment. STUDY DESIGN: Amniotic fluid was retrieved from 331 patients admitted with increased preterm uterine contractions and intact membranes who met the inclusion criteria. Amniotic fluid was processed for microbial cultures, Gram stain, glucose concentration, and white blood cell count. Amniotic fluid samples were stored, and the MMP-8 rapid test was performed after delivery. End points included spontaneous preterm delivery within 48 hours, 7 days, and 14 days.

Diagnostic indices, predictive values, and likelihood ratios were calculated. RESULTS: The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days was 11.6% (38/327), 20.2% (66/327), and 24.5% (80/327), respectively (4 patients with augmentation of labor were excluded). A positive MMP-8 rapid test had a positive predictive value of 70% (23/33) for the identification of patients who delivered spontaneously within 48 hours, and 94% (31/33) for patients who were delivered within 7 days and 14 days (likelihood ratios: 17.5 [95% CI, 9-33.9], 61.3 [95% CI, 15.1-250], and 50 [95% CI, 12-196], respectively).

CONCLUSION: The MMP-8 rapid test can identify patients at risk for preterm delivery within 7 days and 14 days. Moreover, a positive MMP-8 rapid test result can identify patients with intra-amniotic infection/inflammation with a high sensitivity and specificity. This rapid test will give clinicians a fast and accurate assessment of the inflammatory status of the amniotic cavity and allow for better identification of patients at risk for impending preterm delivery.


Maternal BANA Test Status and Preterm Labor
H.-C. CHAN1, C.-T. WU2, K. WELCH1, and W. LOESCHE1

Objective: To address the link between periodontal pathogens measured with the BANA test (N-benzoyl-DL-arginine-2-naphthylamide) and preterm birth (PB) (<37th week gestation).

Methods: A prospective study was performed in Changhua, Taiwan. Periodontal examination included plaque score, gingival bleeding score and measurement of BANA enzyme in plaque samples at the second and third trimester. Independent variables including maternal demographics (age, occupational and educational level, ethnicity, and medical history), risk factors for PB (pre-pregnancy BMI, smoking, alcohol drinking), previous pregnancy outcome (number of previous pregnancies, previous preterm, low birth weight and abortion history), current pregnancy status (genitourinary infection, time of first pre-natal visit, frequency of prenatal visit), and dental history were investigated. Pregnancy outcome data were collected, including gestational age, birth weight at delivery, and complications during pregnancy.

Results: Subjects (n=299) with pregnancy outcome and BANA test results were available for data analysis. There were 19(7%) PB deliveries. Fisher’s exact test revealed that categorical variables of previous PB history, previous LBW, pre-contraction, antepartum hemorrhage(AH), placenta previa(PP) and preterm premature rupture of membrane(PPROM) were significantly related to PB(p=0.044, 0.034, 0.013, <0.001, <0.001 and <0.001 respectively). Maternal weight gain (WG) showed a significantly difference between PB and normal term (p=0.001). These explanatory variables as well as BANA infected sites in the third trimester (BANA) and ethnicity were evaluated as predictor variables in a logistic regression model. Only BANA(Odds ratio(OR)= 5.786, 95% CI=1.198 to 27.950), WG(OR=0.793, 95%CI= 0.656 to 0.959), pre-contraction(OR=3.793, 95%CI=1.012 to 14.211), PP(OR=88.163, 95%CI=1.668 to 4658.869), PPROM(OR=22.674, 95%CI=5.826 to 88.247) were shown to have a significant influence on the PB outcome.

Conclusion: BANA-positive plaques were associated with PB, after controlling for other risk factors.

[Note: dentists may also perform BANA tests around teeth to assess levels of periodontal involvement.  But bleeding gingival tissues on gentle probing may still be the most viable mechanism to assess early stages of inflammation.–Ed]


Periodontitis is associated with high levels of hs-CRP in Preeclampsia

J. HERRERA1, B. PARRA2, J. BOTERO3, R. ARCE3, and A. CONTRERAS

Objectives: recent studies have shown that preeclamptic women present a high prevalence of periodontitis and greater periodontal destruction, suggesting that active periodontal disease may play a role in preeclampsia pathogenesis. This study investigated the effect of the severity of periodontal disease, subgingival microbial composition and serum hs-C-reactive protein levels (hs-CRP) in preeclamptic women.

Methods: a case-control study was carried out in Cali-Colombia comprised of 398 pregnant women between 28-36 weeks of gestational age. Socio-demographic data, obstetric risk factors, periodontal status, subgingival microbial composition and hs-CRP levels were determined in both groups. Preeclampsia cases were defined as blood pressure³140/90 mmHg and 0.3g proteinuria/24 hours. Controls were matched normotensive and non-proteinuric pregnant women in the same community. Variables found to be associated with preeclampsia were included in a multiple logistic regression model. Descriptive statistics and adjusted Odds Ratios were calculated.

Results: the case-control groups were comparable for sociodemographic and obstetric characteristics. hs-C reactive protein levels increased according to the severity of periodontitis (healthy/gingivitis median=4.75 mg/dl, mild periodontitis=5.16 mg/dl, moderate/severe periodontitis=6.90 mg/dl; P=0.03). Periodontal infection with E. corrodens in all women (n=167) was associated with higher levels of hs-CRP (median=6.34 mg/dl) compared with subjects not infected with the bacteria (n=231, median 5.32 mg/dl) (P<0.05). Regression analysis indicated that chronic periodontal disease and E. corrodens subgingival infection were significantly associated with preeclampsia (OR=1.71, 95% CI 1.11-2.65, P=0.01).

Conclusions: periodontitis severity and subgingival infection by E. corrodens were associated with increased levels of serum hs-C reactive protein in preeclampsia.


Small Bacteria–Big Impact

Two studies look at the possible connection periodontal bacteria may have with other systemic conditionsCHICAGO—April 10, 2007—Two new studies in the Journal of Periodontology explore the possible link between periodontal bacteria and coronary artery disease as well as periodontal bacteria and preeclampsia. These studies found that periodontal bacteria, which is often invisible to the naked eye, may account for big effects on general health conditions.

Periodontal bacteria have often been thought to play a role in many of the possible connections between oral health and overall health. Two of the studies in this month’s issue of the JOP further the understanding of these potential connections. One study looked at patients who had been diagnosed with coronary artery disease and examined the bacteria found in their arteries. They were able to identify periodontal pathogens in the coronary and internal mammary arteries in 9 out of 15 of the patients examined.

A second study looked at women who had suffered from preeclampsia during their pregnancy, a condition characterized by an abrupt rise in blood pressure that affects about 5% of pregnancies. The study found that 50% of the placentas from women with preeclampsia were positive for one or more periodontal pathogens. This was compared to just 14.3% in the control group. Both of these studies support the concept that periodontal organisms might be associated with the development of other systemic conditions such as coronary artery disease and preeclampsia.


Teratogenicity on Pregnant Rat Stimulated by A.Actinomycetemcomitans LPS

Y. SATO, N. KUBOYAMA, M. OHTA, T. SAITO, and Y. ABIKO, Nihon University, Matsudo Chiba, Japan

Objectives:Epidemiological studies suggested that maternal periodontal infection by Actinobacillus actinomycetemcomitans (Aa) increased a risk of prematurity and low birth weight, and proinflammatory cytokines may involve the phenomenon. Recently, C-reactive protein(CRP) thought to be an important factor induced low birth weight, however, the effects of Aa infection to dams on CRP production is unclear. To study the mechanism of low birth weight in maternal periodontal infection, effect of Aa LPS treatment on fetal growth restriction and CRP production in a rat dam model was examined. Methods:LPS of an Aa strain Y4 was isolated by hot phenol-water extraction. Timed-pregnant rats were randomly divided into 4 groups (n=5). Aa LPS was injected intravenously to pregnancy rats from gestation day 7 to 17 of pregnancy during fetal organogenesis at dose levels of 10, 100 and 300 microg/kg body weight. Control group was treated with LPS-free saline. The pregnant rats were sacrificed at gestation day 21. Serum levels of proinflammatory cytokines and CRP were measured by ELISA. Results:The embryo-fetal death/resorption rate increased, and fetus body weights was decreased by LPS treatment in a dose dependent manner. LPS treatment significantly increased spleen weight in a dose-dependent manner. A significant positive linear relationship was found between placenta weights and fetus weights in all groups. The LPS significantly induced serum IL-1beta, IL-6 and CRP levels in a dose-dependent manner. Conclusion:Maternal Aa LPS infection increased fetal mortality rate, decreased birth weight of fetus through elevation of IL-1beta, IL-6 and CRP.


Amniotic fluid infections linked to premature births

Researchers find a greater number and variety of bacteria and fungi in a notable portion of women with pre-term deliveries. The more severe the infection, the earlier they were likely to give birth. By Mary Engel, Los Angeles Times Staff Writer
August 30, 2008 Microbes in the wrong place at the wrong time — a woman’s amniotic fluid during pregnancy — may play a role in causing premature births, according to a study published in the online journal PLoS ONE.

Using sensitive molecular techniques, researchers found a greater quantity and variety of bacteria and fungi in a significant portion of women who gave birth prematurely. The more severe the infection, the earlier the women were likely to give birth.

The amniotic sac, which surrounds a fetus, has long been considered a protected, almost inviolable, site.

“Certain kinds of organisms have been known to get in and not necessarily cause any harm,” said Dr. David Relman, an infectious disease specialist at Stanford University School of Medicine and the study’s senior author. “But in general, bugs don’t belong there.”

One in eight American infants is born before full term, which is defined as 37 completed weeks.

The high rate is attributed in part to assisted reproduction, which often results in twins or triplets. But the cause of about half of all spontaneous premature births is a mystery.

Babies born too early can have learning disabilities, neurological problems, lung diseases and cerebral palsy. Prematurity is the leading cause of infant mortality in the United States, accounting for more than a third of all infant deaths, according to the national Centers for Disease Control and Prevention.

Dr. Dan DiGiulio, a research associate in Relman’s laboratory, used two techniques of molecular biology — polymerase chain reaction and DNA sequencing — to look for microbes in amniotic fluid samples from 166 women in preterm labor. Of these women, 113 went on to deliver prematurely and 53 carried their babies to full term.

DiGiulio found evidence of infection in 15% of the samples, all from women who gave birth early. The microbes found represented one fungal and 17 bacterial species, including one that had never been identified, according to the report published Monday.

One of the most common was Leptotrichia, which can be found in the mouth and the vagina. Both gum disease and bacterial vaginosis have been linked with a higher risk of premature delivery.

mary.engel@latimes.com


*major impacts on health

*major impacts on quality of life

*much of the results are in your hands

 
 

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