Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study

Interleukin 1 beta and its association with the periodontal health of pregnant women

Objectives

In this study, we measured and compared serum and gingival crevicular fluid (GCF) levels of interleukin 1 beta (IL-1β) in pregnant women with periodontitis and pregnant women with a healthy periodontium. We also determined the prevalence of periodontitis among pregnant women attending Omdurman Midwifery Hospital.

Materials

This was a hospital-based clinical study and laboratory investigation using ELISA tests of 80 pregnant women in the third trimester conducted at the Omdurman Midwifery Hospital in Khartoum, Sudan. The study group consisted of 50 women while the control group consisted of 30 women.

Results

Independent samples t-tests were used to compare serum and GCF levels of IL-1β between the study and control groups. Pearson's correlation analysis was also used to compare gingival parameters and IL-1β levels in the GCF. For each comparison, the p-value was fixed at 0.05. The GCF in the research group showed a considerable increase in IL-1β levels. There was also a strong positive association between high IL-1β levels in the research group's GCF and probing pocket depth (PPD) and clinical attachment level (CAL) levels.

Conclusions

Our study provides further evidence that periodontitis, as measured by a PD ≥4 mm and a CAL ≥3 mm, is associated with an increased level of IL-1β in the GCF of pregnant women with active periodontal disease during pregnancy and may include the transient translocation of oral organisms to the utero-placental unit, inciting placental inflammation or oxidative stress early in pregnancy, ultimately resulting in placental damage and clinical manifestations.

The Oral Microbiome Throughout Pregnancy: A Scoping Review

INTRODUCTION

Oral health is associated with systemic health, including adverse pregnancy outcomes. Understanding the oral microbiome during pregnancy may lead to targeted interventions for prevention of adverse outcomes. The purpose of this review is to examine the literature on the oral microbiome throughout pregnancy.

METHODS

We conducted a literature search with four electronic databases for original research conducted between 2012 and 2022 that examined the oral microbiome longitudinally using 16s rRNA sequencing during pregnancy.

RESULTS

We identified six studies that examined the oral microbiome longitudinally throughout pregnancy, though comparisons of oral niches, oral microbiome measures, and findings between studies were not consistent. Three studies identified alterations in alpha diversity throughout pregnancy and two studies identified increased pathogenic bacteria during pregnancy. Three studies reported no changes in the oral microbiome throughout pregnancy, and one study identified differences in the composition of the microbiome based on socioeconomic status and antibiotic exposure. Two studies examined adverse pregnancy outcomes in association with the oral microbiome, one reporting no associations and one reported difference in community gene composition in those diagnosed with preeclampsia.

CLINICAL IMPLICATIONS

There is limited research on the composition of the oral microbiome throughout pregnancy. There may be alterations in the oral microbiome during pregnancy such as increased relative abundance of pathogenic bacteria. Socioeconomic status, antibiotic use, and education may contribute to differences in the microbiome composition over time. Clinicians should evaluate oral health and educate on the importance of oral health care during the prenatal and perinatal time period.

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in Dakar, Senegal. Demographic characteristics, lifestyle habits, prenatal clinical status, and oral clinical parameters were recorded. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. Eighty-eight percent of women had gingivitis, 15% were classified as moderate and 73% as severe. A total of 66.7% (95% CI [28.8-92.1]) of the sites had bleeding on interdental brushing. The odds for gingivitis decreased significantly for women consuming more than five portions of fruits and vegetables per day (OR = 0.15; 95% CI [0.03-0.66]) and increased in women who had a professional activity (OR = 6.75; 95% CI [1.27-35.87]) and high education. Concomitantly, the percentage of dental plaque (OR = 131.6; 95% CI [10.80-1619.71] and the severity of clinical attachment loss (OR = 7.70; 95% CI [3.16-18.92]) were important risk factors. Inverse associations were observed with increasing body mass index (OR = 0.76; 95% CI [0.63-0.93]). Our results underline that gingivitis cases and bleeding were particularly high among 3-month pregnant women. Literacy and adequate oral hygiene actions to modify behaviors and to achieve meticulous biofilm disorganization could make a favorable change in the gingival health outcome. Additionally, further research is necessary to precisely determine the role of biofilm-induced gingivitis and systemic-induced gingivitis in improving gingival conditions.

The bidirectional relationship between periodontal disease and pregnancy via the interaction of oral microorganisms, hormone and immune response

Periodontal disease has been suggested to be linked to adverse pregnancy outcomes such as preterm birth, low birth weight, and preeclampsia. Adverse pregnancy outcomes are a significant public health issue with important clinical and societal repercussions. This article systematically reviews the available epidemiological studies involving the relationship between periodontal disease and adverse pregnancy outcomes over the past 15 years, and finds a weak but independent association between adverse pregnancy outcomes and periodontal disease. The bidirectional association and the potential mechanisms are then explored, focusing on three possible mechanisms: inflammatory reaction, oral microorganisms and immune response. Specifically, elevated systemic inflammation and increased periodontal pathogens with their toxic products, along with a relatively suppressed immune system may lead to the disruption of homeostasis within fetal-placental unit and thus induce adverse pregnancy outcomes. This review also explains the possible mechanisms around why women are more susceptible to periodontal disease. In conclusion, pregnant women are more likely to develop periodontal disease due to hormonal changes, and periodontal disease has also been suspected to increase the incidence of adverse pregnancy outcomes. Therefore, in order to lessen the risk of adverse pregnancy outcomes, both obstetricians and dentists should pay attention to the development of periodontal diseases among women during pregnancy.

Maternal and dietary behavior-related factors associated with preterm birth in Southeastern Terai, Nepal: A cross sectional study

Background

Preterm birth (PTB) is a global issue although its burden is higher in low- and middle-income countries. This study examined the risk factors of PTB in Southeastern Terai, Nepal.

Methods

In this community-based cross-sectional study, a total of 305 mothers having children under the age of 6 months were selected using systematic random sampling. Data were collected by structured interviewer-administered questionnaires and maternal antenatal cards from study participants for some clinical information. Predictors of PTB were identified using multi-level logistic regression analysis at a P-value < 0.05.

Results

Of the total 305 mother-live-born baby pairs, 13.77% (42/305) had preterm childbirth. Maternal socio-demographic factors such as mothers from Dalit caste/ethnicity [adjusted odds ratio (AOR) = 12.16, 95% CI = 2.2-64.61] and Aadibasi/Janajati caste/ethnicity (AOR = 3.83, 95% CI = 1.01-14.65), family income in the first tercile (AOR = 6.82, 95% CI = 1.65-28.08), than their counterparts, were significantly positively associated with PTB. Likewise, other maternal and dietary factors, such as birth order first-second (AOR = 9.56, 95% CI = 1.74-52.53), and birth spacing ≤ 2 years (AOR = 5.16, 95% CI = 1.62-16.42), mothers who did not consume additional meal (AOR = 9.53, 95% CI = 2.13-42.55), milk and milk products (AOR = 6.44, 95% CI = 1.56-26.51) during pregnancy, having <4 antenatal (ANC) visits (AOR = 4.29, 95% CI = 1.25-14.67), did not have intake of recommended amount of iron and folic acid tablets (IFA) (<180 tablets) (AOR = 3.46, 95% CI = 1.03-11.58), and not having adequate rest and sleep (AOR = 4.83, 95% CI = 1.01-23.30) during pregnancy had higher odds of having PTB than their counterparts.

Conclusion

Some socio-demographic, maternal, and dietary behavior-related factors were independently associated with PTB. These factors should be considered while designing targeted health interventions in Nepal. In addition, we recommend specific measures such as promoting pregnant women to use available antenatal care and counseling services offered to them, as well as having an adequate diet to a level that meets their daily requirements.

Periodontal Disease and Adverse Neonatal Outcomes: A Systematic Review and Meta-Analysis

Objective

The aim of this study was to evaluate the association between maternal periodontal disease (PD) and three main adverse neonatal outcomes, namely, preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA).

Methods

The Ovid Medline, Web of Science, Embase, and Cochrane Library were searched up to 6 December 2020 for relevant observational studies on an association between PD and risk of PTB, LBW, and SGA. Eligibility criteria included observational studies which compared the prevalence of PTB and/or LBW and/or SGA between PD women and periodontal health controls. The exclusion criteria included incomplete data, animal research, and mixing up various pregnancy outcomes, such as "preterm low birth weight" and languages other than Chinese and English. Data were extracted and analyzed independently by two authors. The meta-analysis was performed using Stata Statistical Software, Release 12 (StataCorp LP, College Station, TX, USA). Odds ratio (OR), confidence intervals (CIs), and heterogeneity (I 2) were computed.

Results

Fourteen case-control studies and 10 prospective cohort studies, involving 15,278 participants, were identified. Based on fixed effect meta-analysis, PTB showed a significant association with PD (OR = 1.57, 95% CI: 1.39-1.77, P < 0.00001) and LBW also showed a significant association with PD (OR = 2.43, 95% CI: 1.75-3.37, P < 0.00001) in a random effect meta-analysis. However, a random effect meta-analysis showed no relationship between PD and SGA (OR = 1.62, 95% CI: 0.86-3.07, P = 0.136).

Conclusion

Our findings indicate that pregnant women with PD have a significantly higher risk of PTB and LBW. However, large prospective, blinded cohort studies with standardized diagnostic criteria of PD and adequate control of confounding factors are still required to confirm the relationship between PD and adverse neonatal outcomes.

Oral bacteria, oral health, and adverse pregnancy outcomes

The link between oral health and adverse pregnancy outcomes has been suggested by numerous epidemiological studies. More recent studies indicate the relationship between severity of periodontal disease and adverse pregnancy outcomes. Two virulence mechanisms are proposed: direct invasion of oral microorganisms or their components into the fetal-placenta unit and inflammatory mediators produced in the oral cavity affecting the fetal-placenta unit. While interventional periodontal therapy still yielded contradictory results, animal studies suggest that maternal supplementation of omega-3 fatty acids protects the fetus by suppressing inflammation as well as bacteria proliferation in the placenta. This article reviews the recent epidemiological, mechanistic, interventional, and therapeutic studies of oral health and adverse pregnancy outcomes.