Association Between Maternal Periodontitis and an Increased Risk of Preeclampsia

The Maternal Microbiome and Gestational Diabetes Mellitus: Cause and Effect

Gestational diabetes mellitus (GDM) is a growing public health concern that affects many pregnancies globally. The condition is associated with adverse maternal and neonatal outcomes including gestational hypertension, preeclampsia, placental abruption, preterm birth, stillbirth, and fetal growth restriction. In the long-term, mothers and children have an increased risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease. Accumulating evidence suggest that alterations in the maternal microbiome may play a role in the pathogenesis of GDM and adverse pregnancy outcomes. This review describes changes in the maternal microbiome during the physiological adaptations of pregnancy, GDM and adverse maternal and neonatal outcomes. Findings from this review highlight the importance of understanding the link between the maternal microbiome and GDM. Furthermore, new therapeutic approaches to prevent or better manage GDM are discussed. Further research and clinical trials are necessary to fully realize the therapeutic potential of the maternal microbiome and translate these findings into clinical practice.

Systemic Profile and Periodontal Condition of Hospitalized Women with High-Risk Pregnancy: A Cross-Sectional Study

INTRODUCTION

The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes.

OBJECTIVE

This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy.

METHODS

Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05).

RESULTS

The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy.

Periodontitis and Preeclampsia in Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVES

A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.

METHODS

Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case-control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran's Q statistic.

RESULTS

Thirty studies including six cohort- and twenty-four case-control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 - 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).

CONCLUSIONS

Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.

Viruses, periodontitis, and comorbidities

Seminal studies published in the 1990s and 2000s explored connections between periodontal diseases and systemic conditions, revealing potential contributions of periodontal diseases in the initiation or worsening of systemic conditions. The resulting field of periodontal medicine led to the publication of studies indicating that periodontal diseases can influence the risk of systemic conditions, including adverse pregnancy outcomes, cardiovascular and respiratory diseases, as well as Alzheimer disease and cancers. In general, these studies hypothesized that the periodontal bacterial insult and/or the associated proinflammatory cascade could contribute to the pathogenesis of these systemic diseases. While investigations of the biological basis of the connections between periodontal diseases and systemic conditions generally emphasized the bacteriome, it is also biologically plausible, under an analogous hypothesis, that other types of organisms may have a similar role. Human viruses would be logical "suspects" in this role, given their ubiquity in the oral cavity, association with periodontal diseases, and ability to elicit strong inflammatory response, compromise immune responses, and synergize with bacteria in favor of a more pathogenic microbial consortium. In this review, the current knowledge of the role of viruses in connecting periodontal diseases and systemic conditions is examined. We will also delve into the mechanistic basis for such connections and highlight the importance of those relationships in the management and treatment of patients.

Maternal HPV Infection: Effects on Pregnancy Outcome

The human papilloma virus (HPV) infection, caused by a ubiquitous virus typically transmitted through the direct contact of infected organs, either through the skin or mucosa, is the most common sexually transmitted infection, placing young women at a high risk of contracting it. Although the vast majority of cases spontaneously clear within 1-2 years, persistent HPV infection remains a serious concern, as it has repeatedly been linked to the development of multiple malignancies, including cervical, anogenital, and oropharyngeal cancers. Additionally, more recent data suggest a harmful effect of HPV infection on pregnancy. As the maternal hormonal environment and immune system undergo significant changes during pregnancy, the persistence of HPV is arguably favored. Various studies have reported an increased risk of adverse pregnancy outcomes among HPV-positive women, with the clinical impact encompassing a range of conditions, including preterm birth, miscarriage, pregnancy-induced hypertensive disorders (PIHD), intrauterine growth restriction (IUGR), low birth weight, the premature rupture of membranes (PROM), and fetal death. Therefore, understanding the mechanisms employed by HPV that negatively impact pregnancy and assessing potential approaches to counteract them would be of interest in the quest to optimize pregnancy outcomes and improve child survival and health.

Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures

Background: Pregnancy is a unique moment in a woman’s life, accompanied with several physiologic changes that have an impact on oral health. Aim of the study: The purpose of the present study was to conduct a critical review of published literature regarding pregnancy and dentistry, the most frequent oral diseases that are encountered during pregnancy, their correlation to adverse pregnancy events, and safe dental treatments that can be performed during pregnancy. Methods: A Medline/COCHRANE search was carried using specific keywords and MeSH terms, combined with the boolean operators “OR” and “AND”. Results: The search led to 146 publications including guidelines, meta-analyses, systematic and non-systematic reviews, published between 2000 and 2021. Discussion and conclusions: Due to the increased inflammatory and immune body response that characterizes pregnancy, periodontal conditions are often aggravated during pregnancy and periodontal disease encountered frequently in pregnant patients. There are conflicting study results in the literature regarding the association between periodontitis and adverse pregnancy outcomes. Periodontal treatment did not show a significant reduction in the adverse outcomes. Many dentists, often due to lack of information, are reluctant to provide dental treatment to pregnant women. However, preventive and restorative dental treatment is safe during pregnancy. Diagnostic radiographs may be performed after the first trimester if absolutely necessary. Analgesics (such as paracetamol) and anesthetics (such as lidocaine) are also considered safe. In case of infection, antibacterial drugs such as amoxicillin, ampicillin, and some cephalosporines and macrolides can also be prescribed. Organogenesis takes place in the first trimester, the time during which the fetus is susceptible to severe malformations (teratogenesis). The ideal time to perform dental treatment is the second trimester (week 17 to 28). However, acute pain or infections make the intervention of the dentist absolutely necessary and emergency treatment can be performed during the whole pregnancy period.

Evaluation of Microflora (Viral and Bacterial) in Subgingival and Placental Samples of Pregnant Women with Preeclampsia with and without Periodontal Disease: A Cross-Sectional Study

Aim

Previous studies showed associated periodontal disease with various systemic ailments. This research work was aimed at studying the presence and role of periodontal microflora on preeclampsia during pregnancy.

Materials and Methods

A cross-sectional study was designed on pregnant women with preeclampsia with and without chronic periodontitis, attending Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India, for prenatal checkups. After obtaining consents, 445 women were recruited in the study. On the basis of systemic and periodontal health, subjects were grouped into Group 1 (women with preeclampsia with chronic periodontitis) and Group 2 (women with preeclampsia without chronic periodontitis). Clinical parameters such as plaque index, bleeding on probing, probing depth, and clinical attachment level were recorded. Quantification of periodontopathic bacteria (Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Tannerella forsythia, Treponema denticola), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV), were detected using real-time polymerase chain reaction in subgingival samples at one point of time and later compared in placental tissue after parturition.

Results

T. forsythia, T. denticola, F. nucleatum, P. intermedia, EBV, CMV, and HSV were expressed more in Group 3 compared to those in Groups 2, 4, and 1, in their subgingival and placental samples.

Conclusion

Elevated levels of bacteria and viruses were expressed in subgingival and placental samples in women with preeclampsia with chronic periodontitis compared to those in women with preeclampsia without chronic periodontitis. This shows that chronic periodontitis is a risk factor for preeclampsia. The results concluded that periodontal flora is not only localized to periodontal tissues but can also enter uterine cavity and may elicit their pathological response on mother and developing fetus.

Oral Health in Women with a History of High Gestational Diabetes Risk

We studied oral health in 115 women with and without a history of gestational diabetes (GDM), expecting poorer oral health in the GDM group. Full-mouth examinations were performed 5 years postpartum and the number of teeth, total dental index (TDI) and decayed, missing, filled teeth (DMFT) index were calculated. Bleeding on probing (BOP), probing depth (PD), visible plaque index (VPI), and clinical attachment level (CAL) were recorded. The periodontal inflammatory burden index (PIBI) was calculated. Panoramic radiographs were taken and signs of infections recorded. Oral health habits, symptoms and participants' own opinion of oral health were recorded with questionnaires. At the time of examination, 45% of the women had a history of GDM in the index pregnancy. Mild periodontitis (62%) and bleeding on probing (46%) were common. VPI (13% and 17%, p = 0.009) and PIBI (13.1 and 17.5, p = 0.041) were lower among women with a history of GDM compared with those with no history of GDM. There was no difference between groups in DMFT scores. All women reported good subjective oral health. Thus, contrary to our hypothesis, women with a history of GDM showed better oral health parameters than women without a history of GDM.

Relationship between General Health, Lifestyle, Oral Health, and Periodontal Disease in Adults: A Large Cross-sectional Study in Japan

The aim of this study was to investigate how general health, oral conditions, and lifestyle were associated with periodontal disease in adults, as clarifying this relationship may be useful in preventing periodontal disease. Medical checkups were conducted on individuals aged 40, 50, or 60 years. Data were obtained for analysis on a total of 36,110 patients (men, 12,784; women, 22,896). A stepwise logistic regression model was used to calculate the odds ratio (OR) for patients who were ≥code 3 according to the Community Periodontal Index (CPI). Approximately 40, 60, and 70% of men aged 40, 50, and 60 years, respectively, had a CPI score of ≥3. There were 10% fewer women than men at each age. Stepwise logistic regression revealed a BMI score of ≥30 kg/m²(OR, 1.44; 95% confidence interval [95%CI], 1.20-1.73); systolic blood pressure of ≥140 mmHg (OR, 1.09; 95%CI, 1.02-1.18); a fasting blood sugar level of ≥110 mg/dl (OR, 1.17; 95%CI, 1.04-1.30); high-density lipoprotein cholesterol level of <40 mg/dl (OR, 1.21; 95%CI, 1.06-1.37); smoker (OR, 1.59; 95%CI, 1.48-1.71); drinking ≥3 cups of Japanese sake per day (OR, 1.09; 95%CI, 1.05-1.14); use of salts for seasoning (OR, 1.17; 95%CI, 1.07-1.28); and fair and poor oral hygiene (OR, 2.27; 95%CI, 2.08-2.47) as significant risk factors for a CPI score of ≥3. These results suggest that smoking, oral hygiene status, and factors associated with metabolic syndrome are associated with periodontitis. This indicates that health guidance on tooth brushing, the importance of quitting smoking, and control of obesity may be effective in preventing the development of periodontal disease in adults.

Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes--systematic review

BACKGROUND AND OBJECTIVES

There is still debate regarding potential relationships between maternal periodontitis during pregnancy and adverse pregnancy outcomes. The aim of this systematic review was to synthesize the available epidemiological evidence on this association.

DATA SOURCES

Combined electronic and hand search of MEDLINE, EMBASE, WEB OF SCIENCE and Cochrane Central Register databases.

STUDY ELIGIBILITY CRITERIA

Original publications reporting data from cross-sectional, case-control or prospective cohort epidemiological studies on the association between periodontal status and preterm birth, low birthweight (LBW) or preeclampsia. The search was not limited to publications in English. All selected studies provided data based on professional assessments of periodontal status, and outcome variables, including preterm birth (<37 weeks gestation), LBW (<2500 g), gestational age, small for gestational age, birthweight, pregnancy loss or miscarriage, or pre-eclampsia.

PARTICIPANTS

Pregnant women with or without periodontal disease, and with or without adverse pregnancy outcomes, assessed either during pregnancy or postpartum. No intervention studies were included. Study appraisal and synthesis methods - Publications were assessed based on predefined screening criteria including type of periodontal assessment, consistency in the timing of the periodontal assessment with respect to gestational age, examiner masking and consideration of additional exposures and confounders.

RESULTS

Maternal periodontitis is modestly but significantly associated with LBW and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Although significant associations emerge from case-control and cross-sectional studies using periodontitis "case definitions," these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia.

LIMITATIONS

There is a high degree of variability in study populations, recruitment and assessment, as well as differences in how data are recorded and handled. As a result, studies included in meta-analyses show a high degree of heterogeneity.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Maternal periodontitis is modestly but independently associated with adverse pregnancy outcomes, but the findings are impacted by periodontitis case definitions. It is suggested that future studies employ both continuous and categorical assessments of periodontal status. Further use of the composite outcome preterm LBW is not encouraged.

Effects of Lipopolysaccharide on Human First Trimester Villous Cytotrophoblast Cell Function In Vitro

It has been shown that adverse obstetrical outcomes such as pre-eclampsia and intrauterine growth retardation correlate with maternal infection. In this study, we investigated mechanisms involved in infection-associated abnormalities in cytotrophoblast function. Primary human first trimester cytotrophoblast cells were isolated and treated with lipopolysaccharide (LPS). Levels of the cytokines and chemokines were measured and cytotrophoblast invasion was investigated. In addition, first trimester decidual macrophages were isolated and treated with the conditioned medium from LPS-treated cytotrophoblast cells, and macrophage migration was assessed. Coculturing decidual macrophages with cytotrophoblast cells was conducted to investigate macrophage costimulatory molecule and receptor expression and intracellular cytokine production. We found that LPS exposure increased cytotrophoblast production of pro-inflammatory cytokines tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6, and chemokines IL-8, macrophage inflammatory protein (MIP)-1alpha, and CXCL12 in a dose-dependent manner. In addition, LPS decreased cytotrophoblast invasion, and its effect was Toll-like receptor 4 (TLR4)-dependent and partly TNF-alpha-dependent. Conditioned medium from LPS-stimulated cytotrophoblast cells increased decidual macrophage migration and this effect was partly TLR4-dependent. Furthermore, coculturing decidual macrophages with LPS-exposed cytotrophoblast cells up-regulated macrophage CD80 and CD86 expression and intracellular TNF-alpha and IL-12p40 production, while down-regulating macrophage CD206 and CD209 expression and intracellular IL-10 secretion. LPS-stimulated macrophages also inhibited cytotrophoblast invasion. In conclusion, our results indicate that LPS increases the production of a subset of proinflammatory cytokines and chemokines by human first trimester cytotrophoblast cells, decreases cytotrophoblast invasion, and alters the cross talk between cytotrophoblast cells and decidual macrophages.

Association Between Periodontitis and Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis

BACKGROUND

To the best of the authors' knowledge, there is no systematic review of the potential association between periodontitis and gestational diabetes mellitus (GDM) in the current literature. The aim of the present systematic review and meta-analysis is to search for scientific evidence regarding the association between periodontitis and GDM.

METHODS

The present study was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (CRD2014010728) with PROSPERO (International prospective register for systematic reviews, University of York, York, UK). A search was conducted in three electronic databases without restrictions regarding language or date of publication. From 190 studies selected, 15 underwent full-text analysis. Eight studies were eligible (five cross-sectional and three case-control studies), and seven were entered in the meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity. Summary effect measures were calculated by odds ratio (OR) and 95% confidence interval (CI).

RESULTS

There was a significant association between periodontitis and GDM in the meta-analyses of four cross-sectional studies (OR 1.67, 95% CI 1.20 to 2.32) and two case-control studies (OR 2.66, 95% CI 1.52 to 4.65). However, sensitivity tests for case-control studies showed a lack of consistency in data; when including one case-control study, the significance was null (meta-analysis of three case-control studies: OR 1.69, 95% CI 0.68 to 4.21).

CONCLUSIONS

There was substantial clinical, methodologic, and statistical heterogeneity among the studies. The scientific evidence cannot affirm a positive association between periodontitis and GDM. Future studies with different designs in distinct populations should be conducted to investigate this association.

Significance of maternal periodontal health in preeclampsia

Objective:

The aim of the present case–control study was to evaluate the association between maternal periodontitis and preeclampsia. Association studies between maternal periodontitis and elevated risk for preeclampsia have shown conflicting results. Periodontal maintenance is necessary to reduce the risk of adverse pregnancy outcomes like preeclampsia.

Materials and Methods:

Periodontal parameters [bleeding on probing, probing depth (PD), and clinical attachment level (CAL)] of 1320 women were assessed, followed by retrieval of their demographic and medical data from the medical records. Based on the medical records, 80 women were excluded from the study, leaving 1240 females as the eligible sample for the study. The women were divided into control group (1120 non-preeclamptic women who gave birth to infants with adequate gestational age) and case group (120 preeclamptic women). Logistic regression analysis revealed that primiparity and maternal periodontitis were the two significant variables causing preeclampsia. Further analysis was carried out by matching the two groups for primiparity to find the significance of maternal periodontitis. Maternal periodontitis was defined as PD ≥4 mm and CAL ≥3 mm at the same site in at least four teeth.

Results:

The results showed that maternal periodontitis (odds ratio 19.8) was associated with preeclampsia. Maternal periodontitis also remained associated with preeclampsia after matching for primiparity, which was another significant confounding factor in the study (odds ratio 9.33).

Conclusion:

Maternal periodontitis is a risk factor associated with preeclampsia, emphasizing the importance of periodontal care in prenatal programs.

Can Porphyromonas gingivalis be a novel aetiology for recurrent miscarriage?

OBJECTIVE

To study the association between Porphyromonas gingivalis (P. gingivalis) infection and recurrent miscarriage.

METHODS

This case control study included women with early pregnancy failure admitted for surgical evacuation of retained products of conception. Cases (group 1) included 50 women with unexplained recurrent early miscarriage whereas the control group (group 2) consisted of 50 women with no such history. The evacuated products of conception, subgingival plaques, cervicovaginal secretions and saliva of all participants were examined to detect P. gingivalis deoxyribonucleic acid (DNA) using a polymerase chain reaction.

RESULTS

The prevalence of P. gingivalis DNA in the chorionic villous tissue samples of group 1 was significantly higher than in group 2 (8 [16%] vs. 1 [2%], respectively; p = 0.036, odds ratio [OR]: 9.3, 95% confidence interval [CI]: 1.1-76.9). The prevalence of P. gingivalis DNA was significantly higher in cervicovaginal secretions of group 1 than in group 2 (9 [18%] vs. 1 [2%], respectively; p = 0.02, OR: 10.8, 95% CI: 1.3-88.5). On the contrary, P. gingivalis DNA could not be detected in subgingival plaques and saliva samples of either group.

CONCLUSION

The current study found an association between P. gingivalis infection of the female genital tract and the occurrence of recurrent miscarriage.

Bi-directional relationship between pregnancy and periodontal disease

During pregnancy profound perturbations in innate and adaptive immunity impact the clinical course of a number of infectious diseases, including those affecting periodontal tissues. Conversely, it has been suggested that periodontal infections may increase the risk of adverse pregnancy outcomes. In this review, a summary of the literature associated with the bidirectional relationship between pregnancy and periodontal disease as well as the possible mechanisms behind this interaction were examined.

Acute maternal infection and risk of pre-eclampsia: a population-based case-control study

BACKGROUND

Infection in pregnancy may be involved in the aetiology of pre-eclampsia. However, a clear association between acute maternal infection and pre-eclampsia has not been established. We assessed whether acute urinary tract infection, respiratory tract infection, and antibiotic drug prescriptions in pregnancy (a likely proxy for maternal infection) are associated with an increased risk of pre-eclampsia.

METHODS AND FINDINGS

We used a matched nested case-control design and data from the UK General Practice Research Database to examine the association between maternal infection and pre-eclampsia. Primiparous women aged at least 13 years and registered with a participating practice between January 1987 and October 2007 were eligible for inclusion. We selected all cases of pre-eclampsia and a random sample of primiparous women without pre-eclampsia (controls). Cases (n=1533) were individually matched with up to ten controls (n=14236) on practice and year of delivery. We calculated odds ratios and 95% confidence intervals for pre-eclampsia comparing women exposed and unexposed to infection using multivariable conditional logistic regression. After adjusting for maternal age, pre-gestational hypertension, diabetes, renal disease and multifetal gestation, the odds of pre-eclampsia were increased in women prescribed antibiotic drugs (adjusted odds ratio 1.28;1.14-1.44) and in women with urinary tract infection (adjusted odds ratio 1.22;1.03-1.45). We found no association with maternal respiratory tract infection (adjusted odds ratio 0.91;0.72-1.16). Further adjustment for maternal smoking and pre-pregnancy body mass index made no difference to our findings.

CONCLUSIONS

Women who acquire a urinary infection during pregnancy, but not those who have a respiratory infection, are at an increased risk of pre-eclampsia. Maternal antibiotic prescriptions are also associated with an increased risk. Further research is required to elucidate the underlying mechanism of this association and to determine whether, among women who acquire infections in pregnancy, prompt treatment or prophylaxis against infection might reduce the risk of pre-eclampsia.

Relationship between periodontitis and pre-eclampsia: a meta-analysis

BACKGROUND

Studies have suggested controversial results regarding a possible association between pre-eclampsia (PE) and periodontal disease (PD) and no meta-analysis has been performed to clarify this issue.

METHODS

A literature search of electronic databases was performed for articles published through March 24, 2013, followed by a manual search of several dental and medical journals. The meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed with the χ(2)-based Cochran Q test and I(2) statistic. The level of significance was set at P <0.05.

RESULTS

Fifteen studies were included, including three cohort and 12 case-control studies. A positive association was found between PE and PD (OR 2.17, 95% CI 1.38-3.41, P = 0.0008). However, a high and significant heterogeneity was found (χ(2) = 62.42, P<0.00001, I(2) = 75%). In most cases, subgroup analysis had low power to detect significant differences between PE and non-PE groups.

CONCLUSION

Based on the findings of the meta-analysis, PD appears to be a possible risk factor for PE. However, given the important differences in the definitions and diagnoses of PD and PE among the studies, as well as their lack of good methodological quality, future trials are needed to confirm the results of the present meta-analysis.

Periodontal disease and risk of preeclampsia: a meta-analysis of observational studies

Background

Many epidemiological studies have found a positive association between periodontal disease (PD) and the risk of preeclampsia, but the magnitude of this association varies and independent studies have reported conflicting findings. We performed a meta-analysis to ascertain the relationship between PD and preeclampsia.

Methods

The PubMed database was searched up to January 12, 2013, for relevant observational studies on an association between PD and the risk of preeclampsia. Data were extracted and analyzed independently by two authors. The meta-analysis was performed using comprehensive meta-analysis software.

Results

Thirteen observational case-control studies and two cohort studies, involving 1089 preeclampsia patients, were identified. Based on a random-effects meta-analysis, a significant association between PD and preeclampsia was identified (odds ratio = 2.79, 95% confidence interval CI, 2.01–3.01, P<0.0001).

Conclusions

Although the causality remains unclear, the association between PD and preeclampsia may reflect the induction of PD by the preeclamptic state, or it may be part of an overall exaggerated inflammatory response to pregnancy. Larger randomized controlled trials with preeclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect the biological mechanisms involved.

Dietary behaviors and oral-systemic health in women

The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed.

Very low and low birth weight associated with maternal periodontitis

AIM

The aim of this study was to evaluate the association of very low and low birth weight (VLBW and LBW) with maternal periodontitis.

MATERIAL AND METHODS

Overall, 1206 women were examined at post-partum and two alternative criteria for periodontitis definition were used: (1) four or more teeth with at least one site with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 3 mm; and (2) at least one site with PD and CAL ≥ 4 mm. For each definition, two multivariate analyses were performed: (1) linear regression for birth weight; (2) ordinal logistic regression for birth weight, categorized as adequate (n = 1046), LBW (n = 145) and VLBW (n = 15).

RESULTS

Linear regression showed that maternal periodontitis was associated with a decrease in mean birth weight (periodontitis definition 1: p = 0.027; periodontitis definition 2: p = 0.003). Ordinal logistic regression showed that maternal periodontitis was associated with LBW and VLBW [odds ratio (OR) = 2.0; 95% confidence interval (CI) 1.39-2.90, when considering periodontitis definition 2]; and with LBW (OR = 1.65; 95% CI 1.15-2.36, when considering periodontitis definition 1).

CONCLUSION

Maternal periodontitis was associated with a decrease in mean birth weight, as well as with LBW and VLBW.

Severe preeclampsia and maternal self-report of oral health, hygiene, and dental care

BACKGROUND

Maternal periodontal disease diagnosed by a detailed oral health examination is associated with preeclampsia. Our objective was to measure the association between maternal self-report of oral symptoms/problems, oral hygiene practices, and/or dental service use before or during pregnancy and severe preeclampsia.

METHODS

A written questionnaire was administered to pregnant females at the time of prenatal ultrasound and outcomes were ascertained by chart abstraction. The χ(2) test compared maternal oral symptoms/problems, hygiene practices, and dental service use between females with severe preeclampsia versus normotensive females. Multivariable logistic regression was used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for severe preeclampsia.

RESULTS

A total of 48 (10%) of 470 females reported ≥2 oral symptoms/problems in the 6 months before pregnancy and 77 (16%) since pregnancy. Fifty-one (11%) reported previous periodontal treatment. Twenty-eight (6%) of 470 developed severe preeclampsia. Females with a history of periodontal treatment were more likely to develop severe preeclampsia (aOR = 3.71; 95% CI = 1.40 to 9.83) than females without a history of periodontal treatment. Self-reported oral health symptoms/problems, oral hygiene practices, or dental service use before or during pregnancy were not associated with severe preeclampsia when considered in the context of other maternal risk factors.

CONCLUSION

Maternal self-report of previous periodontal treatment before pregnancy is associated with severe preeclampsia.

Periodontal disease is not associated with preeclampsia in Canadian pregnant women

BACKGROUND

The findings from the studies on the relationship between periodontal disease and preeclampsia are inconsistent. The objective of this study is to examine the relationship between periodontal disease and preeclampsia.

METHODS

A multicenter case-control study was conducted in Quebec, Canada. Preeclampsia was defined as blood pressure ≥140/90 mm Hg and ≥1+ proteinuria after 20 weeks of gestation. Periodontitis was defined as the presence of ≥4 sites with a probing depth ≥5 mm and a clinical attachment loss ≥3 mm at the same sites.

RESULTS

A total of 92 preeclamptic women and 245 controls were analyzed. The percentage of periodontal disease was 18.5% in preeclamptic women and 19.2% in normotensive women (crude odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.52 to 1.77). After adjusting for confounding variables, periodontitis remained not associated with preeclampsia (adjusted OR = 1.13, 95% CI = 0.59 to 2.17).

CONCLUSION

This study does not support the hypothesis of an association between periodontal disease and preeclampsia.

Impact of periodontitis definition in epidemiological research. Results from the EPIPAP study in postpartum women

The purpose of this investigation was to study the impact of using various definitions of periodontitis on the frequency of periodontitis and on the associations with some known risk factors for periodontitis in a population of postpartum women in France. A clinical examination was performed within 2-4 d postpartum in 932 at-term women at five maternity units. We studied six definitions of periodontitis; five were applicable if at least two teeth were found to have the following: (i) a proximal clinical attachment level (CAL) of ≥ 3 mm; (ii) a probing depth (PD) of ≥ 4 mm; (iii) a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site; (iv) a proximal PD of ≥ 5 mm or a proximal CAL of ≥ 4 mm; or (v) a PD of ≥ 4 mm and a CAL ≥ 3 mm and bleeding on probing at the same site. The sixth definition required the involvement of four teeth with a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site. Associations between case status according to each definition and maternal characteristics (age, educational level, smoking before pregnancy, and time since last dental visit) were analyzed using generalized estimating equation models. The definition of periodontitis had an impact on the frequency of periodontitis, which ranged from 12.1% to 37.7%, and produced different ORs for the associations with risk factors for periodontitis.

Levels of gingival crevicular metalloproteinases-8 and -9 in periodontitis

Matrix metalloproteinases (MMPs), the key enzymes responsible for matrix degradation, are derived from polymorphonuclear leukocytes during the early stages of periodontitis. The aim of this study was planned to determine the levels of GCF (gingival crevicular fluid) matrix metalloproteinase-8 (MMP-8) and metalloproteinase-9 (MMP-9) patients with periodontitis and in healthy controls. Levels of crevicular MMP-8 and -9 were determined by ELISA in subjects with healthy without any periodontal disease (n = 10) and periodontitis (n = 10). Significantly higher crevicular MMP-8 and -9 were observed in cases of periodontitis compared to healthy adults. Crevicular MMP-8 and -9 may serve as biomarkers of periodontal disease and aid in early detection of periodontitis.

Association between periodontal diseases and systemic diseases

Current evidence suggests that periodontal disease may be associated with systemic diseases. This paper reviewed the published data about the relationship between periodontal disease and cardiovascular diseases, adverse pregnancy outcomes, diabetes and respiratory diseases, focusing on studies conducted in the Brazilian population. Only a few studies were found in the literature focusing on Brazilians (3 concerning cardiovascular disease, 7 about pregnancy outcomes, 9 about diabetes and one regarding pneumonia). Although the majority of them observed an association between periodontitis and systemic conditions, a causal relationship still needs to be demonstrated. Further studies, particularly interventional well-designed investigations, with larger sample sizes, need to be conducted in Brazilian populations.

Maternal periodontal disease and risk of preeclampsia: a case-control study

BACKGROUND

We examined whether pregnant women with periodontal disease have an increased risk of preeclampsia, and we empirically evaluated the extent to which associations between periodontal disease and preeclampsia are dependent upon diagnostic criteria used to define periodontal disease operationally.

METHODS

One hundred and fifty preeclampsia cases and one-fifty normotensive controls who delivered a singleton infant at term were enrolled. Periodontal examinations were performed within 48 h after delivery. Participants' periodontal health status was classified, a priori, into four categories according to the extent and severity of periodontal disease. Putative risk factors for periodontal disease and preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

No clinically meaningful differences were observed between cases and controls with regard to periodontal parameters. After controlling for known confounders, severe clinical periodontal disease was not associated with an increased risk of preeclampsia (OR = 0.92, 95% CI: 0.26-3.28). In addition, there was no evidence of a linear increase in risk of preeclampsia with increasing severity of periodontal disease (P for trend = 0.65). When different diagnostic criteria previously used in other studies were used, the prevalence of periodontal disease varied substantially. However, the magnitude and direction of associations between periodontal disease and preeclampsia were largely similar regardless of the diagnostic criteria used to define periodontal disease.

CONCLUSIONS

This study provides no convincing evidence that periodontal disease is associated with preeclampsia risk among Thai women.

Colonization of maternal and fetal tissues by Porphyromonas gingivalis is strain-dependent in a rodent animal model

OBJECTIVE

The objective of this study was to develop a rodent model of Porphyromonas gingivalis infection during pregnancy.

STUDY DESIGN

Sprague Dawley rats were infected intravenously with 10(5), 10(7), or 10(9) CFU per dam of P gingivalis strain W83, ATCC 33277, or A7436 at gestational day 14 and necropsied at gestational day 18. Maternal organs were cultured to assess the spread of the infection. Six fetal units (placenta, amniotic fluid, membranes, and fetus) per dam were cultured; additional fetal units were examined by histopathology. Polymerase chain reaction was performed on placentas.

RESULTS

Colonization rates were dependent on the strain of P gingivalis used and the infection dose. At an infection dose of 10(9) CFU/dam, P gingivalis W83, ATCC 33277, or A7436 was detected in 33%, 83%, or 100% of placentas, respectively. Epithelial hyperplasia, cellular necrosis, and inflammatory infiltrate were observed in infected placental tissues.

CONCLUSION

This study demonstrated that P gingivalis can invade both maternal and fetal tissues, resulting in chorioamnionitis and placentitis.

Maternal infection and risk of preeclampsia: systematic review and metaanalysis

There are lingering questions regarding the association between maternal infection and preeclampsia. Systematic review and metaanalysis was conducted of observational studies that examined the relationship between maternal infection and preeclampsia. Forty-nine studies met the inclusion criteria. The risk of preeclampsia was increased in pregnant women with urinary tract infection (pooled odds ratio, 1.57; 95% CI, 1.45-1.70) and periodontal disease (pooled odds ratio, 1.76; 95% CI, 1.43-2.18). There were no associations between preeclampsia and presence of antibodies to Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus, treated and nontreated HIV infection, and malaria. Individual studies did not find a relationship between herpes simplex virus type 2, bacterial vaginosis, and Mycoplasma hominis and preeclampsia. Urinary tract infection and periodontal disease during pregnancy are associated with an increased risk of preeclampsia. More studies are required to verify this as well as to explore whether or not such relationships are causal and, if so, the mechanisms involved.