Periodontal Disease and Adverse Pregnancy Outcomes: A Prospective Study in a Low-Risk Population.

BACKGROUND: Periodontal disease has been associated with systemic inflammation and adverse pregnancy outcomes, including preeclampsia and preterm birth. OBJECTIVE: To examine the relationship between periodontal disease in early pregnancy and the risk of amniotic inflammation, preterm birth, and preeclampsia. METHODS: We performed a prospective cohort study of women undergoing amniocentesis for fetal karyotype between 15 and 24 weeks' gestation. Participants underwent periodontal examination by a certified dentist, and a sample of amniotic fluid was collected. Periodontal disease was defined as the presence of one or more sites with probing depths ≥ 4 mm and ≥ 10% bleeding on probing. Matrix metalloproteinase-8 and interleukin-6 concentrations in the amniotic fluid were measured. Medical charts were reviewed for perinatal outcomes. Univariate and multivariate logistic regression analyses were used to assess the association between periodontal disease and adverse pregnancy outcomes. RESULTS: We recruited 273 women at a median gestational age of 16 weeks (range 15 to 24), and 258 (95%) agreed to undergo periodontal examination. Periodontal disease was observed in 117 of the participants (45%). We observed no significant association between periodontal disease and preterm birth (relative risk [RR] 2.27; 95% CI 0.74 to 6.96) or spontaneous preterm birth (RR 0.90; 95% CI 0.20 to 4.11). However, women with periodontal disease were more likely to develop preeclampsia, and this association remained significant after adjustment for potential confounders (adjusted RR 5.89; 95% CI 1.24 to 28.05). Periodontal disease was not associated with significant differences in the intra-amniotic concentration of matrix metalloproteinase-8 (13.0 ± 46.6 vs 5.7 ± 10.4 ng/mL, P = 0.098) or interleukin-6 (3.3 ± 20.3 vs 1.0 ± 1.6 ng/mL, P = 0.23), although a non-significant trend was observed. CONCLUSION: Periodontal disease is associated with preeclampsia but not with spontaneous preterm birth. The current study cannot exclude an association between periodontal disease and intra-amniotic inflammation.

[Active periodontitis as a potential risk factor of preferm delivery]. / Aktywne zapalenie przyzebia jako potencjalny czynnik ryzyka wystapienia porodu przedwczesnego.

The influence of active periodontitis on the incidence of preterm delivery has been widely described in numerous scientific papers. Studies suggest that an implementation of a periodontal treatment during pregnancy is not only safe for both, the mother and the child, but it also has a beneficial effect on the pregnancy and embryo-fetal development, consequently reducing morbidity and mortality among premature infants. Therefore, mandatory dental examinations in pregnant women may facilitate early implementation of periodontal treatment and reduce the rates of preterm delivery

Effect of periodontal treatment on the incidence of preterm delivery: a systematic review.

Preterm birth is a major problem in public health in developed and developing countries and the search for risk factors of this event is important. The aim of this study was to review the effect of periodontal treatment on the incidence of preterm delivery. A wide research was executed considering an evaluation period between November of 1998 and October of 2009 at MEDLINE/PUBMED databases. The selection strategy consisted of the search for the following key-words: "periodontal therapy" or "periodontal disease" and "pregnancy outcome" or "preterm birth". The search was limited for articles written in English. The randomized clinical trials that evaluated the effect of the non-surgical periodontal treatment on the incidence of Preterm Low Birth Weight (PLBW) were selected. In a total of 7 papers selected, the incidence of PLBW was lower in groups of women who were submitted to periodontal treatment. Reductions of Preterm Birth (PTB) ranged from 0.8% to 28.01%, while reduction of Low Birth Weight (LBW) ranged from 0.44% to 33%. In studies that analyzed these two variables together, there was variation between 4.57% to 71.5% in rates reduction. Due to heterogeneity of the data, the meta-analysis was not applied. The majority of the studies concluded that non-surgical periodontal treatment in pregnant women reduces incidence of preterm babies with low weight.

Prevention of preterm delivery with periodontal treatment.

OBJECTIVE: To demonstrate the role of periodontal treatment (PT) in the prevention of preterm delivery (PD). METHODS: A comparative prospective study of two groups of pregnant women with threatening PD was carried out at the Department of Obstetrics and Gynaecology of the University of Szeged: group A (n = 39) comprised patients who were merely examined dentally for periodontitis, and group B (n = 44) consisted of patients who received periodontal treatment during pregnancy. RESULTS: Periodontitis was identified in 19 cases (48.7%) in group A and in 18 cases (40.9%) in group B. The mean birth weight of the newborns was significantly higher in group B (3,009.1 g) than in group A (2,580.8 g; p = 0.007). The rate of premature birth was significantly lower in the group who received PT (p = 0.012, odds ratio = 3.5, 95% confidence interval = 1.38-8.86). CONCLUSIONS: The PT of pregnant women can decrease the rate of premature birth and consequently lead to a better neonatal health outcome.

Periodontal disease and preterm birth relationship: a review of the literature.

Despite medical care improves consistently, the rate of preterm birth has risen in recent years. In Italy the rate of preterm birth between the XXXIII and the XXXVI week is 13.5%, while it amounts to 1.3% for preterm birth between XXIV and the XXXII week. Consequently, the identification of risk factors for preterm birth that might be modified would have far-reaching and long-lasting effects. A significant number of preterm birth may be attributed to infections of the urogenital tract, such as bacterial vaginosis. In the last decade, great interest has been generated to support the hypothesis that sub-clinical infection at sites that are also distant from the genito-urinary tract may be an important cause of preterm labour, probably through the activation of abnormal inflammatory responses within the uterus and intrauterine tissues. There is emerging evidence of a possible relationship between maternal periodontal diseases as a potential risk factor of adverse pregnancy outcomes, like preterm low birth weight even though not all of the actual data support such hypothesis. Further studies are clearly required to clarify the causes and/or relationships linking pathologic oral conditions and adverse pregnancy outcomes. So far, from a clinical standpoint, it would appear that the assessment of the periodontal status of pregnant women during an early pregnancy might be useful in providing an important indicator of risk for future obstetric complications.

Periodontal disease and pregnancy outcomes: state-of-the-science.

UNLABELLED: To examine the existing evidence on the relationship between periodontal disease and adverse pregnancy outcomes, we conducted a systematic review of studies published up to December 2006. Studies published in full text were identified by searching computerized databases (e.g., MEDLINE, EMBASE). A meta-analysis was performed to pool the effect size of the clinical trials. Forty-four studies were identified (26 case-control studies, 13 cohort studies, and 5 controlled trials). The studies focused on preterm low birth weight, low birth weight, preterm birth, birth weight by gestational age, miscarriage or pregnancy loss, preeclampsia, and gestational diabetes mellitus. Of the chosen studies, 29 suggested an association between periodontal disease and increased risk of adverse pregnancy outcome (odds ratios [ORs] ranging from 1.10 to 20.0) and 15 found no evidence of an association (ORs ranging from 0.78 to 2.54). A meta-analysis of the clinical trials suggested that oral prophylaxis and periodontal treatment may reduce the rate of preterm low birth weight (pooled risk ratio (RR): 0.53, 95% confidence interval [CI]: 0.30-0.95, P < 0.05), but did not significantly reduce the rates of preterm birth (pooled RR: 0.79, 95% CI: 0.55-1.11, P > 0.05) or low birth weight (pooled RR: 0.86, 95% CI: 0.58%1.29, P > 0.05). The authors conclude that periodontal disease may be associated with increased risk of adverse pregnancy outcomes. More methodologically rigorous studies are needed in this field. Currently, there is insufficient evidence to support the provision of periodontal treatment during pregnancy for the purpose of reducing adverse pregnancy outcomes. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to state that the published literature is not vigorous to clinically link periodontal disease and/or its treatment to specific adverse pregnancy outcomes, and explain that more rigorous studies with world-wide agreed-upon definitions are particularly needed before periodontal disease treatment can be recommended.

Progressive periodontal disease and risk of very preterm delivery.

OBJECTIVE: The goal was to estimate whether maternal periodontal disease was predictive of preterm (less than 37 weeks) or very preterm (less than 32 weeks) births. METHODS: A prospective study of obstetric outcomes, entitled Oral Conditions and Pregnancy (OCAP), was conducted with 1,020 pregnant women who received both an antepartum and postpartum periodontal examination. Predictive models were developed to estimate whether maternal exposure to either periodontal disease at enrollment (less than 26 weeks) and/or periodontal disease progression during pregnancy, as determined by comparing postpartum with antepartum status, were predictive of preterm or very preterm births, adjusting for risk factors including previous preterm delivery, race, smoking, social domain variables, and other infections. RESULTS: Incidence of preterm birth was 11.2% among periodontally healthy women, compared with 28.6% in women with moderate-severe periodontal disease (adjusted risk ratio [RR] 1.6, 95% confidence interval [CI] 1.1-2.3). Antepartum moderate-severe periodontal disease was associated with an increased incidence of spontaneous preterm births (15.2% versus 24.9%, adjusted RR 2.0, 95% CI 1.2-3.2). Similarly, the unadjusted rate of very preterm delivery was 6.4% among women with periodontal disease progression, significantly higher than the 1.8% rate among women without disease progression (adjusted RR 2.4, 95% CI 1.1-5.2). CONCLUSION: The OCAP study demonstrates that maternal periodontal disease increases relative risk for preterm or spontaneous preterm births. Furthermore, periodontal disease progression during pregnancy was a predictor of the more severe adverse pregnancy outcome of very preterm birth, independently of traditional obstetric, periodontal, and social domain risk factors. LEVEL OF EVIDENCE: II-2.

The Association Between Socio-demographic Factors, Dental Problems, and Preterm Labor for Pregnant Women Residing in Hawai'i.

Periodontal disease during pregnancy has the potential to increase the risk of adverse perinatal outcomes including preterm labor (PTL), prematurity, and low birth weight (LBW). Despite professional recommendations on the importance and safety of dental assessments and treatments, the rate of dental care utilization during pregnancy remains low. The purpose of this study was to document the utilization of dental services and explore the relationships among socio-demographic factors, dental problems, and PTL in pregnant women residing in Hawai'i. Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) survey results were analyzed from 4,309 women who experienced live births between the years 2009-2011. Results revealed that 2 in 5 women in Hawai'i had their teeth cleaned during pregnancy, while 1 in 5 reported seeing a dentist for a dental problem. Women who reported having a dental problem during pregnancy were more likely to experience PTL (OR=1.46, 95% CI=1.10-1.94, P=.008) compared to women without a dental problem. In addition, Native Hawaiian and Part-Hawaiian women were more likely to experience PTL (OR=1.73, 95% CI=1.22-2.46, P=.002) compared to Caucasian women. These findings document the underutilization of dental services in pregnant women in Hawai'i and reveal an association between poor dental care and PTL. Identification of groups at risk for maternal complications may assist in the development of programs that are sensitive to the diverse cultures and variability of community resources that exist throughout Hawai'i.

Periodontal disease as a risk factor in pregnancy.

There is growing evidence that periodontal disease represents a risk factor for preterm delivery and premature membrane rupture. To prevent an oral inflammatory process evolving into a full-blown form of periodontitis, with possible severe repercussions on pregnancy outcome following systemic spread, future mothers should receive regular professional oral hygiene care throughout pregnancy.

Preterm delivery and intimacy during pregnancy: interaction between oral, vaginal and intestinal microbiomes.

During pregnancy, the microbiomes of the mouth, vagina and intestine undergo changes to adapt to the demands of the body, increasing the relationship and similarity between them. Therefore, it is pertinent to consider a literature review to determine the existence of influencing factors for a specific microbiome, which could also modify others. An example is the case of the mouth microbiome that is dependent on the intimate activities of the female, and therefore could be a factor that relates to preterm labor.

Durante el embarazo los microbiomas bucal, vaginal e intestinal de la mujer sufren cambios para adaptarse a las demandas del cuerpo, aumentando la relación y similitud entre ellos. Debido a esto se considera pertinente realizar una revisión literaria con el propósito de determinar la existencia de factores que influyen en un microbioma específico y que posteriormente podrían modificar a los demás. Este es el caso del microbioma bucal que depende de la actividad íntima de la mujer y por consiguiente puede ser un factor que se relacione con el desarrollo de un embarazo pretérmino.

Can oral anaerobic bacteria cause adverse pregnancy outcomes?

AIM: Maternal periodontal infection has been recognized as a risk factor for premature and low birthweight infants. It is suspected that pathogens causing periodontal disease may translocate to the amniotic cavity and so contribute to triggering an adverse pregnancy outcome. The aim of this study was to evaluate whether the presence of specific periodontal pathogens may influence the incidence of preterm labor and premature birth. MATERIAL AND METHODS: This study was designed as a hospital-based case-control study. A total of 70 pregnant women, aged 18-40 with single live pregnancy were recruited from the Departement of Gynecolgy and Obstetrics at a General hospital in Sibenik, Croatia, between March 2013 to March 2014. The case group: 30 pregnant women who were hospitalised with signs of premature labor. CONTROL GROUP: 40 patients with normal pregnancy post-delivery up to 48 hrs, who had given birth at term, and the baby had a weight of more than 2500 gr. These women had undergone microbiological examination at the time of recruitment, microbial samples, paper point subgingival swabs were obtained in both groups and processed by anaerobic culturing. Standard procedures were used for culture and identification of bacteria. Information was collected on demographics, health behaviors, and obstetric and systemic diseases that may have influence the premature delivery. RESULTS: The levels of periodontal pathogens tended to be higher in the premature (case group) labor compared to the term deliveries (control group). Levels of Porphyromonas gingivalis, Fuscobacterium nucleatum, Actinomyces actinomycetecomitans were statistically significantly higher in premature births as compared to term deliveries, adjusting for baseline levels. The joint effects of red and orange microbial clusters were significantly higher in the premature group compared to the term group. CONCLUSIONS: The study shows a significant association betwen periodontal anaerobic infection and adverse pregnancy outcome. High levels of periodontal pathogens during pregnancy are associated with an increased risk for preterm delivery. Further studies elucidating the role of the microbial load and maternal immune response as related to pregnancy outcome seem merited.

Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth.

OBJECTIVE: To estimate the relationship between maternal periodontal disease and both early spontaneous preterm birth and selected markers of upper genital tract inflammation. METHODS: In this case-control study, periodontal assessment was performed in 59 women who experienced an early spontaneous preterm birth at less than 32 weeks of gestation, in a control population of 36 women who experienced an early indicated preterm birth at less than 32 weeks of gestation, and in 44 women with an uncomplicated birth at term (>or = 37 weeks). Periodontal disease was defined by the degree of attachment loss. Cultures of the placenta and umbilical cord blood, cord interleukin-6 levels, and histopathologic examination of the placenta were performed for all women. RESULTS: Severe periodontal disease was more common in the spontaneous preterm birth group (49%) than in the indicated preterm (25%, P =.02) and term control groups (30%, P =.045). Multivariable analyses, controlling for possible confounders, supported the association between severe periodontal disease and spontaneous preterm birth (odds ratio 3.4, 95% confidence interval 1.5-7.7). Neither histologic chorioamnionitis, a positive placental culture, nor an elevated cord plasma interleukin-6 level was significantly associated with periodontal disease (80% power to detect a 50% difference in rate of histological chorioamnionitis, alpha = 0.05). CONCLUSION: Women with early spontaneous preterm birth were more likely to have severe periodontal disease than women with indicated preterm birth or term birth. Periodontal disease was not associated with selected markers of upper genital tract inflammation. LEVEL OF EVIDENCE: II-2

The prevalence and relationship between periodontal disease and pre-term low birth weight infants at King Khalid University Hospital in Riyadh, Saudi Arabia.

The aim of this study was to examine the prevalence and relationship between periodontal disease and pre-term low birth weight (PLBW) among Saudi mothers at King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. The periodontal status and the relative risk were also analyzed. The study consisted of 30 cases [infants <37 weeks and/or weighing <2.500 kilograms (kg)] and a daily random sample of 60 controls [> 37 weeks and/or weighing >2.500 kg]. Clinical periodontal indices were measured on the labor wards. Associated risk factors for periodontal disease and PLBW were ascertained by means of a structured questionnaire and maternal notes. The prevalence of the PLBW was found to be 11.3%, and the prevalence of periodontal disease was high among the study population. The risk of PLBW remained high with increasing periodontal disease (odds ratio [OR] 4.21, 95% confident interval [CI] 1.99-8.93) despite controlling the other risk factors such as age, smoking, and social class. In conclusion, there is a correlation between periodontal disease and PLBW in KKUH.

Pathogenic mechanisms linking periodontal diseases with adverse pregnancy outcomes.

In the last 2 decades, a large proportion of studies have focused on the relationship between maternal periodontal disease and poor obstetric outcomes. The aim of the present review is to summarize the current knowledge about human studies on the pathogenetic mechanisms linking periodontal diseases with adverse pregnancy outcomes. A search of the medical literature was conducted using NIH (National Institute of Health) Pubmed through April 2011. Articles were identified with the Medical Subject Heading (MeSH) and free text terms "small for gestational age (SGA)," "preeclampsia," "preterm labor," and "periodontal disease." Experimental human studies have shown that periodontal pathogens may disseminate toward placental and fetal tissues accompanied by an increase in inflammatory mediators in the placenta. As such, new inflammatory reactions within the placental tissues of the pregnant woman may occur, the physiological levels of prostaglandin E(2) (PGE(2)) and tumor necrosis factor-α (TNF-α) in the amniotic fluid may increase and eventually lead to premature delivery. Although many data from clinical trials suggest that periodontal disease may increase the adverse pregnancy outcome, the exact pathogenetic mechanism involved remains controversial. The findings explain the potential link between periodontal infections and adverse pregnancy outcomes. First, periodontal bacteria can directly cause infections both of the uteroplacenta and the fetus; second, systemic inflammatory changes induced by periodontal diseases can activate responses at the maternal-fetal interface. Of note, associative studies have produced different results in different population groups and no conclusive evidence has still been produced for the potential role of preventive periodontal care to reduce the risk factors of preterm birth.

Conocimiento de médicos de 2 hospitales peruanos sobre la relación entre enfermedad periodontal y alteraciones sistémicas / Knowledge of physicians, from 2 peruvian hospitals on the relationship between periodontal and systemic diseases

Objetivo: Determinar el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares, en médicos de 2 hospitales peruanos. Material y método El presente estudio, transversal y descriptivo, se desarrolló entre abril y mayo de 2014 e incluyó un total de 77 médicos, 39 del Hospital Belén de Trujillo y 38 del Víctor Lazarte Echegaray (Trujillo, Perú), a quienes se les aplicó un cuestionario, sometido previamente a validación por expertos y análisis de confiabilidad (Alfa de Cronbach = 0,605). Resultados El nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en un 57,1 por ciento y regular en un 41,6 por ciento de los médicos evaluados. No se encontraron diferencias con respecto a la especialidad médica (p = 0,348) ni al tiempo de ejercicio profesional (p = 0,403). Conclusión Los resultados permiten concluir que el nivel de conocimiento sobre la enfermedad periodontal y su relación con la diabetes mellitus, la gestación y las enfermedades cardiovasculares fue bueno en el 57,1 por ciento de los médicos de los hospitales Belén y Víctor Lazarte Echegaray de Trujillo, Perú, 2014.

Objective: To determine the level of knowledge of physicians from two Peruvian hospitals on the relationship between periodontal and systemic diseases. Methods This cross-sectional and descriptive study was conducted between April and May 2014 and included a total of 77 physicians, 39 from Hospital Belen de Trujillo and 38 from Hospital Victor Lazarte Echegaray (Trujillo, Peru). They were given a questionnaire that was previously submitted for validation by experts and reliability analysis (Cronbach's alpha = 0.605). Results The level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent and moderate in 41.6 percent of physicians who responded. No differences were found as regards medical specialty (P = .348) or professional experience (P = .403). Conclusion The results suggest that the level of knowledge on periodontal disease and its relationship with diabetes mellitus, cardiovascular disease and pregnancy was good in 57.1 percent of physicians from Victor Lazarte Echegaray and Belen hospitals in Trujillo, Peru, in 2014.

Dynamic among periodontal disease, stress, and adverse pregnancy outcomes.

OBJECTIVE: The aim of this study was to determine the dynamic between periodontitis and stress and the incidence of preterm birth (PTB), low birth weight (LBW) and preterm low birth weight (PLBW) in pregnant women from Pasto, Nariño, Colombia. METHODS: Forty-six women who attended to "Hospital Local Civil" localized in the city were involved. Periodontal clinical evaluation, pregnancy outcome variables and a stress scale were collected. Data were analyzed using descriptive and analytic statistics. RESULTS: The incidence of PTB was 13 %, of LBW was 4.3 %, and the occurrence of PLBW was 21.7 %. Our findings showed that the presence of periodontitis and stress all together increase the risk of LBW babies (OR=4.6; 95 % CI: 0.2-86.6). Regarding, periodontitis and stress interaction, the risk of PTB (OR=0.9; 95 % CI: 0.08-9.6) and PLBW (OR=1.1; 95 % CI: 0.1-7.1) decreased in the presence of these two variables, although their values were higher in the absent of stress (PTB, OR=2.3; 95 % CI: 0.3- 14.7 and PLBW, OR=10.3; 95 % CI:1.1-93.2). CONCLUSIONS: The periodontal disease in this study was associated with PTB, LBW and PLBW. However, their risk depends on the physiological changes produced by stress.

Periodontal health in mothers of preterm and term infants.

OBJECTIVE: Recent studies have suggested that chronic periodontitis may induce an inflammatory response which can cause premature delivery. This study was designed to assess the association between periodontal health and preterm labor in Iranian female population. MATERIALS AND METHODS: In this case-control study, 201 pregnant women without systemic disease or other risk factors for preterm labor were chosen. The control group (n = 99) had term labor (infants > or =37 weeks) and the case group (n = 102) had preterm labor (infants < 37 weeks). Bleeding index, pocket depth and debris index were measured. RESULTS: The data of bleeding index (cases, 0.64 +/- 0.38; controls, 0.57 +/- 0.35), probing depth (cases, 2.80 +/- 0.30; controls, 1.63 +/- 0.23) and debris index (cases, 1.38 +/- 0.67; controls, 0.81 +/- 0.38) revealed a statistically significant difference between the two groups (p < 0.05). CONCLUSION: According to the findings of this study, there is a noticeable relationship between periodontal health and duration of pregnancy; periodontal disease could be a risk factor for preterm labor. Oral hygiene is strongly recommended to be included in prenatal care.

Dynamic among periodontal disease, stress, and adverse pregnancy outcomes / Dinámica entre enfermedad periodontal, estrés y resultados adversos del embarazo

Objective The aim of this study was to determine the dynamic between periodontitis and stress and the incidence of preterm birth (PTB), low birth weight (LBW) and preterm low birth weight (PLBW) in pregnant women from Pasto, Nariño, Colombia. Methods Forty-six women who attended to "Hospital Local Civil" localized in the city were involved. Periodontal clinical evaluation, pregnancy outcome variables and a stress scale were collected. Data were analyzed using descriptive and analytic statistics. Results The incidence of PTB was 13 percent, of LBW was 4.3 percent, and the occurrence of PLBW was 21.7 percent. Our findings showed that the presence of periodontitis and stress all together increase the risk of LBW babies (OR=4.6; 95 percent CI: 0.2-86.6). Regarding, periodontitis and stress interaction, the risk of PTB (OR=0.9; 95 percent CI: 0.08-9.6) and PLBW (OR=1.1; 95 percent CI: 0.1-7.1) decreased in the presence of these two variables, although their values were higher in the absent of stress (PTB, OR=2.3; 95 percent CI: 0.3- 14.7 and PLBW, OR=10.3; 95 percent CI:1.1-93.2). Conclusions The periodontal disease in this study was associated with PTB, LBW and PLBW. However, their risk depends on the physiological changes produced by stress.

Objetivo El objetivo de este estudio fue determinar la dinámica entre periodontitis, estrés y la incidencia de nacimientos prematuros (NP), de bajo peso al nacer (BPN) y de prematuros y bajo peso al nacer (NPBP) de mujeres embarazadas de Pasto, Nariño, Colombia. Materiales y Métodos Un total de 46 mujeres que asistían al Hospital Local Civil de la ciudad fueron incluidas. Una evaluación clínica periodontal, variables sobre el parto y una escala de estrés fueron registradas. Los datos fueron analizados usando estadística descriptiva y analítica. Resultados La incidencia de NP fue 13 por ciento, de BPN de 4,3 por ciento, y la ocurrencia de NPBP de 21,7 por ciento. Nuestros hallazgos muestran que la presencia de periodontitis y estrés en conjunto incrementan el riesgo de BPN (OR=4,6; IC al 95 por ciento : 0,2-86,6). De acuerdo, con la interacción entre periodontitis y estrés, el riesgo de NP (OR=0,9; IC al 95 por ciento :0,08- 9,6) y NPBP (OR=1,1; IC al 95 por ciento: 0,1-7,1) disminuyó en la presencia de las dos variables, aunque sus riesgos fueron más elevados en la ausencia de estrés (NP, OR=2,3; IC al 95 por ciento: 0,3-14,7 y NPBP, OR=10,3; IC al 95 por ciento :1,1-93,2). Conclusión La enfermedad periodontal en este estudio estuvo asociada con NP, BPN y NPBP. Sin embargo, su riesgo depende de los cambios fisiológicos producidos por el estrés.

La enfermedad periodontal como factor de riesgo para el parto pretérmino / Periodontal disease as a risk factor for preterm labor

Se realizó un estudio analítico de casos y controles, para determinar la influencia de la enfermedad periodontal durante el embarazo como factor de riesgo para el parto pretérmino en las puérperas registradas en el Depto de Maternidad del Hospital Provincial Docente Antonio Luaces Iraola, provincia Ciego de Avila, durante el año 2008. Las puérperas se dividieron en dos grupos: casos (mujeres con partos pretérmino) y controles (mujeres con partos a término). A todas las seleccionadas que cumplieron con los criterios de inclusión se les realizó una entrevista y un examen clínico periodontal. Se confeccionó una planilla que recogieron las variables: grupos de edades, higiene bucal, hábito de fumar y antecedentes de diabetes mellitus. Las enfermedades periodontales se relacinaron con los partos pretérmino con alta significación estadística, con casi 3 veces más posibilidades que las no enfermas. Existió asociación altamente significativa de la periodontitis con estos partos. Las enfermas de 18 a 35 años de edad tuvieron mayor riesgo de parto pretérmino que las no enfermas, mientras que las de 36 y más años de edad estos riesgos no fueron significativos. La higiene bucal deficiente y el hábito de fumar fueron factores de riesgo que presentaron alta significación estadística con los partos pretérmino, por lo que se llegó a la conclusión que las enfermedades periodontales están asociadas con los partos pretérmino como un factor de riesgo más.

Ethylene oxide exposure may increase the risk of spontaneous abortion, preterm birth, and postterm birth.

Ethylene oxide is a gas used in some dental offices to sterilize equipment. In pregnant laboratory animals, ethylene oxide increases malformations and feral loss. Increased gestation length has also been reported. In humans, two studies have reported increased spontaneous abortions among ethylene oxide-exposed women, but few other data exist. We sent questionnaires to 7,000 dental assistants, age 18-39 years, registered in California in 1987; 4,856 responded (69%). We based our analysis on 1,320 women whose most recent pregnancy was conceived while working full-time. Thirty-two women reported exposure to ethylene oxide; unexposed dental assistants comprised the comparison group. We estimated relative risks of spontaneous abortion and preterm birth using a person-week model. We estimated relative risks of postterm birth (> or = 42 weeks) and a combined adverse outcomes model using logistic regression. Among exposed women, the age-adjusted relative risk of spontaneous abortion was 2.5 [95% confidence interval (CI) = 1.0-6.3], for preterm birth 2.7 (95% CI = 0.8-8.8), and for postterm birth 2.1 (95% CI = 0.7-5.9). The estimated relative risk of any of these adverse outcomes among exposed women was 2.5 (95% CI = 1.0-6.1) after adjusting for age, nitrous oxide, and number of mercury amalgams prepared. These data further implicate ethylene oxide as a possible reproductive toxicant in humans.