Influence of Socioeconomic Status on the Association between Prenatal Periodontal Care and Preterm Low Birthweight Delivery: A Population-Based Case-Control Study

Abstract

We report the effect of in-pregnancy periodontal care intensity on the risk of preterm low birthweight (PLBW) births, and the role of household income in this association. Only a few studies have examined the role of socioeconomic status (SES) in the relationship between prenatal periodontal care and risk of PLBW delivery under universal health care. This study adopted a population-based, case-control study using medical claims data in Taiwan. Mothers of PLBW and non-PLBW babies with livebirth deliveries between 2001 and 2005 (cases, n=20430 and controls, n=81573, respectively) were identified using the National Health Insurance Research Database (NHIRD) and matched. Periodontal disease and disease-specific (gingivitis and periodontitis) dental service utilization was calculated during gestational period and analyzed for its association with risk for PLBW delivery. Household income as proxy for SES was tested for modification effect. Prevalence of periodontitis and gingivitis was significantly higher in cases than in controls. Women who had these inflammatory conditions and sought treatment for either condition more frequently in gestation were at significantly lower risk for PLBW deliveries (periodontitis AOR: 0.757, 95% CI: 0.689-0.832; gingivitis AOR: 0.684, 95% CI: 0.582-0.805). Moreover, household income did not appear to be a significant effect modifier in the association between in-pregnancy periodontal/gingival care and PLBW delivery amongst study subjects. We found evidence that the intensity of disease-specific dental care during pregnancy acts as independent risk factor for PLBW delivery for periodontal and gingival women, and that the modification effect by SES was not evident under the context of universal health care system.

Risk of Allergic Rhinitis, Allergic Conjunctivitis, and Eczema in Children Born to Mothers with Gum Inflammation during Pregnancy

“…Also, we do not have the problem of parental recall bias when details about periodontal and overall health during pregnancy need to be surveyed for study. Since periodontal treatments, or simply general dental visits, are typically avoided during pregnancy in the current population [ 11 ], it is expected that we have identified mothers with chronic inflammations by extracting subjects within this time window (and not mothers with asymptomatic or acute periodontal disease who are unlikely to seek dental care during pregnancy). Premature deaths, which can bias our results, are considered as competing risk in the survival analyses.…”

“…This research database contains health care data of over 99% of Taiwan’s population including enrollment registry, dates of outpatient visits and inpatient stays, diagnostic codes, prescription orders and related cost items ranging from laboratory tests to surgical procedures. The extensiveness and quality of this database can be supported by numerous pediatric and immunoepidemiology studies found in existing literature [ 11 , 22 – 24 ].…”

“…This condition can trigger antibody responses against oral pathogens that lead to inflammation and destruction of periodontal tissues [ 10 ]. Periodontitis in pregnant females has not only been linked with poor neonatal outcomes [ 11 ], its pathogens are also believed to be capable of entering the circulation and generate prenatal or in utero sensitization [ 12 , 13 ]. This disease is characterized by a destructive inflammatory process which causes ulcerated gingival pockets that can give off bacteria and pro-inflammatory cytokines (i.e.…”

“…The role of maternal allergen exposure during pregnancy in early life sensitization has further been demonstrated in animals [ 20 ]. Although the prevalence of periodontitis in young Taiwanese females has not been precisely estimated, Taiwan’s 2005 national health statistics indicate that around 31% of the population aged 16–64 years received periodontal and/or gingival treatment [ 11 ]. A community-based study revealed a prevalence of over 90% in its 35–44 years subject sample [ 21 ].…”

Risk of Autoimmune Disease in Adults with Chronic Insomnia Requiring Sleep-Inducing Pills: A Population-Based Longitudinal Study

“…The household insurance premiums of the participants for the index year were used as a proxy for household income, based on the fact that payroll-based premiums paid to the National Health Insurance are proportional to household income level. 20 Diagnosis Criteria. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth ed.…”