Mechanisms Involved in the Association between Periodontitis and Complications in Pregnancy

Abstract

The association between periodontitis and some of the problems with pregnancy such as premature delivery, low weight at birth, and preeclampsia (PE) has been suggested. Nevertheless, epidemiological data have shown contradictory data, mainly due to differences in clinical parameters of periodontitis assessment. Furthermore, differences in microbial composition and immune response between aggressive and chronic periodontitis are not addressed by these epidemiological studies. We aimed to review the current data on the association between some of these problems with pregnancy and periodontitis, and the mechanisms underlying this association. Shifts in the microbial composition of the subgingival biofilm may occur during pregnancy, leading to a potentially more hazardous microbial community. Pregnancy is characterized by physiological immune tolerance. However, the infection leads to a shift in maternal immune response to a pathogenic pro-inflammatory response, with production of inflammatory cytokines and toxic products. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the fetus-placenta unit. In severe periodontitis patients, the infection agents and their products are able to activate inflammatory signaling pathways locally and in extra-oral sites, including the placenta-fetal unit, which may not only induce preterm labor but also lead to PE and restrict intrauterine growth. Despite these evidences, the effectiveness of periodontal treatment in preventing gestational complications was still not established since it may be influenced by several factors such as severity of disease, composition of microbial community, treatment strategy, and period of treatment throughout pregnancy. This lack of scientific evidence does not exclude the need to control infection and inflammation in periodontitis patients during pregnancy, and treatment protocols should be validated.

Adverse Pregnancy Outcomes and Maternal Periodontal Health

“…20 However, it is estimated that in 50% of preterm births, the direct cause is not immediately known. 13 Research has discovered that there are multiple factors responsible for the occurrence of preterm births and LBW babies. Some of these documented factors include a history of premature baby, chronic health conditions (high blood pressure, preeclampsia, diabetes), insufficient maternal weight gain during pregnancy, smoking, alcohol consumption, and taking street drugs/abusing prescription drugs, stress, and being of a certain racial/ethnic group (African-American).…”

“…Some of these documented factors include a history of premature baby, chronic health conditions (high blood pressure, preeclampsia, diabetes), insufficient maternal weight gain during pregnancy, smoking, alcohol consumption, and taking street drugs/abusing prescription drugs, stress, and being of a certain racial/ethnic group (African-American). 13,[25][26][27] The prevalence of preterm births and LBW infants signify a necessity to focus prenatal care on reducing or eliminating any and all risk factors that may contribute to its occurrence. This includes acknowledging the possible relationship of these adverse pregnancy outcomes with untreated maternal periodontal disease and incorporating oral health practice guidelines into all routine obstetrical care.…”

“…5,13 In pregnancy gingivitis, the most common oral disease in pregnancy, clinical manifestations include gingival inflammation, erythema, and bleeding, whether spontaneous or after manipulation. 1 It is estimated that the majority of pregnant women experience gingivitis resulting from pregnancy-related hormonal changes.…”

“…1 It is estimated that the majority of pregnant women experience gingivitis resulting from pregnancy-related hormonal changes. 3,13,28 Various studies have identified a large range regarding the prevalence of pregnancy gingivitis, from 36% in one study to 100% in another. 3,13,28 Differences in study design and demographics of study participants may account for these considerable variations.…”

“…3,13,28 Various studies have identified a large range regarding the prevalence of pregnancy gingivitis, from 36% in one study to 100% in another. 3,13,28 Differences in study design and demographics of study participants may account for these considerable variations. Periodontitis, an inflammatory disease of the periodontal tissues, is the advanced stage of gingival disease, involving inflammation and destruction of the supporting structures of the teeth.…”