Oral and uro‐vaginal intra‐amniotic infection in women with preterm delivery: A case‐control study

Abstract

Aim The aim of the present study was to establish the association between the presence of oral and uro‐vaginal microorganisms in the placental membrane and preterm delivery (PTD), the premature rupture of membranes (PRM), and the clinical signs of intra‐amniotic infection. Methods Eighty‐four women with PTD and 127 women with delivery at term were assessed for the PRM, clinical signs of intra‐amniotic infection, and the presence of periodontitis. Twenty‐seven microorganisms were identified in the placental tissue using nested polymerase chain reaction (PCR). Porphyromonas gingivalis (P. gingivalis) was quantified by droplet digital PCR. Results The prevalence of microorganisms was 9.47% (20/211). P. gingivalis was the most prevalent (12/211, 5.68%). Mycoplasma hominis, Ureaplasma urealyticum, Staphylococcus spp, and Fusobacterium nucleatum were isolated at a very low frequency in the placenta. Candida albicans was associated with PTD (P = 0.027). Periodontitis was associated with clinical signs of infection (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 1.28‐13.5) and with PTD (OR = 1.99; 95% CI: 1.07‐3.72). Conclusion The presence of P. gingivalis in the placenta was not associated with perinatal complications. Detecting microorganisms in the placenta by nested PCR is not relevant, as it has a poor association with clinical variables that establish the diagnosis of chorioamnionitis. However, periodontitis was associated with the clinical signs of intra‐amniotic infection and PTD.

Porphyromonas gingivalis Placental Atopobiosis and Inflammatory Responses in Women With Adverse Pregnancy Outcomes

“…The amniotic cavity of women with PTB has a much higher DNA content (more than previously believed) with a great diversity of microorganisms, including many that have not yet been characterized; The strength of these findings, due to the amount and timing in which they occur, could be useful in formulating a hypothesis to establish a causal association with APOs (DiGiulio et al, 2008); In the study from which our samples came from (Montenegro et al, 2019), the percentage of intrauterine infection was 9.47% (20/211), similar to that reported by previous studies, in which percentages varied between 10 and 25% in the third trimester of pregnancy (DiGiulio et al, 2008;Combs et al, 2014;Morgan, 2016).…”

“…P. gingivalis was the most prevalent identified oral microorganism in PI (12/211, 5.68%); however, in most cases it was not associated with the presence of clinical signs of intrauterine infection, although its frequency was higher in cases with APO (Montenegro et al, 2019). In the P. gingivalis PI cases, the presence of periodontitis linked to the subgingival presence of P. gingivalis was greater (60% for group 2 and 75% for group 3) and independent of the presence of APO.…”

“…This study involved a group of subjects from a larger previously published case control study (Montenegro et al, 2019) whose objective was to stablish the association between oral and UGM in the placenta and PTB, PPROM, and clinical signs of intraamniotic infection. All participants agreed to participate in the study and signed an informed consent approved by the Institutional Ethics Committee of Universidad El Bosque, PCI-2014-18.…”

“…A total of 224 pregnant women aged ≥18 years that were admitted for delivery at the Service of Gynecology and Obstetrics of Hospital Simon Bolivar in Bogotá, Colombia from August 2014 to August 2016 were initially enrolled in the case control study of oral and urogenital intra-amniotic infection in women with preterm delivery (Montenegro et al, 2019), in which women included should have been monitored in the hospital during their pregnancy and have a detailed record of prenatal care, especially records for the presence or absence of associated infection, vaginosis, and CA. The diagnosis of clinical CA was based on the Gibbs and Duff antepartum criteria and on the clinical criteria of the abnormal appearance of post-delivery membranes postpartum.…”

“…This would explain why not all the subjects with subgingival P. gingivalis have periodontitis or why not all the patients with PI with P. gingivalis show signs of clinical intrauterine infection or APO. Other factors, such as the amount of inoculum, virulence of the isolated microorganism, and individual immune response to the microorganism, could be associated with perinatal complications (Montenegro et al, 2019). P. gingivalis itself is not a proinflammatory pathogen, but by using different mechanisms it evades and alters components of the host's immune response (disrupts innate immunity: TLRs and complement), which alters the development of the entire biofilm; then P. gingivalis exerts its role of "keystone pathogen" modulating the host response in susceptible individuals (Hajishengallis et al, 2012), which could explain why findings FIGURE 3 | Cytokine profiles among groups analysis.…”