Periodontal disease and adverse birth outcomes: a study from Pakistan

Abstract

OBJECTIVES-Periodontal disease may increase the risk of adverse birth outcomes; however, results have been mixed. Few studies have examined periodontal disease in developing countries. We describe the relationship between periodontal disease and birth outcomes in a community setting in Pakistan. METHODS-Enrollment occurred at 20-26 wks.A study dentist performed the periodontal examination to assess probing depth (PD), clinical attachment level (CAL), gingivitis index (GI) and plaque index (PI). Outcomes included stillbirth, neonatal mortality, <32 wk preterm birth (PTB), 32-36 wk PTB, and low birthweight (LBW), and are presented for increasing periodontal disease severity by quartiles (Q1-4).RESULTS-Dental examinations and outcome data were completed for 1152 women. 81% were multiparous with a mean age of 27 yrs. 33% had no education. Dental caries were present in 47%, missing teeth in 27%, and 92% had no dental care in the last year. Periodontal disease was common: 87% had ≥ 4 teeth with a PD of >3mm, 54% had ≥4 teeth with a PI = 3, and 58% had ≥ 4 teeth with a GI = 3. In general, as the measure of periodontal disease increased, stillbirth, PTB <32 wks and neonatal mortality also increased. Late PTB and LBW were not related to measures of periodontal disease. Adjustment for demographic characteristics did not significantly change the relationships.

Periodontal Infections and Adverse Pregnancy Outcomes: The Oral Health—Fetal Connection

“…In a prospective cohort study in Pakistan, 1152 women were assessed for dental status and followed for pregnancy outcomes. 17 Low birth weight was not related to measures of periodontal disease but stillbirth and neonatal and perinatal deaths increased with severity of periodontal disease. In a study of 1404 pregnant women in Spain, Lopez 18 reported a modest association between periodontitis and preterm birth.…”

Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women

“…On the other hand, some studies have showing a modest association between PD and adverse pregnancy outcomes [9], or no association at all. [10-12].…”

The association between periodontal disease and periosteal lesions in the St. Mary Graces cemetery, London, England A.D. 1350-1538

“…Many studies within living populations have shown significant associations between periodontal disease and other diseases, such as cardiovascular diseases, respiratory infections, cancer (e.g., lung, kidney, pancreatic, oral, esophageal, upper gastrointestinal, gastric, and kidney cancers), Alzheimer's disease, obesity, diabetes, renal disease, osteoporosis, and rheumatoid arthritis (for example, see the following reviews: Hollister and Weintraub, 1993;Li et al, 2000;Kowolik et al, 2001;Slots, 2004;Pihlstrom et al, 2005;Johnson et al, 2006;Irwin et al, 2008;Williams et al, 2008). Periodontal disease is also associated with increased risks of spontaneous preterm birth, preeclampsia, low birth weight, and stillbirth (Holmstrup et al, 2003;Goepfert et al, 2004;Boggess, 2005;Boggess et al, 2006;Mobeen et al, 2008;Ruma et al, 2008;Polyzos et al, 2009).…”