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Keywords:

  • amniotic fluid;
  • bacteria;
  • cytokine;
  • orange complex;
  • periodontitis;
  • preterm delivery;
  • red complex

Abstract

Background: Why chronic periodontitis may induce an inflammatory response with premature pregnancy termination is unclear.

Aims: (1) To assess if periodontitis predicts premature gestation; (2) to study amniotic fluid cytokines and periodontitis variables in early-stage pregnancy.

Material and Methods: A periodontal examination and collection of amniotic fluid was performed (weeks 15–20) of pregnancy in 36 women at risk for pregnancy complications. Amniotic fluid (bacteria), vaginal smears and intra-oral plaque samples were studied. Cytokine levels in amniotic fluid were studied in relation to other study variables.

Results: Periodontitis was diagnosed in 20% of normal and in 83% of preterm birth cases (p<0.01). Bacteria were never found in the amniotic fluids studied. Sub-gingival plaque samples including bacteria in the orange and red complexes were found in 18% of full-term 100% of preterm cases (p<0.001) and total colony-forming units (CFUs) were higher in preterm birth (p<0.01). Amniotic levels of interleukin (IL)-6 and prostaglandin-E2 (PGE2) were higher in preterm cases (p<0.001). Amniotic IL-6 (r=0.56, p<0.01) and PGE2 (r=0.50, p<0.01) cytokine levels were correlated with CFU from sub-gingival plaque samples (r2=0.44).The odds ratio of preterm delivery and having periodontitis was 20.0 (95% confidence interval (CI): 2.0–201.7, p<0.01). The odds of >60 CFU in sub-gingival plaque and preterm birth was 32.5:1 (95% CI: 3.0–335.1, p<01).

Conclusions: Pregnant women with findings of elevated amniotic fluid levels of PGE2, IL-6 and IL-8 in the 15–20 weeks of pregnancy and with periodontitis are at high risk for premature birth. The implication of this is that periodontitis can induce a primary host response in the chorioamnion leading to preterm birth.