Periodontitis, a marker of risk in pregnancy for preterm birth
Article first published online: 8 DEC 2004
Journal of Clinical Periodontology
Volume 32, Issue 1, pages 45–52, January 2005
How to Cite
Dörtbudak, O., Eberhardt, R., Ulm, M. and Persson, G. R. (2005), Periodontitis, a marker of risk in pregnancy for preterm birth. Journal of Clinical Periodontology, 32: 45–52. doi: 10.1111/j.1600-051X.2004.00630.x
- Issue published online: 6 JAN 2005
- Article first published online: 8 DEC 2004
- Accepted for publication 6 April 2004
- amniotic fluid;
- orange complex;
- preterm delivery;
- red complex
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.