Periodontal disease and adverse pregnancy outcome

PERIODONTAL DISEASE AND ADVERSE PREGNANCY OUTCOME

A STUDY
1
2

SAPNA SINGH, MBBS, MS

ARVIND KUMAR, BDS, MDS, Reader

NAVIN KUMAR, BDS, MDS, Student

SHALINI VERMA, MBBS, DGO, Senior Resident

NEELAM SONI, MBBS, DNB, DGO, Senior Resident
4

RAVISH AHUJA, BDS, MDS, Student

ABSTRACT
The objective of the present study was to assess whether periodontal disease is predictive of
premature gestation in an identified population of women at risk for birth complications as a
consequence of medical factors.
The study population consisted of pregnant women who received uniform pre-natal care in Rama
Medical College, Kanpur eastern Uttar Pradesh state of India. Criteria for inclusion were; women aged
18-39 years, with singleton gestation, any weeks gestation. Exclusion criteria were; multiple gestation,
high risk gestation, hypertension, gestational diabetes, any systemic disease, placenta previa and less
than 20 natural teeth. A total of 90 volunteer mothers were entered in the study after giving written
consent.
This research demonstrated that periodontal disease in normal pregnant women is significantly
associated with decreased infant birth weight, providing new evidence on the relationship
between periodontal disease and birth weight. Nevertheless, the association between periodontal
disease and birth weight infant should be further explored in new observational and intervention
studies to establish whether it is casual or incidental, and to generalize the findings in diverse
populations.
Key words: Pregnancy, Gingivitis, Periodontitis, Preterm baby

INTRODUCTION
Pregnancy gingivitis usually starts around the
second month of pregnancy and decreases during the
ninth month. If pregnant women are already having
gingivitis, it will most likely get worse during pregnancy especially without treatment. New research
suggests a link between preterm, low birth weight
babies and gingivitis. Excessive bacteria, which cause
gingivitis, can enter the bloodstream. If this happens,

the bacteria can travel to the uterus, triggerering the

production of chemicals called prostaglandins,
which case uterine contractions that induce premature
labor.
There is interest in the hypothesis that periodontal
disease during pregnancy is associated with a higher
incidence of adverse pregnancy outcome. A case control study (Offenbacher et al 1996)1 and more recently
several prospective studies (Jeffcoat et al 2001, Lopez

Asst Professor, Dept of Obs & Gynae, Rama Medical College, Kanpur, Uttar Pradesh, India
Dept of Pedodontics, Rama Dental College, Kanpur, Uttar Pradesh, India
3
Dept of Oral & Maxillofacial Surgery, Rama Dental College, Kanpur, Uttar Pradesh, India
4,5
Dept of Obs & Gynae, Ram-Janki Hospital, Gorakhpur, Uttar Pradesh, India
Corresponding author: Dr Arvind Kumar, Flat No 406, Staff Accommodation, Rama Dental College Hospital,
Kanpur-208024, Uttar Pradesh, India, Email: drarvindverma29@rediffmail.com
2,6

Pakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)

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Periodontal disease and adverse pregnancy outcome

et al. 2002)2,3 have found that preterm birth is

associated with poorer periodontal health. It is proposed that periodontal disease in pregnancy is a source
of chronic infection which has the potential to have a
deleterious effects on the mother and fetus leading to
an early delivery (Offenbacher et al 1996).1 Studies
have suggested that women with periodontitis are at
greater risk of having a preterm gestation with the
result of a low birth weight (Offenbacher et al 1996).1
Intervention studies, however, have suggested that
non-surgical periodontal therapy in pregnant
women with periodontitis may reduce the risk for
preterm delivery and low birth weight birth (Lopez et
al 2002).4
Therefore, the objective of the present study was to
assess if periodontal disease is predictive of premature
gestation in an identified population of women at risk
for birth complications as a consequence of medical
factors.
METHODOLOGY
The study population (90) consisted of pregnant
women who received uniform pre-natal care in
Rama Medical College, Kanpur eastern Uttar Pradesh
state of India. Criteria for inclusion were, women
aged 18-39 years, with singleton gestation, anyweeks gestation. Exclusion Criteria were, multiple
gestation, high risk gestation, hypertension, gestational diabetes, any systemic disease, placenta previa
and less than 20 natural teeth. A total of 90 volunteer
mothers were entered in the study after giving written
consent.
In the first visit, detailed data about previous
pregnancies and the outcome of the current pregnancy
from the patients prenatal record and history from
current and previous pregnancies were gathered. The
following variable were recorded for each woman; age,
educational level, number of prenatal visits, previous
pregnancy history, number carried to full term, number of previous pregnancies aborted, tobacco consumption, alcohol consumption, use of illicit drugs, domestic
violence, gestational age and dental treatment. After
delivery, on the second visit, the following variables
were recorded; gestational age, birth weight. Women
were grouped according to birth weight and gestational
age. If delivered baby with a birth weight under 2500 g
Pakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)

they were classified as Low Birth Weight Group. If

they delivered before 36 weeks of gestation they were
classified as Preterm Birth Group. Normal women
grouped women were those who delivered infant with
a birth weight superior to 2500 g and after 36 completed
weeks gestation. The patients were examined on a
straight chair under natural light using the diagnostic
instruments. The Plaque index (Silness & Low;)5 and
the gingival index (Low & Silness)6 were used to access
the Plaque accumulation and gingivitis.
RESULT
Characteristics of study group (90) are shown in
Table 1. Clinical variables related to pregnancy infant
birth weight are reported in Table 2. Variables related
to gestational age are shown in Table 3. Infant birth
weight in relation to gestational age are visible in
Table 4. The characteristics of womens periodontal
condition related to birth weight are shown in Table 5.
Womens periodontal condition related to gestational
age can be seen in Table 6.
TABLE 1: CHARACTERISTICS OF STUDY
POPULATION (90)
Variable

Number

Percentage

<18 Years

18

20.0

18-25 Years

43

47.8

>25 Years

29

32.2

TABLE 2: CLINICAL VARIABLE RELATED TO

INFANT BIRTH WEIGHT
Variable
Weight (gram)

Number

Percentage

<2500

5.6

2500-3499

57

63.3

>3500

28

31.1

TABLE 3: CLINICAL VARIABLE RELATED TO

GESTATIONAL AGE
Variable
(Gestational age
at time of
delivary)

Number

Percentage

Term

84

93.3

Pre-Term

6.7
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Periodontal disease and adverse pregnancy outcome

TABLE 4: INFANT BIRTH WEIGHT IN RELATION

TO GESTATIONAL AGE
Gestational
age term
(> 36 weeks)
84

Gestational
age pre-term
(< 36 weeks)
6

3 (3.6%)

2 (33%)

2500-3499

54 (64.3%)

3 (50.0%)

>3500

27 (32.1%)

1 (17%)

Infant birth
weight (Gram)
<2500

TABLE 5: CHARACTERISTICS OF WOMENS

PERIODONTAL CONDITION RELATED TO
INFANTS BIRTH WEIGHT
Characteristics

Number
Infant birth
weight (g) <2500

Healthy

Gingivitis

Periodontitis

23
(25.5%)
0

42
(46.7%)
3

25
(27.8%)
2

In this respect, the data of the present study

showed a consistent relationship between maternal
periodontal health status and infant birth weight. The
average birth weight decreased as the severity of the
mothers periodontal health increased.
The mechanism how periodontal disease reduces
the birth weight is still not clear, but there is evidence
that this association has biologically feasible bases. It
has been suggested (Offenbacher et al, 1996)1 that
effect of periodontal disease on LBW could result from
stimulation of foetal membranes on prostaglandin
synthesis by cytokines produced by inflamed gingival
tissues, or through the effect of endotoxin derived
periodontal infection. Endotoxin can stimulate prostaglandin production by macrophages in human amnion (Romero et al. 1988).10
REFERENCES
1

Infant birth
weight (g) 2500-3499

16

24

17

Infant birth
weight (g) <3500

15

TABLE 6: CHARACTERISTICS OF WOMENS

PERIODONTAL CONDITION RELATED TO
GESTATIONAL AGE
Gestatinal age
at delivery

veral authors in different populations (Dasanayke et al.

2001, Jeffcoat et al. 2001 a, Offenbacher et al. 2001).7,8,9

Gingivitis

Periodontitis

23
(25.5%)

42
(46.7%)

25
(27.8%)

Term

23

39

22

Pre-term

Number

Healthy

DISCUSSION
This study demonstrates that periodontal disease
in pregnant women is significantly associated with a
reduction in the infant birth weight. The relationship
between mothers periodontal health status and
birth weight infant shown in this research agrees
with the positive correlation between periodontal
disease and LBW (<2500 g) demonstrated by sePakistan Oral & Dental Journal Vol 31, No. 1 (June 2011)

10

Offenbacher, S, Katz, V, Gertik, G, Collins, J., Boyd, D,

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Offenbacher, S. Lieff, S. Boggess, K. A. Murtha, A. P. Madianos,
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