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Gum disease not tied to pregnancy risks

American Journal of Obstetrics and Gynaecology, May 2009
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Contrary to earlier reports, gum disease, also referred to as "periodontal" disease, does not appear to be associated with preterm births and other pregnancy problems.

Adverse pregnancy outcomes including preterm birth, preeclampsia, poor fetal growth and stillbirth have been linked to infection and/or inflammation as a causative factor and thus plausibly associated with periodontal disease. But these studies had largely focused on a single pregnancy outcome and have shown variable association.

To look at the impact of gum disease on a group of pregnancy-related problems, researchers from America enrolled 3111 women from three hospitals who were between 6 and 20 weeks' pregnant. Of these, 1566 (50.3%) screened positive for gum disease while 1545 (49.7%) screened negative. The researchers then included 311 women with periodontal disease (20% of screen positive patients) and 475 women without periodontal disease (30.7% of screen negative patients) in the study.

There was no difference in level of education, or prevalence of women with chronic hypertension, diabetes, bacterial vaginosis, or history of a prior preterm delivery between the 2 groups. Women with periodontal disease though tended to be older, had a greater maternal weight, were more likely to be African American, and use tobacco; all known risk factors for periodontal disease.

The researchers did not observe an association between the presence of periodontal disease and a composite adverse pregnancy outcome that included preeclampsia, preterm birth, intrauterine growth restriction, and perinatal death. In addition, there were no significant observed associations between periodontal disease and the individual outcomes of preeclampsia and preterm birth.

These findings are in contrast to several studies that have demonstrated an association between periodontal disease and a variety of adverse events. Even though the relationship between periodontal disease and adverse pregnancy outcomes is biologically plausible because of the role of infection/inflammation in adverse pregnancy outcomes, there are several potential explanations for the inconsistencies in the literature. Several varying criteria have been used to define periodontal disease, the timing of this assessment in trelation to pregnancy outcome is inconsistent, and the effect of confounders.

The results of this study warrant continued research to investigate the causes of adverse pregnancy outcomes and to investigate strategies that may prevent them.

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