Gum Infection and Birth Problems

Periodontitis can be associated with low birth weight and prematurity

(RxWiki News) Expectant mothers must pay detailed attention to their health so they have the best chance of giving birth with no complications. And oral health is no exception. 

In a recent workshop, researchers reviewed the current evidence on the connection between birth issues and maternal periodontitis — a gum infection that can affect the bones, tissues and teeth in the mouth, as well as put a person at risk for heart issues.

These researchers discussed previous studies that showed an association between maternal periodontitis and premature birth and low birthweight.

The authors of this review recommended that oral health professionals ask patients if they are pregnant or trying to get pregnant before performing any treatment for any infection, and that medical health professionals should include oral health in a patient's general health history.

"Tell your OB/GYN about your oral health history."

The European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) jointly put on this workshop.

The lead author on behalf of the EFP was Mariano Sanz, MD, PhD, DDS, of the University of Complutense of Madrid, Spain. The lead author on behalf of the AAP was Kenneth Kornman, PhD, DDS, of Interleukin Genetics in Waltham, Massachusetts.

The two groups put on this workshop to review, interpret and clarify all the existing evidence surrounding the connection between maternal periodontitis and preterm birth, low birthweight and pre-eclampsia (a condition in which the pregnant mother develops high blood pressure and large amounts of protein in her urine).

The authors explained that data surrounding this connection is limited because previous studies did not test for the same things, use similar study populations or fully understand the underlying pathway of fetal infection in the body. They also tended to focus on specific clinical measures and often overlook actual burden of the infection on the mother.

The authors of this review argued that studies need to do at least two evaluations — one at the beginning of pregnancy and one at the end — to see how the infection changes and affects the mother over the course of pregnancy, and should include information on social factors such as economic status, smoking, the use of recreational drugs and race and ethnicity.

Next, the authors discussed the most likely pathways of infection from mother to fetus. There are two direct and two indirect pathways through the body that have been suggested in previous research. 

A direct pathway is when the infection travels through the blood stream to the fetus either from the mouth or the genital and urinary area of the mother. An indirect pathway is when the immune cells create defense molecules to destroy the damaged tissue and the fetal tissues become infected.

The authors revealed that the strongest available evidence suggests that fetal infection most likely happens through a direct pathway where the infection site in the mother's mouth acts as a gateway for the aggressive bacteria to filter into the mother's blood stream and then into the fetal area.

The authors discussed the effectiveness of the available periodontal therapy methods, explaining that therapy has been shown to improve infections in pregnant women but not to decrease the rates of preterm birth or low birth rate.

The authors concluded that more research is needed on both the basic biological processes that determine the link between periodontitis and birth issues, and treatments that can benefit both the mother and the fetus that can differ according to the type, length and intensity of the infection.

The authors strongly recommended that oral health professionals should provide pregnant women with comprehensive oral health care and education. They also recommend that every oral healthcare professional ask every female patient of childbearing age if she is pregnant or trying to get pregnant before performing any oral health treatment.

The authors also suggested that medical health professionals need to include a patient's oral health history as part of their general health history and should do an oral examination when they conduct the initial general health examination.

This workshop consensus report was published in the April editions of both the Journal of Periodontology and Journal of Clinical Periodontology.

It was funded by an educational grant given to both the European Federation of Periodontology and the American Academy of Periodontology by Colgate-Palmolive.

Review Date: 
August 30, 2013