Home | About Us | Editorial Board | Current Issue | Archives | Search | Instructions | Subscription | Feedback | e-Alerts | Login 
Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
 Users Online: 1997  
 
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size


 
  Table of Contents    
ORIGINAL ARTICLE
Year : 2021  |  Volume : 39  |  Issue : 2  |  Page : 183-188
 

Association of preterm low-birth-weight infants and maternal periodontitis during pregnancy: An interventional study


1 Department of Pediatric and Preventive Dentistry, K.M.Shah Dental College and Hospital, Sumandeep Vidyapeeth, Gujarat, India
2 Department of Periodontology, K.M.Shah Dental College and Hospital, Sumandeep Vidyapeeth, Gujarat, India
3 Department of Obstetrics and Gynaecology, SBKS Medical College and Hospital, Sumandeep Vidyapeeth, Gujarat, India

Date of Submission10-Jun-2020
Date of Decision09-Feb-2021
Date of Acceptance05-Apr-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Bhavna Haresh Dave
Department of Paediatric and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara - 391 760, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisppd.jisppd_270_20

Rights and Permissions

 

   Abstract 


Context: The impact of periodontal disease during pregnancy and its effect on adverse pregnancy outcomes is seen in the literature. When it comes to the link of disease related to periodontium to that of adverse pregnancy outcomes, a need can arise if a significant cause-effect relationship does exist or not between them. Aim: The study was aimed to determine the association of periodontal health status in pregnant women with the occurrence of preterm low birth weight (LBW) infants in Vadodara, Gujarat. Settings and Design: An interventional study with 100 patients was conducted, of which 67 participants were included in the control group and 33 participants were included in the intervention group. A total of 12 participants dropped out from the study and 88 were analyzed for the outcome. Subjects and Methods: The Community periodontal Index of Treatment needs index was taken for all enrolled participants and then were divided into interventional group and control group. Participants in the interventional group underwent scaling and root planning. Data related to the time of delivery and weight of the baby was taken from the hospital records. Statistical Analysis: A comparison of baseline characteristics was made using unpaired t-test. Chi-square test was used for the analysis of intergroup comparison. The odds ratio and the relative risk calculation were also done. P ≤ 0.05 was considered for statistical significance. Results: The odds ratio for both preterm and LBW were 3.86 times and 2.96, respectively. The Chi-square statistical test analysis was statistically significant for both preterm and LBW infants on the intergroup comparison. Conclusion: Periodontal disease can be considered as one of the risk factors for preterm LBW babies as not only the presence of disease condition causes an increase in inflammatory mediator but also the elimination of the disease condition reduces the adverse pregnancy outcomes.


Keywords: Low-birth-weight, maternal periodontitis, periodontitis, preterm birth, preterm low-birth-weight, scaling and root planning


How to cite this article:
Dave BH, Shah EB, Gaikwad RV, Shah SS. Association of preterm low-birth-weight infants and maternal periodontitis during pregnancy: An interventional study. J Indian Soc Pedod Prev Dent 2021;39:183-8

How to cite this URL:
Dave BH, Shah EB, Gaikwad RV, Shah SS. Association of preterm low-birth-weight infants and maternal periodontitis during pregnancy: An interventional study. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2022 Aug 8];39:183-8. Available from: http://www.jisppd.com/text.asp?2021/39/2/183/322502





   Introduction Top


An increase in hormones named estrogen and progesterone is seen during pregnancy.[1] Both these hormones lead to increased gingival vascularization and decreased immune response and wound healing. Moreover, studies[2] reveal that microorganisms (Prevotella species) tend to utilize these steroidal hormones for their growth and increase the tendency of gingival bleeding which later worsens gingival inflammation. As a result, pregnant mothers have severe gingival inflammation even with reasonably low plaque levels.

Xiong et al.[3] in a systematic review suggested that disease is also related to adverse physiological condition outcome, however additional method analysis is needed within the same field. Checking upon the link between disease and adverse physiological condition outcomes, a requirement arises to create a customary operative protocol for pregnant females and to make a decision upon whether or not to include scaling and root planning (SRP) before conceiving or throughout the trimester. Hence, a hypothesis was assumed that there's nil association between the disease existence in pregnant ladies and preterm low-birth-weight (LBW) infants for this trial. In this study, the association between periodontal health status in pregnant ladies and incidence of preterm (<37 weeks) LBW (<2500 g) infants in Vadodara, Gujarat was assessed.


   Subjects and Methods Top


An interventional study was conducted with an interdisciplinary approach of a medical hospital and a dental hospital, Vadodara, Gujarat, wherein expectant mothers were screened visiting the OPD of the Department of Obstetrics and Gynecology at a medical hospital from March 2018 to March 2019. The study protocol was approved by the ethical committee of the university. A total of 400 patients were assessed and screened in 1-year time. On screening of patients, only 100 patients could meet the inclusion criteria and were selected [Figure 1].
Figure 1: Consort diagram

Click here to view


The inclusion criteria for the study were as follows:

  • Women between 21 and 25 years of age
  • Women weighing >40 kg
  • Women having hemoglobin > 10 g per deciliter
  • Women who are having the first gestation with no history of previous miscarriage
  • Women who are systemically healthy
  • Women who agreed to participate in the study.


Women with a positive history of the use of tobacco or other related products in either smoking or smokeless form or those who denied participation in the study were excluded from the study.

The purpose and nature of the study were explained to all participants before the study and written informed consent either in English or in the local language, i.e., Gujarati was obtained from the participants.

After the enrollment of patients, they were examined by the examiner. All essential data such as name, age, weight, contact details, date of last menstrual period (LMP), and hemoglobin count were noted for each participant. Thereafter, the participant was referred to the dental hospital for further procedure. Complete oral examination was done by a calibrated periodontist. Participants were asked to sit on the dental chair, and therefore, the periodontal health status was evaluated using the Community Periodontal Index of Treatment Needs (CPITN).[4] Patients were then made aware about the role of maintaining oral hygiene and its effects on the fetus. All patients were then motivated to undergo the SRP procedure. According to the willingness of the patient to undergo treatment, they were divided into two groups:

1. Control group (Group 1) includes expectant mothers in the III trimester (25–40 weeks) and expectant mothers of the I (1–12 weeks) and II trimesters (13–24 weeks) who are not willing to undergo scaling and root planning procedure

2. Intervention group (Group 2) included expectant mothers in their first (1–12 weeks) and second trimesters (13–24 weeks) who underwent SRP.

Participants in the first trimester were recalled for scaling and treatment in the second trimester. Reinforcement of the oral hygiene instructions was done during follow-up. Sixty-seven participants totaled up in the control group, whereas 33 were enrolled in the interventional group.

After the complete dental examination and evaluation of periodontal disease using CPITN, SRP was performed for participants in the interventional group. A semi-supine participant position was preferred, and participants were asked to gargle with 0.2% chlorhexidine mouthwash for 30 s. After that, the ultrasonic scaling was performed by a calibrated periodontist for the participants following all the principles of instrumentation. Woodpecker UDS P LED Piezoelectric ultrasonic scaler that operates at 28,000–36,000 cycles/second was used. The instrument tip was activated which had back-and-forth vibrating movement and thus removed the calculus and debris from the side of the tooth. When the SRP was completed, all the patients were instructed for oral hygiene with the correct tooth brushing technique explained. 10 ml, 0.2% chlorhexidine gluconate mouthwash in 1:1 concentration was prescribed twice daily for a week. Participants were then recalled for follow-up after 7 days. Oral hygiene reinforcement was done during follow-up.

Data related to the time of delivery, i.e. preterm or full term, and weight of baby, i.e. LBW or normal birth weight, were taken from the hospital records using the LMP information taken at the first visit. The statistician was kept blinded in the study.

Loss to follow-up was seen in each group as the expectant mother delivered the baby at other general hospital. A total of twelve patients– seven within the control group and five within the interventional group – were dropped out from the study as they did not show up for follow-up visits.


   Results Top


A total of 400 individuals were screened, of which 100 individuals who meet the inclusion criteria were registered in the study. During the follow-up phase, 88 participants followed up for delivery of baby, whereas 12 participants dropped out as they did not report to the general hospital for their delivery.

All the participants enrolled in Group I and Group II had the same baseline characteristics when compared for their demographic data. An unpaired t-test was used for the comparison of mean age, mean weight, and mean hemoglobin counts for all 100 patients, and the test was found to be statistically not significant.

[Table 1] shows the demographic details of the mean age comparison between both groups. On comparison, the two-tailed P value was 0.0718 which showed that the unpaired t-test was not statistically significant. The confidence interval for mean age comparison was − 0.08–1.85. On comparison of demographic details of mean weight between both the groups, the two-tailed P value was 0.4097 which showed that the unpaired t-test was not statistically significant. The confidence interval for mean weight comparison was − 2.37–5.77. Finally, on comparison of demographic details of mean hemoglobin comparison between both the groups, the two-tailed P value was 0.1224 which showed that the unpaired t-test was not statistically significant. The confidence interval for mean hemoglobin comparison was − 1.0208–0.1228.
Table 1: Demographic details of mean age, mean weight, and mean hemoglobin of all participants recruited in the study

Click here to view


[Table 2] shows the details of preterm birth as well as full-term birth outcomes of patients after the delivery. The Chi-square statistical test analysis was done, and the Chi-square statistic was 4.4698 and P value was 0.034498 which was statistically significant (P < 0.05). Out of the total of 88 participants, 22 participants suffered from preterm birth, of which 19 participants were from the control group and 3 participants were from the intervention group who underwent SRP.
Table 2: Comparison of preterm birth versus full-term birth in participants of control group and intervention group

Click here to view


On calculation for odds ratio for preterm birth, it was noted that in the control group participants had 3.86 times more chance to have preterm birth than the participants in the interventional group. The relative risk ratio for the same was 2.96 which indicated that participants in the control group had 2.96 times more risk to have preterm birth.

[Table 3] shows the details of LBW as well as normal birth weight outcomes of participants after the delivery. The Chi-square statistical test analysis was done, and the Chi-square statistic value was 5.2381 and P value was 0.022097 which was statistically significant (P < 0.05). Out of 88 participants, 44 participants suffered from LBW infants. A total of 9 participants from the interventional group and 35 participants from the control group had LBW infants.
Table 3: Comparison of low birth weight versus normal birth weight in participants of control group and intervention group

Click here to view


On calculation for odds ratio for LBW, it was noted that the participants in the control group had 2.96 times more chance to have LBW than the participants in the interventional group. The relative risk ratio for the same was 1.81 which indicated that participants in the control group had 1.81 times more risk to have LBW.

On comparison of the data in [Table 4] about increasing severity of periodontitis with an increase in periodontal CPITN score and its effect on the occurrence of preterm delivery and LBW infants using Chi-square test analysis, the test was found to be statistically not significant (P > 0.05).
Table 4: Distribution of Community Periodontal Index of Treatment Needs score in all the participants of both the groups

Click here to view



   Discussion Top


Periodontitis is considered a risk issue for preterm LBW outcomes, due to increase in inflammatory markers in periodontitis. In 1996, Offenbacher et al.[5] stated that periodontal disease was found to be a risk factor for premature delivery and LBW, with expectant mothers with periodontal disease at greater risk (seven times) to deliver a preterm or LBW. Jeffcoat et al.[6] found a 4-time rise in the odds of preterm birth before 37 weeks of gestation, rising to a seven-fold increase before 32 weeks of gestation in expectant mothers with generalized or severe periodontal disease.

On contrary, Moore et al.[7] found no association between preterm birth, LBW, and periodontal disease, although a link between indicators of poor periodontal health and late miscarriage were mentioned in the study. In the present study, female participants of an average age of 22 years have participated with a weight of approximately 47 kg and with hemoglobin >10 g per deciliter. A study done by Symington et al.[8] stated that maternal hemoglobin levels were associated with preterm LBW. Hence, participants with <10 g per deciliter of hemoglobin were not included in the study. Furthermore, when compared with the baseline characteristics for mean hemoglobin, as shown in [Table 1] for both the groups, no statistically significant differences between both the groups were noted.

A study conducted by Elshibly and Schmalisch[9] showed relation between the order of birth and the weight of the baby at the time of birth. The study showed that the LBW rate of firstborn babies was 12.2% which was nearly twice than their counterpart infants. Hence, in the present study, only the mothers with first gestation and no history of miscarriage were included.

A study done by Wachamo et al.[10] stated the weight of the mother can be considered as a contributing risk factor for LBW for newborn. Furthermore, maternal age <20 years at birth had a significantly increased risk of delivering an LBW baby. In the present study, both the risk factors are considered, and as shown in [Table 1], both the variables show no statistical significance when compared between the groups.

The present study shows that all the participants who underwent intervention of SRP had less chance to have preterm LBW than the participants who did not undergo SRP. Out of 88 participants, 44 participants suffered from LBW babies and 22 participants suffered from preterm birth, of which 9 participants suffered from the LBW babies and 3 participants suffered from preterm birth in the interventional group.

On comparison, the risk to have preterm birth was found to be 3.86 times more in participants who did not go for scaling while 2.96 times had more chances to have LBW in the control group. The systematic review conducted by Teshome and Yitayeh[11] showed an odds ratio ranging from 2.04 to 4.19. Out of the selected studies in the systematic review, nine studies implied a link among periodontal disease and increased risk of preterm birth, LBW, and/or preterm LBW outcome.


   Conclusion Top


Periodontitis is more commonly seen in many pregnant females. Awareness regarding oral hygiene maintenance is less encountered among participants. Plausible knowledge of periodontal disease link with adverse pregnancy outcomes is also not commonly seen among females. The incidence of LBW in India varies between 25% and 30%.[12] Hence, sensitization of females is required regarding the change in immune response and inflammatory response mediators due to increased progesterone and estrogen levels in pregnancy that can result in increased susceptibility of pregnant mothers to periodontal disease. Adverse pregnancy outcomes are generally associated with elevated local and systemic inflammatory mediators and intrauterine infections.

Looking to the results in the present study, periodontal disease can be considered as one of the risk factors for preterm LBW babies as not only the presence of disease condition causes an increase in inflammatory mediator but also the elimination of the disease condition by the intervention of SRP gives a positive result in the reduction of the adverse pregnancy outcomes.

Limitations

The present study was conducted at a single-center, with participants of the same socioeconomic status and small sample size. Hence, a multicentric study involving rural as well as urban population of both government and private clinic setups with large sample size should be conducted. Furthermore, the distribution of participants in both the groups was based on the willingness of the participants to undergo SRP, so the distribution of participants in both groups is unequal.

Recommendations

Looking to the results from the present study, a routine protocol of SRP can be implemented as a standard operating protocol along with routine dental checkups for all the females who are planning to conceive or are pregnant.

Proper knowledge of oral hygiene and its effect on adverse pregnancy outcomes can be made aware to society.

In the present situation, the government is spending a huge amount for the welfare of mothers and infants for their antenatal care and also for the nourishment of low birth infants. If a small step toward oral hygiene maintenance can help in reducing one of the risk factors for preterm LBW, then efforts can be made to implement a standard operating protocol for pregnant females.

Financial support and sponsorship

This study was financially supported by self and Sumandeep Vidhyapeeth.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hashim R, Akbar M. Gynecologists' knowledge and attitudes regarding oral health and periodontal disease leading to adverse pregnancy outcomes. J Int Soc Prev Community Dent 2014;4:S166-72.  Back to cited text no. 1
    
2.
Ercan E, Eratalay K, Deren O, Gur D, Ozyuncu O, Altun B, et al. Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight. Acta Odontol Scand 2013;71:553-9.  Back to cited text no. 2
    
3.
Xiong X, Buekens P, Fraser WD, Beck J, Offenbacher S. Periodontal disease and adverse pregnancy outcomes: A systematic review. BJOG 2006;113:135-43.  Back to cited text no. 3
    
4.
Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987;37:222-33.  Back to cited text no. 4
    
5.
Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G. Periodontai infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67:1103-13.  Back to cited text no. 5
    
6.
Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: Results of a prospective study. J Am Dent Assoc 2001;132:875-80.  Back to cited text no. 6
    
7.
Moore S, Ide M, Coward PY, Randhawa M, Borkowska E, Baylis R, et al. A prospective study to investigate the relationship between periodontal disease and adverse pregnancy outcome. Br Dent J 2004;197:251-8.  Back to cited text no. 7
    
8.
Symington EA, Baumgartner J, Malan L, Wise AJ, Ricci C, Zandberg L, et al. Maternal iron-deficiency is associated with premature birth and higher birth weight despite routine antenatal iron supplementation in an urban South African setting: The NuPED prospective study. PLoS One 2019;14:e0221299.  Back to cited text no. 8
    
9.
Elshibly EM, Schmalisch G. The effect of maternal anthropometric characteristics and social factors on gestational age and birth weight in Sudanese newborn infants. BMC Public Health 2008;8:244.  Back to cited text no. 9
    
10.
Wachamo TM, Bililign Yimer N, Bizuneh AD. Risk factors for low birth weight in hospitals of North Wello zone, Ethiopia: A case-control study. PLoS One 2019;14:e0213054.  Back to cited text no. 10
    
11.
Teshome A, Yitayeh A. Relationship between periodontal disease and preterm low birth weight: Systematic review. Pan Afr Med J 2016;24:215.  Back to cited text no. 11
    
12.
Raman TR, Devgan A, Sood SL, Gupta A, Ravichander B. Low birth weight babies: Incidence and risk factors. Med J Armed Forces India 1998;54:191-5.  Back to cited text no. 12
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (732 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Subjects and Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1562    
    Printed58    
    Emailed0    
    PDF Downloaded356    
    Comments [Add]    

Recommend this journal


Contact us | Sitemap | Advertise | What's New | Copyright and Disclaimer | Privacy Notice
  2005 - Journal of Indian Society of Pedodontics and Preventive Dentistry | Published by Wolters Kluwer - Medknow 
Online since 1st May '05