Download Complications of Pregnancy Basis of Current Understanding

Complications of Pregnancy
Basis of Current Understanding: Prospective Studies
Strength of Statistical Evidence: Weak to Moderate
Studies Link Periodontal Treatment to Reduction of Disease: Possibly
Reported Risk: Pre-term Births - 77-720%; Low Birth Weight - 180-260%
Several studies have linked Periodontal Disease to pregnancy complications, most
notably the delivery of pre-term, and/or low-birth weight babies. The extent of the
relationship is complicated by the number of definitions used for Periodontal Disease.
When gum disease is defined broadly, the results are small and not statistically
significant. More stringent definitions have resulted in statistically significant risk ratios.
At present, our understanding of the mechanisms underlying the relationship between
Periodontal Disease and pregnancy complications is not well understood. It is speculated
that several mechanisms could cause the increased problems.
In women with gingivitis or Periodontal Disease, the numbers and types of bacteria
have been found to be much higher than in women with normal gums. Researchers have
speculated that fewer bacteria in the mouth may result in fewer bacteria in the amniotic
fluid and chorionic membranes. Study results appear to supporting this concept. The
beneficial effect of gum care on pre-term delivery has been shown for women with early
and moderate gum disease, but the benefit disappears in women with advance Periodontal
Disease. This may be due to the effect of increase bacterial circulation directly after
scaling and root planing in the advance Periodontal Disease group.
Proteins called cytokines are released throughout the body when gum disease is
present. Cytokines have been shown to cause problems with many of our body’s
functions. For instance, Tumor Necrosis Factor-α (TNF-α) can damage the lining of
blood vessels. This may affect the fetal blood supply and the highly vascular vaginal or
uterine tissues.
Gum disease is an inflammatory disease that has been shown to cause oxidative stress
and create oxygen free radicals. These reactive chemicals attack cells and disrupt cell
functions. In general, any disease that causes stress to the body can rob pregnant women
of nutrients necessary for normal fetal development.
Several studies have attempted to show improvement in pregnancy complications
when participants received periodontal treatment during their pregnancies. While a few
studies failed to find a statistically significant link, other studies have supported the
relationship. Results from the Obstetrics and Periodontal Therapy (OPT) Study released
in 2008, suggest that periodontal care reduced pre-term births in cases of gingivitis or
mild gum disease, but not in cases of more advanced gum problems. In 2009, Polyzos, et
al, showed significant reductions in low birth weight (52%) and pre-term births (45%)
after scaling and root planing.
It should be noted that several large insurance carriers (including Aetna and CIGNA)
feel that current evidence is strong enough to offer their female clients additional dental
care when they are pregnant.