title: Periodontitis, a marker of risk in pregnancy for preterm birth.
abstract: BACKGROUND
  Why chronic periodontitis may induce an inflammatory response with premature pregnancy termination is unclear.
  
  
  OBJECTIVE
  (1) To assess if periodontitis predicts premature gestation; (2) to study amniotic fluid cytokines and periodontitis variables in early-stage pregnancy.
  
  
  METHODS
  A periodontal examination and collection of amniotic fluid was performed (weeks 15-20) of pregnancy in 36 women at risk for pregnancy complications. Amniotic fluid (bacteria), vaginal smears and intra-oral plaque samples were studied. Cytokine levels in amniotic fluid were studied in relation to other study variables.
  
  
  RESULTS
  Periodontitis was diagnosed in 20% of normal and in 83% of preterm birth cases (p<0.01). Bacteria were never found in the amniotic fluids studied. Sub-gingival plaque samples including bacteria in the orange and red complexes were found in 18% of full-term 100% of preterm cases (p<0.001) and total colony-forming units (CFUs) were higher in preterm birth (p<0.01). Amniotic levels of interleukin (IL)-6 and prostaglandin-E2 (PGE2) were higher in preterm cases (p<0.001). Amniotic IL-6 (r=0.56, p<0.01) and PGE2 (r=0.50, p<0.01) cytokine levels were correlated with CFU from sub-gingival plaque samples (r2=0.44). The odds ratio of preterm delivery and having periodontitis was 20.0 (95% confidence interval (CI): 2.0-201.7, p<0.01). The odds of >60 CFU in sub-gingival plaque and preterm birth was 32.5:1 (95% CI: 3.0-335.1, p<01).
  
  
  CONCLUSIONS
  Pregnant women with findings of elevated amniotic fluid levels of PGE2, IL-6 and IL-8 in the 15-20 weeks of pregnancy and with periodontitis are at high risk for premature birth. The implication of this is that periodontitis can induce a primary host response in the chorioamnion leading to preterm birth.
authors.affiliation: Department of Periodontology and Fixed Prosthodontics, University of Bern, Switzerland. orhun.doertbudak@meduniwien.ac.at
authors.forename: Orhun
authors.initials: O
authors.lastname: Dörtbudak
authors.forename: Rita
authors.initials: R
authors.lastname: Eberhardt
authors.forename: Martin
authors.initials: M
authors.lastname: Ulm
authors.forename: G Rutger
authors.initials: GR
authors.lastname: Persson
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry / Q000382:microbiology; D015169:Colony Count, Microbial; D016207:Cytokines / Q000032:analysis; D003773:Dental Plaque / Q000382:microbiology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D016017:Odds Ratio; D010514:Periodontal Pocket / Q000382:microbiology; D010518:Periodontitis / Q000150:complications*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology; D047928:Premature Birth / Q000209:etiology* / Q000382:microbiology; D018709:Statistics, Nonparametric; D014621:Vagina / Q000382:microbiology; D014626:Vaginal Smears
chemical_list: D016207:Cytokines