title: Periodontal disease increases the risk of preterm delivery among preeclamptic women.
abstract: BACKGROUND
  Preterm births are a major cause of neonatal morbidity and mortality, and represent an important public health issue. About 30% of preterm births are due to medical conditions of the mother or the fetus, among "which preeclampsia plays a major role. We have previously reported that maternal periodontal disease enhances the risk for preterm delivery and preeclampsia. Our current objective was to determine whether maternal periodontal disease increases the risk for preterm delivery among preeclamptic women.
  
  
  METHODS
  Women were enrolled prior to their twenty-sixth week of gestation. Periodontal status was assessed at baseline and defined as healthy, mild, or moderate/severe. Repeat examinations were performed at delivery to assess changes in periodontal status.
  
  
  RESULTS
  A cohort of 1,020 women was studied, 47 of whom had preeclampsia. A strong association between periodontal disease status at enrollment and rate of premature delivery was observed among preeclamptic women after adjusting for the major risk factors for preterm delivery, including maternal race; age; marital status; WIC (women, infants, children program) or food stamps; insurance; previous preterm delivery; and chorioamnionitis. Among preeclamptic women, 49.3% with mild periodontal disease and 82.6% with moderate to severe disease delivered preterm (hazard ratios [HR] 4.11 and 11.0, respectively). Periodontal disease worsening during pregnancy in preeclamptic women was also associated with an increased risk of preterm births (HR 8.44).
  
  
  CONCLUSIONS
  These results suggest that mothers with preeclampsia may be at greater risk for preterm delivery if periodontal disease is present early in pregnancy or progresses during pregnancy.
authors: Center for Oral and Systemic Diseases and Comprehensive Center for Inflammatory Disorders, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Estelle L
authors: EL
authors: Riché
authors: Kim A
authors: KA
authors: Boggess
authors: Susi
authors: S
authors: Lieff
authors: Amy P
authors: AP
authors: Murtha
authors: Richard L
authors: RL
authors: Auten
authors: James D
authors: JD
authors: Beck
authors: Steven
authors: S
authors: Offenbacher
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010510:Periodontal Diseases / Q000150:complications*; D011225:Pre-Eclampsia / Q000150:complications*; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013312:Stress, Physiological / Q000150:complications