title: Maternal periodontitis and adverse pregnancy outcomes.
abstract: OBJECTIVE
  Maternal periodontal diseases have been associated with increased risk of preterm birth and restricted fetal growth among relatively low socioeconomic groups. Whether the association can be generalized to middle-class populations remains uncertain. We evaluated periodontitis in relation to preterm birth (<37 weeks' gestation) and small-for-gestational-age (SGA, birth weight below the 10th percentile of birth weight for gestational age) among a group of medically insured women.
  
  
  METHODS
  We conducted a prospective study among participants of Project Viva, a US cohort study of pregnant women and their offspring from 1999 to 2002. Pregnancy outcomes were obtained from medical records. Self-reported periodontitis was assessed during the second trimester of pregnancy, and validated against radiographs. Logistic regression analyses were employed to evaluate the association of periodontitis with pregnancy outcomes adjusted for age, race/ethnicity, smoking status, income, frequency of dental check-ups, prepregnancy body mass index, pregnancy weight gain, gravidity, prior history of preterm birth and history of genitourinary infection.
  
  
  RESULTS
  Of the 1635 women, 72.7% were Caucasian, 65.0% had annual household income >$70 000, 3.8% reported having periodontitis, 6.4% delivered preterm, 5.4% delivered SGA babies, and 11.0% had poor pregnancy outcome (either preterm birth or SGA). The odds ratio (OR) associated with periodontitis was 1.74 (95% CI 0.65-4.66) for preterm delivery and 2.11 (95% CI 0.76-5.86) for SGA individually. When preterm delivery and/or SGA were combined, the OR was 2.26 (95% CI 1.05-4.85) relating periodontitis with poor pregnancy outcome.
  
  
  CONCLUSIONS
  Within the limitations of the study, the results suggest that periodontitis is an independent risk factor for poor pregnancy outcome among middle-class women.
authors.affiliation: Department of Oral Health Policy & Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA. waranuch@post.harvard.edu
authors.forename: Waranuch
authors.initials: W
authors.lastname: Pitiphat
authors.forename: Kaumudi J
authors.initials: KJ
authors.lastname: Joshipura
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.forename: Chester W
authors.initials: CW
authors.lastname: Douglass
authors.forename: Janet W
authors.initials: JW
authors.lastname: Rich-Edwards
mesh_terms: D000328:Adult; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D016017:Odds Ratio; D010518:Periodontitis / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D047928:Premature Birth / Q000209:etiology*; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D012923:Social Class; D011795:Surveys and Questionnaires