title: Fetal exposure to oral pathogens and subsequent risk for neonatal intensive care admission.
abstract: BACKGROUND
  Maternal periodontal infection has been associated with adverse maternal and neonatal outcomes. In utero fetal exposure to oral pathogens was also recognized as deleterious to the fetus. The objective of this study was to determine the relationship between fetal exposure to oral pathogens and neonatal intensive care unit (NICU) admission.
  
  
  METHODS
  This was a secondary analysis of a prospective cohort study of maternal oral health and pregnancy outcome. Fetal immunoglobulin M against oral pathogens was detected in umbilical cord serum by immunoblot. The presence of at least one oral pathogen-specific antibody was considered seropositivity. The cord level of C-reactive protein was determined by enzyme-linked immunosorbent assay and categorized as detectable versus undetectable. Chi-square and logistic regression analyses were used to determine the association between cord serum seropositivity or detectable C-reactive protein and NICU admission and length of stay.
  
  
  RESULTS
  Of 650 infants, 45 (6.9%) were admitted to the NICU. The admission rate was higher among seropositive infants compared to seronegative infants (11% versus 5%; P = 0.0019). Seropositive infants were also more likely than seronegative infants to stay >3 or >7 days (8% versus 3% and 6% versus 2%; P = 0.004 and 0.003, respectively). Adjusting for gestational age, the odds ratio (95% confidence interval) for NICU admission was 2.14 (1.01 to 4.54); for a length of stay >3 or >7 days, it was 2.38 (1.01 to 5.60) and 3.29 (1.13 to 9.58), respectively. The NICU admission rate was not significantly higher for those with detectable versus undetectable umbilical cord serum C-reactive protein (8% versus 6%; P = 0.3).
  
  
  CONCLUSIONS
  In utero fetal exposure to oral pathogens increases the risk for NICU admission and the length of stay. Interventions that interrupt fetal exposure to oral pathogens may reduce these risks.
authors.affiliation: Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. heather_jared@rhoworld.com
authors.forename: Heather
authors.initials: H
authors.lastname: Jared
authors.forename: Kim A
authors.initials: KA
authors.lastname: Boggess
authors.forename: Kevin
authors.initials: K
authors.lastname: Moss
authors.forename: Carl
authors.initials: C
authors.lastname: Bose
authors.forename: Richard
authors.initials: R
authors.lastname: Auten
authors.forename: James
authors.initials: J
authors.lastname: Beck
authors.forename: Steven
authors.initials: S
authors.lastname: Offenbacher
mesh_terms: D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D044883:Campylobacter rectus / Q000276:immunology; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D016967:Fusobacterium nucleatum / Q000276:immunology; D005865:Gestational Age; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007902:Length of Stay; D008297:Male; D008431:Maternal-Fetal Exchange / Q000276:immunology; D010343:Patient Admission; D010462:Peptostreptococcus / Q000276:immunology; D010510:Periodontal Diseases / Q000382:microbiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000382:microbiology*; D011256:Pregnancy Outcome; D018713:Prevotella intermedia / Q000276:immunology; D045242:Prevotella nigrescens / Q000276:immunology; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M; D002097:C-Reactive Protein