title: Association between maternal dental periapical infections and pregnancy outcomes: results from a cross-sectional study in Malawi.
abstract: OBJECTIVE
  Maternal infections are associated with intrauterine growth restriction (IUGR) and preterm birth (PTB). Dental infections are common in low-income settings, but their contribution to adverse pregnancy outcomes is unknown. We studied the epidemiology of dental periapical infections among pregnant women and their association to foetal growth restriction and the duration of pregnancy in a rural sub-Saharan African population.
  
  
  METHODS
  This was a cross-sectional study on the association between maternal dental periapical infections and birth outcomes, in Malawi, Africa. We assessed oral health clinically and radiologically among recently delivered women with known duration of pregnancy and measured birthweight (BW), length and head circumference of their infants.
  
  
  RESULTS
  Of 1024 analysed participants, 23.5% had periapical infections. Mean duration of pregnancy was 39.4 weeks, BW 2979 g and length 49.7 cm. Women with periapical infection had mean (95% CI) pregnancy duration 0.4 weeks (0.1-0.8) shorter and delivered infants with 79 g (13-145) lower BW and 0.5 cm (0.2-0.9) shorter neonatal length than women without periapical infection. The incidence of PTB was 10.0% among women with periapical infection and 7.3% among those without (adjusted difference 3.5%, 95% CI -1.1-8.1%). Corresponding prevalences for stunting were 20.9% and 14.2% (adjusted difference 9.0%, 95% CI 2.7%-15.2%). The population-attributable risk fraction attributable to periapical infection was 9.7% for PTB and 12.8% for stunting.
  
  
  CONCLUSIONS
  Periapical infection was associated with shorter pregnancy duration and IUGR in the study area; interventions addressing this risk factor may improve birth outcomes in low-income settings.
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Harjunmaa
authors.affiliation: Department of Radiology, Medical Imaging Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Jorma
authors.initials: J
authors.lastname: Järnstedt
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland.
authors.forename: Lotta
authors.initials: L
authors.lastname: Alho
authors.affiliation: Department of Nutrition, University of California, Davis, Davis, CA, USA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Dewey
authors.affiliation: Centre for Quantitative Medicine, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
authors.forename: Yin Bun
authors.initials: YB
authors.lastname: Cheung
authors.affiliation: FHI360, Food and Nutrition Technical Assistance III Project (FANTA), Washington, DC, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Deitchler
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Ashorn
authors.affiliation: School of Public Health, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Maleta
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Klein
authors.affiliation: Department for International Health, University of Tampere School of Medicine, Tampere, Finland.|Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Ashorn
keywords: caries dentaires; caries dental; crecimiento intrauterino retardado; dental caries; duración del embarazo; duration of pregnancy; durée de la grossesse; femmes enceintes; infección periapical; infections; intrauterine growth restriction; mujer embarazada; parodontite; periapical infection; periodontitis; pregnant women; restriction de croissance intra-utérine