title: Periodontal Disease and Adverse Pregnancy Outcomes: A Prospective Study in a Low-Risk Population.
abstract: BACKGROUND
  Periodontal disease has been associated with systemic inflammation and adverse pregnancy outcomes, including preeclampsia and preterm birth.
  
  
  OBJECTIVE
  To examine the relationship between periodontal disease in early pregnancy and the risk of amniotic inflammation, preterm birth, and preeclampsia.
  
  
  METHODS
  We performed a prospective cohort study of women undergoing amniocentesis for fetal karyotype between 15 and 24 weeks' gestation. Participants underwent periodontal examination by a certified dentist, and a sample of amniotic fluid was collected. Periodontal disease was defined as the presence of one or more sites with probing depths ≥ 4 mm and ≥ 10% bleeding on probing. Matrix metalloproteinase-8 and interleukin-6 concentrations in the amniotic fluid were measured. Medical charts were reviewed for perinatal outcomes. Univariate and multivariate logistic regression analyses were used to assess the association between periodontal disease and adverse pregnancy outcomes.
  
  
  RESULTS
  We recruited 273 women at a median gestational age of 16 weeks (range 15 to 24), and 258 (95%) agreed to undergo periodontal examination. Periodontal disease was observed in 117 of the participants (45%). We observed no significant association between periodontal disease and preterm birth (relative risk [RR] 2.27; 95% CI 0.74 to 6.96) or spontaneous preterm birth (RR 0.90; 95% CI 0.20 to 4.11). However, women with periodontal disease were more likely to develop preeclampsia, and this association remained significant after adjustment for potential confounders (adjusted RR 5.89; 95% CI 1.24 to 28.05). Periodontal disease was not associated with significant differences in the intra-amniotic concentration of matrix metalloproteinase-8 (13.0 ± 46.6 vs 5.7 ± 10.4 ng/mL, P = 0.098) or interleukin-6 (3.3 ± 20.3 vs 1.0 ± 1.6 ng/mL, P = 0.23), although a non-significant trend was observed.
  
  
  CONCLUSIONS
  Periodontal disease is associated with preeclampsia but not with spontaneous preterm birth. The current study cannot exclude an association between periodontal disease and intra-amniotic inflammation.
authors.affiliation: Faculty of Medicine, Université Laval, Quebec QC; Centre de recherche du CHU de Québec, Quebec QC.
authors.forename: Laurence
authors.initials: L
authors.lastname: Soucy-Giguère
authors.affiliation: Centre de recherche du CHU de Québec, Quebec QC.
authors.forename: Amélie
authors.initials: A
authors.lastname: Tétu
authors.affiliation: Faculty of Dentistry, Université Laval, Quebec City QC.
authors.forename: Simon
authors.initials: S
authors.lastname: Gauthier
authors.affiliation: Faculty of Dentistry, Université Laval, Quebec City QC.
authors.forename: Marianne
authors.initials: M
authors.lastname: Morand
authors.affiliation: Faculty of Dentistry, Université Laval, Quebec City QC.
authors.forename: Fatiha
authors.initials: F
authors.lastname: Chandad
authors.affiliation: Centre de recherche du CHU de Québec, Quebec QC; Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec QC.
authors.forename: Yves
authors.initials: Y
authors.lastname: Giguère
authors.affiliation: Centre de recherche du CHU de Québec, Quebec QC; Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec QC.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology; D010512:Periodontal Index; D010518:Periodontitis / Q000175:diagnosis* / Q000453:epidemiology*; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D011792:Quebec; D013223:Statistics as Topic; D055815:Young Adult
chemical_list: D018836:Inflammation Mediators
keywords: Pregnancy; amniotic fluid; periodontitis; preeclampsia; preterm birth