High risk pregnancies

The following pilot study attempts to furnish a possible relationship between the periodontal status and the condition of IHCP through biochemical as well as periodontal parameters. Understanding the periodontal status of pregnant women with IHCP could lead to improved interdisciplinary care, where gynecologists and periodontists can work collaboratively to monitor and manage oral health during pregnancy, especially for those with conditions like IHCP that may exacerbate periodontal issues.

The goal of this study was to investigate metabolic changes in lipids and oxidative stress parameters in the first trimester of pregnancy with the more specific aim of estimating the significance and strength of researched parameters in the prediction of preeclampsia. Design and Methods. The study included 87 high-risk pregnant (HRG) female subjects, 14 with developed preeclampsia (PEC) and 43 healthy pregnant female subjects matched for gestational age (CG). Thiobarbituric acid-reactive substances (TBARS) concentration, lipid hydroperoxides (LOOH), pro-oxidant antioxidant balance (PAB) and total oxidative status (TOS) were measured as oxidative stress markers, while total antioxidant capacity (TAC) was measured as an antioxidative defense parameter. The Atherogenic Index of Plasma (AIP) was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides (TG) to the plasma concentration of highdensity lipoprotein cholesterol (HDL-C), with each concentration expressed in mmol/L. Results: The results have shown that lipid indices, especially AIP, were significantly higher in the first trimester of HRG (p < 0.001) and PEC (p < 0.001). Oxidative stress parameters were significantlly higher, while TAC was significantly lower in HRG vs. CG [0.7 ± 0.15 vs 1.1 ± 0.16; (p < 0.001)] and in PEC [0.6 ± 0.12 vs 1.1 ± 0.16; (p < 0.001)] vs. CG. Also, in the HRG, results have shown an independent association of AIP with the preeclampsia development (p < 0.05), while placental growth factor did not show the expected level of significance (p = 0.648). Analysis of the Receiver Operating Characteristics (ROC) curves indicated that certain parameters included in the research model have very good diagnostic accuracy for preeclampsia (AUC = 0.856). Conclusions: AIP is associated with high-risk pregnancies. Furthermore, our results firmly underscored AIP as a potential marker for preeclampsia prediction.

This study aimed to explore the association between pre-pregnancy BMI and longitudinal changes in inflammatory markers from the second trimester of pregnancy to 6–8 weeks postpartum in women with periodontitis. This is a secondary exploratory analysis of 68 women who took part in a feasibility clinical trial in Rio de Janeiro, Brazil. Inflammatory markers included C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), and matrix metalloproteinase-9 (MMP-9) blood concentrations at 11–22 (T0) and 30–36 gestational weeks (T1), and 6–8 weeks postpartum (T3). Longitudinal generalised linear mixed-effects models were used to identify possible associations between pre-pregnancy BMI and changes in concentrations of inflammatory markers. Pre-pregnancy excess weight (β = 4.39; 95% CI, 2.12–6.65) was significantly associated with increased CRP levels from pregnancy to postpartum. There were no significant associations between pre-pregnancy BMI and longitudinal changes in IL-6,...

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6–8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early...

Objectives: The objective of our study was to identify the effect of low serum vitamin D levels on hypertension & to make a comparison of levels of vitamin D in hypertensives and healthy individuals. Materials and Method: A cross-sectional comparative study carried out in Cardiology Department of Shaikh Zayed Hospital and Punjab Institute of Cardiology, which involved measurement and comparison of serum Vitamin D levels in 64 subjects, categorized in two groups; hypertensives and normotensives, in order to establish a potential association between vitamin D levels and hypertension. Results: Our study showed that Serum Vitamin D was equally sub-optimal in all participants of study, including both hypertensive group and the healthy controls. As a result of this finding, a clear pattern of association of vitamin D deficiency with hypertension could not be seen. Mean ±SD Vitamin D levels was 19.5±10.0 ng/L in hypertensives and 19.5±13.6 in healthy individuals. This study did not lead to...

Objective: Recent studies have suggested that chronic periodontitis may induce an inflammatory response which can cause premature delivery. This study was designed to assess the association between periodontal health and preterm labor in Iranian female population. Materials and Methods: In this case-control study, 201 pregnant women without systemic disease or other risk factors for preterm labor were chosen. The control group (n = 99) had term labor (infants ≥ 37 weeks) and the case group (n = 102) had preterm labor (infants < 37 weeks). Bleeding index, pocket depth and debris index were measured. Results: The data of bleeding index (cases, 0.64 ± 0.38; controls, 0.57 ± 0.35), probing depth (cases, 2.80 ± 0.30; controls, 1.63 ± 0.23) and debris index (cases, 1.38 ± 0.67; controls, 0.81 ± 0.38) revealed a statistically significant difference between the two groups (p < 0.05). Conclusion: According to the findings of this study, there is a noticeable relationship between periodontal health and duration of pregnancy; periodontal disease could be a risk factor for preterm labor. Oral hygiene is strongly recommended to be included in prenatal care.

Background The aim of the study was to evaluate serumlevels of interleukin-1, beta (IL-1β) and tumor necrosis factoralpha (TNF-α) at birth and compare the values in case of preterm birth and normal birth groups of mothers considering the mothers’ periodontal status. Materials and methods Blood samples from 81 women (preterm birth, 41 women, and term birth, 40 women) were collected within half an hour of after delivery. Serum levels of IL-1β and TNF-α were measured. Periodontal status was characterized by bleeding on probing (BOP) and probing depth (PD). Results The frequency of BOP differed significantly between preterm and term groups; however, mean PD did not show a significant difference. Serum IL-1β levels were significantly higher in the preterm birth group. The levels TNF-α were slightly bigger in the term birth group, the difference was significant. The rank correlation showed a significant negative relationship between serum IL-1β and TNF-α level and birth weight and the len...

Objective: It has been suggested that periodontal disease may be a risk factor for a number of multifactorial systemic conditions such as preterm deliveries. The aim of the present study was to examine the relationship between maternal periodontal disease and body size of newborns. Methods: After controlling traditional risk factors for premature child birth and low birth weight. One-hundred eighty mothers were selected: 17 were periodontally healthy, 77 had gingivitis, 72 had initial periodontitis and 14 suffered from established periodontitis. These mothers and their newborns formed the study population. The body size consisting of weight, height, and head and chest circumference, were taken from newborns' hospital files. Findings: A decrease in the newborns' body size was observed as the mothers' periodontal disease severity increased. Birth weight, height, and head and chest circumference of babies born of mothers with established periodontal disease were significantly lower than those who were born of mothers with healthy periodontal condition, gingivitis and initial periodontal disease (P=0.006, P=0.016, P<0.001 and P<0.001, respectively). Conclusion: The data suggest that there is a considerable association between periodontal disease in pregnant women and body size of their newborns, this preliminary finding needs to be confirmed in more extensive studies.

Background and Aim: Preeclampsia is a considerable complication of pregnancy. Chronic inflammations such as periodontitis may lead to a transient low-grade bacteremia in the maternal-fetal circulation, inducing systemic immune responses, placental abnormalities, and other clinical manifestations of preeclampsia. There are inconsistent findings regarding the correlation between periodontitis and preeclampsia. The aim of this study was to compare periodontal parameters in preeclamptic and normotensive pregnant women. Materials and Methods: This case-control study was conducted among pregnant women visiting Akbarabadi Teaching Hospital, Tehran, Iran, for specialized care during 2015-16. From among 260 pregnant women, 100 with gestational hypertension were selected as the case group, and 100 without gestational hypertension were recruited as the control group. The examined periodontal parameters included Probing Depth (PD), Clinical Attachment Loss (CAL), Bleeding on Probing (BOP), and Plaque Control Record (PCR). The participants' demographic data, prenatal history, and family history were collected through interviewing and assessing their medical records. Data were analyzed by Mann-Whitney U test. Results: Although there were significant statistical differences between the groups with regards to the mean ± standard deviation (SD) of PD (P<0.0001), CAL (P<0.0001), PCR (P=0.001), and BOP (P=0.016) indices, yet the differences were clinically smaller than 0.3 mm and could not be measured with a periodontal probe. Also, the percentage of periodontal diseases was 98% in preeclamptic women and 93% in normotensive women (P=0.17). Conclusion: The present study did not support the theory of the relationship between periodontal parameters and preeclampsia.

A lot of studies have shown periodontal diseases as a risk factor for adverse pregnancy outcomes. The association between periodontitis and preeclampsia has been studied recently with controversy. Considering the importance of preventing preeclampsia as a dangerous and life-threatening disease in pregnant women, the present study was carried out. Two hundred and ten pregnant women participated in this case-control study (105 controls & 105 cases) during years 2007 and 2008. Preeclamptic cases were defined as blood pressure ≥140/90mmHg and proteinuria +1. Control group were pregnant women with normal blood pressure without proteinuria. Both groups were examined during 48 hours after child delivery. Plaque Index (PLI), Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding On Probing (BOP), Gingival Recession (GR) were measured on all teeth except for third molars and recorded as periodontal examination. Data was analyzed using t-test, chi-square, and Mann-Whitney U statistical ...

Objective: To determine the efficacy of periodontal intervention on pregnancy outcome in mild preeclamptic women. Methods: A sample of 60 pregnant women with mild preeclampsia (blood pressure levels &lt; 160/110 mm and proteinuria &gt;300 mg/l in 24 hours urine) from the Hospital Universitario del Valle (Cali, Colombia) was included to the study. Preeclamptic women were randomized in two groups, one with periodontal intervention (PIG, N=28) and another in which the periodontal intervention was practiced after childbirth (NPIG, N=32). Maternal socio-demographic, medical and periodontal data were obtained. PIG included patients in which supragingival and subgingival cleaning within ultrasonic and manual devices were performed after study inclusion. The progression from mild to severe preeclampsia, eclampsia or HELLP syndrome, the number of days of clinical stability and the percentile of birth-weight adjusted for gestational age were evaluated in both groups. Results: Most of the pati...

The goal of this study was to investigate metabolic changes in lipids and oxidative stress parameters in the first trimester of pregnancy with the more specific aim of estimating the significance and strength of researched parameters in the prediction of preeclampsia. Design and Methods. The study included 87 high-risk pregnant (HRG) female subjects, 14 with developed preeclampsia (PEC) and 43 healthy pregnant female subjects matched for gestational age (CG). Thiobarbituric acid-reactive substances (TBARS) concentration, lipid hydroperoxides (LOOH), pro-oxidant antioxidant balance (PAB) and total oxidative status (TOS) were measured as oxidative stress markers, while total antioxidant capacity (TAC) was measured as an antioxidative defense parameter. The Atherogenic Index of Plasma (AIP) was calculated as the base 10 logarithm of the ratio of the plasma concentration of triglycerides (TG) to the plasma concentration of highdensity lipoprotein cholesterol (HDL-C), with each concentration expressed in mmol/L. Results: The results have shown that lipid indices, especially AIP, were significantly higher in the first trimester of HRG (p < 0.001) and PEC (p < 0.001). Oxidative stress parameters were significantlly higher, while TAC was significantly lower in HRG vs. CG [0.7 ± 0.15 vs 1.1 ± 0.16; (p < 0.001)] and in PEC [0.6 ± 0.12 vs 1.1 ± 0.16; (p < 0.001)] vs. CG. Also, in the HRG, results have shown an independent association of AIP with the preeclampsia development (p < 0.05), while placental growth factor did not show the expected level of significance (p = 0.648). Analysis of the Receiver Operating Characteristics (ROC) curves indicated that certain parameters included in the research model have very good diagnostic accuracy for preeclampsia (AUC = 0.856). Conclusions: AIP is associated with high-risk pregnancies. Furthermore, our results firmly underscored AIP as a potential marker for preeclampsia prediction.

To investigate the association between plasma CRP levels and periodontal disease during pregnancy. Materials and Methods: Fifty-six pregnant women attending the Antenatal Clinic, UMMC for their first antenatal checkup consented and were recruited for this study: 28 subjects with diseased periodontium (test group) and 28 subjects with healthy periodontium (control). The test group underwent nonsurgical periodontal therapy and the control group was given oral hygiene education. Periodontal parameters and CRP levels were evaluated at baseline and 6 weeks. Pregnancy outcome data were recorded from the Antenatal Clinic, UMMC. Results: Plasma CRP levels in the test group were statistically significantly elevated compared to the control group (8.55 ± 5.28 mg/l vs 5.66 ± 2.91 mg/l). After nonsurgical periodontal therapy, a statistically significant reduction in the CRP level in the test group (2.06 mg/l) along with statistically significant improvement in periodontal status in both groups was observed. The mean birth weight for infants of both groups showed no statistically significant difference. Conclusions: Plasma CRP levels in pregnant women with diseased periodontium were statistically significantly reduced after nonsurgical periodontal therapy. However, no association between CRP levels and adverse pregnancy outcome was observed.

OBJECTIVE-To test the effects of maternal periodontal disease treatment on the incidence of preterm birth (delivery before 37 weeks of gestation). METHODS-The Maternal Oral Therapy to Reduce Obstetric Risk Study was a randomized, treatment-masked, controlled clinical trial of pregnant women with periodontal disease who were receiving standard obstetric care. Participants were assigned to either a periodontal treatment arm, consisting of scaling and root planing early in the second trimester, or a delayed treatment arm that provided periodontal care after delivery. Pregnancy and maternal periodontal status were followed to delivery and neonatal outcomes until discharge. The primary outcome (gestational age less than 37 weeks) and the secondary outcome (gestational age less than 35 weeks) were analyzed using a χ 2 test of equality of two proportions. RESULTS-The study randomized 1,806 patients at three performance sites and completed 1,760 evaluable patients. At baseline, there were no differences comparing the treatment and control arms for any of the periodontal or obstetric measures. The rate of preterm delivery for the treatment group was 13.1% and 11.5% for the control group (P=.316). There were no significant differences when comparing women in the treatment group with those in the control group with regard to the adverse event rate or the major obstetric and neonatal outcomes. CONCLUSION-Periodontal therapy did not reduce the incidence of preterm delivery. CLINICAL TRIAL REGISTRATION-ClinicalTrials.gov, www.clinicaltrials.gov, NCT00097656.

We assessed the risk of adverse pregnancy outcomes (preterm birth [PTB], preeclampsia [PRE], fetal growth restriction [FGR], or perinatal death) in women with periodontal disease (PD) compared to those without. STUDY DESIGN: A multicenter prospective cohort study enrolled women from 3 sites between 6 and 20 weeks' gestation. The presence of PD was defined as periodontal attachment loss Ն to 3 mm on 3 or more teeth. The primary binary composite outcome included PRE, PTB, FGR, or perinatal death. Multivariable logistic regression (MVLR) was used to control for confounders. RESULTS: Three hundred eleven patients with and 475 without PD were included. There was no association between PD and the composite outcome, PRE, or PTB in unadjusted analyses. There was no association between PD and the composite outcome (adjusted odds ratio [AOR], 0.81; 95% confidence interval [CI], 0.58-1.15; P ϭ .24), preeclampsia (AOR, 0.71; 95% CI, 0.37-1.36; P ϭ .30), or preterm birth (AOR, 0.77; 95% CI, 0.49-1.21; P ϭ .25) after adjusting for relevant confounders. CONCLUSION: Despite the body of literature suggesting an association between PD and adverse pregnancy outcomes in urban populations, this large prospective study failed to demonstrate an association.

Objective: To evaluate the clinical approach, the diagnostic method and the most appropriate therapeutic management of thrombotic microangiopathies (TMA) in pregnancy, still leading killers in the obstetric area today. Materials and methods: A large review of the international literature and available clinical studies has been carried out in order to define the current state of the art regarding TMA in pregnancy. In the light of this, 9 clinical cases, among 152 TMA cases, of pregnant women hospitalized and who gave birth in the Pisa University Hospital O.O. U.U. Gynecology and Obstetrics 1 and 2 from 2010 to 2019, were identified, analyzed and re-discussed. Results: Analyzing the diagnostic method and the medical records, we made a critical review of these 9 cases, accurately analyzing the diagnoses made. Among these cases, 6 Thrombotic Thrombocytopenic Purpura (TTP), 2 HELLP Syndrome and 1 Atypical Hemolytic Uremic Syndrome (aHUS) were diagnosed during pregnancy. By analyzing the ...

Objective: To evaluate the clinical approach, the diagnostic method and the most appropriate therapeutic management of thrombotic microangiopathies (TMA) in pregnancy, still leading killers in the obstetric area today. Materials and methods: A large review of the international literature and available clinical studies has been carried out in order to define the current state of the art regarding TMA in pregnancy. In the light of this, 9 clinical cases, among 152 TMA cases, of pregnant women hospitalized and who gave birth in the Pisa University Hospital O.O. U.U. Gynecology and Obstetrics 1 and 2 from 2010 to 2019, were identified, analyzed and re-discussed. Results: Analyzing the diagnostic method and the medical records, we made a critical review of these 9 cases, accurately analyzing the diagnoses made. Among these cases, 6 Thrombotic Thrombocytopenic Purpura (TTP), 2 HELLP Syndrome and 1 Atypical Hemolytic Uremic Syndrome (aHUS) were diagnosed during pregnancy. By analyzing the medical records, the diagnostic method and the therapeutic management of these patients, we questioned the diagnoses made. These diagnoses, from our analytical point of view, are partially not corresponding, being 4 cases of TTP and 5 possible cases of aHUS. Conclusion: From the review of our case history, in the Pisa Obstetric clinics, it is possible to find an under diagnosis of the aHUS cases compared to those of TTP and HELLP syndrome, due both to the unavailability of the ADAMTS13 functionality test and to the unused LDH/AST ratio, which in our opinion could represent a future resource in diagnostic approach to thrombotic microangiopathies in pregnancy.

Objective: To verify a possible association between periodontitis and low birth weight babies. Materials and methods: Two hundred and eighty antepartum women were examined aged between 18 and 37 years. Demographic, medical and clinical histories were taken under obstetrician's guidance. A thorough periodontal examination was done in all the participants with their consent which included bleeding on probing, pocket depth and clinical attachment level. After delivery, gestational age (in weeks) and birth weight of baby (in kg) were collected from hospital records. Infants were placed into following categories by gestational age (WHO) and by birth weight preterm-<37 weeks, term-37 to 42 weeks, post-term-42 weeks completed and above, low birth weight-<2,500 gm, normal birth weight-2,500 to 3,900 gm, high weight->3,900 gm. Results: Based on the findings of the study, a significant correlation was observed between periodontitis and low birth weight and preterm low birth weight (p ≤0.001) and a significant relation was observed between periodontitis and gestational age (p < 0.001). Conclusion: Periodontitis was considered a risk indicator for reduced gestational age and birth weight. Multicentric trials will greatly help to establish the independent role of periodontal disease and their relationship in terms of pregnancy outcomes.

Background: Periodontal diseases are considered a risk factor for adverse pregnancy outcomes, including preterm birth, fetal growth restriction, low birth weight, pre-eclampsia and gestational diabetes. Periodontal bacteria originating in the gingival biofilm directly affect the feto-placental unit subsequent to bacteremia and inflammatory mediators secreted by the subgingival inflammatory site are carried to the feto-placental unit, where they then cause an inflammatory response are two possible mechanisms involve. The role of dentists is important to promote good oral hygiene in expecting mothers during routine prenatal visits to reduce chances of adverse pregnancy outcomes.

Background: This study explored whether there is an association between prepregnancy obesity and periodontitis among pregnant females. Methods: A retrospective cohort study was conducted by using data from a previous case-control study at Woman's Hospital, Baton Rouge, Louisiana. One hundred fifty-nine pregnant females were recruited at their prenatal care visits. Periodontal status was assessed through dental examinations performed at an average of 31 weeks gestation. Periodontitis was defined as the presence of one or more sites exhibiting probing depth ‡4 mm or clinical attachment level ‡4 mm. A Poisson regression with robust error variance was used to estimate risk ratio (RR) and 95% confidence interval (CI). Results: Prepregnancy obesity was statistically significantly associated with periodontitis during pregnancy, with obese females at 1.7 times higher risk compared with under/normal-weight females (RR = 1.7, 95% CI = 1.2 to 2.3, P <0.01). There is no difference in the association between maternal obesity and periodontitis between females with gestational diabetes mellitus (GDM) and females without GDM. Conclusion: There is a positive association between prepregnancy obesity and periodontitis among pregnant females.

Aim: To assess the risk association between chronic periodontitis and pre-eclampsia before and after matching for known risk factors of preeclampsia (maternal age, chronic hypertension and multiparity). Methods: 232 Primigravida women, 18-35 years of age, with gestation period of more than 20 to 26 weeks without known comorbidities were selected from the outpatient department of Obstetrics and Gynaecology, Zonal hospital, Mandi, H.P. A detailed medical and dental history with information regarding maternal age, demographic area, educational qualification and socioeconomic status and clinical parameters as gingival index (GI), gingival bleeding index (GBI), probing depth (PD), clinical attachment loss (CAL) were recorded. Results: It was observed that more cases of severe( CAL ≥ 5mm)and moderate periodontitis (CAL 3-4mm) were present in pre-eclamptic subjects as compared to non pre-eclamptic subjects (p-value &lt;0.001). It was also observed that women suffering from pre-eclampsia, w...

Objectives The aim was to investigate the prevalence of and factors associated with periodontal disease among pregnant Sudanese women. A cross-sectional study was conducted at the Antenatal Care Clinic of Saad Abualila Hospital (Khartoum, Sudan) from August to October 2018. Socioeconomic-demographic information and reproductive history were gathered using a questionnaire. Body mass index was computed from the weight and height. The diagnosis of periodontal disease was performed using criterion that also evaluated bleeding upon probing. Results Four hundred and four women were enrolled in the study, with a mean (SD) gestational age of 30.0 (8.7) weeks. Their mean (SD) age and parity were 27.0 (5.7) years and 1.6 (1.7), respectively. Ninety-seven (24.0%) of these 404 women had periodontal disease, which was mild, moderate and severe in 49 (12.1%), 36 (8.9%) and 12 (3.0%) women respectively, while 307 (76.0%) women had no periodontal disease. In logistic regression, age, parity, educat...

We assessed the risk of adverse pregnancy outcomes (preterm birth [PTB], preeclampsia [PRE], fetal growth restriction [FGR], or perinatal death) in women with periodontal disease (PD) compared to those without. STUDY DESIGN: A multicenter prospective cohort study enrolled women from 3 sites between 6 and 20 weeks' gestation. The presence of PD was defined as periodontal attachment loss Ն to 3 mm on 3 or more teeth. The primary binary composite outcome included PRE, PTB, FGR, or perinatal death. Multivariable logistic regression (MVLR) was used to control for confounders. RESULTS: Three hundred eleven patients with and 475 without PD were included. There was no association between PD and the composite outcome, PRE, or PTB in unadjusted analyses. There was no association between PD and the composite outcome (adjusted odds ratio [AOR], 0.81; 95% confidence interval [CI], 0.58-1.15; P ϭ .24), preeclampsia (AOR, 0.71; 95% CI, 0.37-1.36; P ϭ .30), or preterm birth (AOR, 0.77; 95% CI, 0.49-1.21; P ϭ .25) after adjusting for relevant confounders. CONCLUSION: Despite the body of literature suggesting an association between PD and adverse pregnancy outcomes in urban populations, this large prospective study failed to demonstrate an association.

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates w...

Background Premature delivery is among the leading causes of perinatal mortality and morbidity in developed societies, which is an important obstetrics problem. Maternal periodontitis is a prevalent condition that has been suspected to be associated with adverse pregnancy outcomes such as premature birth. However, there are still conflicting results about this possible relationship, therefore this study was designed to test the association between maternal periodontitis and premature birth. This study also provides information about a new screening tool recommended for use by nurses and midwives to screen for periodontal diseases during antenatal consultations in order to improve the health of mothers and children. Methods A retrospective case-control study was conducted at 12 health facilities in the Southern Province of Rwanda from February to August, 2018. A total of 555 women in the postpartum period were enrolled in the study. Cases and controls were enrolled in a ratio of 1:2;...

Background: Studies have suggested controversial results regarding a possible association between pre-eclampsia (PE) and periodontal disease (PD) and no meta-analysis has been performed to clarify this issue. Methods: A literature search of electronic databases was performed for articles published through March 24, 2013, followed by a manual search of several dental and medical journals. The meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and PRISMA. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed with the x 2-based Cochran Q test and I 2 statistic. The level of significance was set at P,0.05. Results: Fifteen studies were included, including three cohort and 12 case-control studies. A positive association was found between PE and PD (OR 2.17, 95% CI 1.38-3.41, P = 0.0008). However, a high and significant heterogeneity was found (x 2 = 62.42, P,0.00001, I 2 = 75%). In most cases, subgroup analysis had low power to detect significant differences between PE and non-PE groups. Conclusion: Based on the findings of the meta-analysis, PD appears to be a possible risk factor for PE. However, given the important differences in the definitions and diagnoses of PD and PE among the studies, as well as their lack of good methodological quality, future trials are needed to confirm the results of the present meta-analysis.

Background: Despite previous studies addressing the link between preterm or low birth weight infants and maternal periodontitis, extreme preterm births have received far less attention. This study is designed to address the possible association between maternal periodontal disease and preterm or extreme preterm birth. Methods: Immediately after childbirth, 1,207 women underwent an examination in which periodontal disease was assessed according to two alternative definitions: 1) four or more teeth with at least one site showing probing depth (PD) ‡4 mm and clinical attachment loss (AL) ‡3 mm, and 2) at least one site showing PD and clinical AL ‡4 mm. For each of these definitions, two types of multivariate analysis were conducted: a linear regression analysis for the number of gestation weeks, and a more specific ordinal logistic regression analysis for the ordinal variable gestation time categorized as normal (term) (n = 1,046 women) or mild-moderate (n = 146 women) or extreme preterm (n = 15 women). Results: Periodontal disease was associated with fewer weeks of gestation by linear regression (definition 1: P = 0.012; definition 2: P <0.001) and with preterm (n = 161; mildmoderate and extreme) or extreme preterm births (n = 15) by ordinal logistic regression (definition 1: odds ratio [OR] = 1.83, 95% confidence interval [CI]: 1.28 to 2.62; definition 2: OR = 2.37, 95% CI: 1.62 to 3.46). Conclusion: Our findings suggest that periodontal disease is associated with a premature or extremely premature birth.

The present study aims to determine the association between periodontal disease and gestational diabetes mellitus (GDM) and the effect of this association on pregnancy outcome in North Indian population. A total of 584 primigravidae were recruited at 12-14 weeks of gestation. Their periodontal examination was done along with 75g oral glucose load test at the time of recruitment. GDM was diagnosed as per the DIPSI (The Diabetes in Pregnancy Study group India) guidelines (≥140mg/dL). Women with normal plasma glucose values underwent a repeat 75g oral glucose load test at 24-28 weeks of gestation. All patients were followed up for pregnancy outcomes. Out of 584 primigravida, 184 (31.5%) had gingivitis and 148 (25.3%) had periodontitis. Overall, 332 (56.8%) pregnant women had periodontal disease. It was associated with GDM with adjusted hazard ratio (aHR) of 2.85 (95%CI=1.47-5.53). The occurrence of preeclampsia was associated with periodontal disease with aHR of 2.20 (95%CI=0.86-5.60)....

Background: The present study was conducted to evaluate the levels of interleukin (IL) – 17 in gingival crevicular fluid (GCF) and placental tissue samples of pregnant females as a possible marker in determining whether or not an association exists between chronic periodontitis and preterm labor. Methods: This case-control study included a random sample of 40 female patients, aged 18 to 35 years, who were assigned to one of the following four groups (10 subjects each): group 1 included patients who underwent spontaneous preterm birth (PB) and were diagnosed with chronic periodontitis upon clinical examination (preterm/periodontitis); group 2 included patients who underwent spontaneous PB and who had a healthy periodontium upon clinical examination (preterm/healthy periodontium); group 3 included patients who underwent spontaneous normal term birth and were diagnosed with chronic periodontitis upon clinical examination (term/periodontitis); and group 4 included patients who underwent...

Background: Chronic inflammation has been implicated in the pathogenesis of gestational diabetes mellitus (GDM). Periodontal disease is associated with increased levels of inflammatory mediators and may be a risk factor for GDM. The authors aimed to examine the association between periodontitis and GDM among non-smoking pregnant females. Methods: This case-control study included 50 females who were diagnosed with GDM and 50 age-and hospitalmatched females without diabetes in Khon Kaen, Thailand. Full-mouth periodontal examinations were performed during pregnancy by two calibrated dentists who were unaware of the case-control status. Periodontitis was defined as ‡1 site with probing depth (PD) ‡5 mm and clinical attachment level (CAL) ‡2 mm at the same site. Serum samples were collected to measure C-reactive protein (CRP), tumor necrosis factor-a, and interleukin-6 levels. Analyses were performed using conditional logistic regression. Results: Fifty percent of the case females had periodontitis compared to 26% of the controls. Females with GDM had significantly higher mean PD and CAL, more sites with bleeding on probing, and increased levels of CRP compared to the controls. Periodontitis was significantly associated with GDM (odds ratio = 3.00, 95% confidence interval = 1.19 to 7.56). The association remained significant with additional adjustment for family history of diabetes, prepregnancy body mass index, and weight gain during pregnancy. Conclusions: The results suggest that periodontitis is associated with GDM. Therefore, clinicians should assess periodontal conditions of pregnant females.

Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health. Periodontal disease is related to low socioeconomic status (OSG 2000) and lower educational achievement (Machuca 1999). Periodontal disease has been linked to microbial infections which lead to systemic increase in proinflammatory prostaglandins and cytokines (Kim 2006). These have been hypothesised, through systemic inflammatory pathways, to lead to a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes (Papapanou 2015). While periodontal disease is common in women of reproductive age overall (e.g. 19% of Australian females 15 and over (Chrisopoulos 2012)), it is believed that gum conditions tend to worsen during pregnancy due to hormonal changes (Figuero 2013; Krejci 2002). Observational studies in humans have shown associations between periodontal disease and adverse pregnancy outcomes including preterm birth (Ide 2013; Jeffcoat 2001; Jeffcoat 2002; Offenbacher 1996a), preterm premature rupture of the membranes (PPROM) (Offenbacher 1996b), pre-eclampsia (Boggess 2003), pregnancy loss (Xiong 2007), and postcaesarean endometritis (Swamy 2002). Not all observational studies, however, have found an association between preterm birth or low birth weight and periodontal disease. Davenport and colleagues in London, UK, in a case-control study of 236 preterm infants and 507 term controls, using clinical periodontal indices measured on the labour ward, found the risk of preterm low birth weight decreased with increasing pocket depth (adjusted odds ratio (OR) 0.78, 95% confidence interval (CI) 0.64 to 0.99). The authors concluded that their results did "not support a specific drive to improve periodontal health of pregnant women as a means of improving pregnancy outcomes" (Davenport 2002). Moore and colleagues failed to find an association between preterm birth and periodontal disease in a large prospective cohort study and a smaller case-control study (Moore 2004; Moore 2005). Periodontal treatment may involve nonsurgical and surgical therapies, used alone or in combination. The most common periodontal therapy involves counselling on oral hygiene to educate patients on how to prevent the accumulation of dental plaque and calculus. In nonsurgical approaches, a dental hygienist or dentist removes plaque and calculus by using either hand instruments (scalers and curettes), ultrasound equipment (mechanical debridement), or polishing (Worthington 2013). When patients do not respond favourably to the initial nonsurgical treatment, surgical intervention may be required. Antiseptic mouthwashes such as chlorhexidine can be used as a short-term adjunct to oral hygiene measures, particularly after surgery when the patient cannot brush the area that has been operated on. Sometimes patients are given gels aimed at reducing oral bacterial load, and oral or topical antimicrobials (doxycycline, metronidazole) (Ciancio 0124 Treating periodontal disease for preventing adverse birth outcomes in pregnant women 3 / 69 Data extraction was done independently and in duplicate into data extraction forms. We extracted relevant data from full-text articles that met the inclusion criteria. If reported, information was collected on. Trial setting: country and number of trial centres. Methods: study design, total study duration and date. Participant characteristics: age, sociodemographics, ethnicity, diagnostic criteria and total number. Eligibility criteria: inclusion and exclusion criteria. 0124 Treating periodontal disease for preventing adverse birth outcomes in pregnant women 5 / 69 Funnel plot of Comparison 1 Periodontal treatment versus no treatment, Outcome 1.1 Gestational age (preterm birth).

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6–8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early...

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates w...

Background: The aim of this study was to investigate maternal periodontitis associated with prematurity. Methods: We carried out a case-control study including 718 puerperae who experienced a spontaneous delivery: 360 cases (premature) and 358 controls (full-term). Sociodemographic, obstetric, prenatal, perinatal and periodontal data were obtained within 48 h after delivery. Periodontitis was defined as probing depth 34 mm and attachment loss 33 mm at same site, for 34 teeth. Results: Periodontitis was associated with prematurity (odds ratio 6.95; confidence interval 3.69-13.09). Prematurity was associated with maternal age < 20 years, family income < one minimum salary, maternal schooling < 8 years, premature birth history, premature membrane rupture, ruptured membranes > 24 h, smoking, urinary tract infection, leukorrhea, pre-eclampsia, prenatal consultations < 3 and precarious housing. After multivariate confounder adjustments, periodontitis remained independently associated with prematurity (odds ratio 6.05; confidence interval 3.01-12.16). Conclusions: Periodontitis is strongly associated with prematurity, indicating necessity for regular periodontal investigation and treatment during pregnancy.

We assessed the risk of adverse pregnancy outcomes (preterm birth [PTB], preeclampsia [PRE], fetal growth restriction [FGR], or perinatal death) in women with periodontal disease (PD) compared to those without. STUDY DESIGN: A multicenter prospective cohort study enrolled women from 3 sites between 6 and 20 weeks' gestation. The presence of PD was defined as periodontal attachment loss Ն to 3 mm on 3 or more teeth. The primary binary composite outcome included PRE, PTB, FGR, or perinatal death. Multivariable logistic regression (MVLR) was used to control for confounders. RESULTS: Three hundred eleven patients with and 475 without PD were included. There was no association between PD and the composite outcome, PRE, or PTB in unadjusted analyses. There was no association between PD and the composite outcome (adjusted odds ratio [AOR], 0.81; 95% confidence interval [CI], 0.58-1.15; P ϭ .24), preeclampsia (AOR, 0.71; 95% CI, 0.37-1.36; P ϭ .30), or preterm birth (AOR, 0.77; 95% CI, 0.49-1.21; P ϭ .25) after adjusting for relevant confounders. CONCLUSION: Despite the body of literature suggesting an association between PD and adverse pregnancy outcomes in urban populations, this large prospective study failed to demonstrate an association.

Objectives A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia. Methods Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case–control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran’s Q statistic. Results Thirty studies including six cohort- and twenty-four case–control studies were ...

Objective: To evaluate the clinical approach, the diagnostic method and the most appropriate therapeutic management of thrombotic microangiopathies (TMA) in pregnancy, still leading killers in the obstetric area today. Materials and methods: A large review of the international literature and available clinical studies has been carried out in order to define the current state of the art regarding TMA in pregnancy. In the light of this, 9 clinical cases, among 152 TMA cases, of pregnant women hospitalized and who gave birth in the Pisa University Hospital O.O. U.U. Gynecology and Obstetrics 1 and 2 from 2010 to 2019, were identified, analyzed and re-discussed. Results: Analyzing the diagnostic method and the medical records, we made a critical review of these 9 cases, accurately analyzing the diagnoses made. Among these cases, 6 Thrombotic Thrombocytopenic Purpura (TTP), 2 HELLP Syndrome and 1 Atypical Hemolytic Uremic Syndrome (aHUS) were diagnosed during pregnancy. By analyzing the ...

Maternal periodontal disease, a chronic oral infectious and inflammatory disorder, is associated with an increased risk for preeclampsia. Our objective was to determine the relationship between maternal periodontal disease, maternal systemic inflammation, and the development of preeclampsia. STUDY DESIGN: A secondary analysis of data from the Oral Conditions and Pregnancy Study was performed. A cohort of healthy pregnant women enrolled at less than 26 weeks underwent an oral health examination, serum sampling, and delivery follow-up. Periodontal disease was categorized clinically as present or absent. Maternal serum was assayed for C-reactive protein by high-sensitivity enzyme-linked immunosorbent assay and stratified as elevated (Ն 75th percentile) or not elevated (Ͻ 75th percentile). Preeclampsia was defined as blood pressure Ͼ 140/90 mmHg and at least 1ϩ proteinuria on a catheterized urine specimen. Risk ratios (RR) for preeclampsia were calculated, stratified by periodontal disease and C-reactive protein level. RESULTS: Thirty-one (4%) of 775 women with complete data developed preeclampsia. Women with CRP Ն 75th percentile were more likely than those with CRP Ͻ 75th percentile to develop preeclampsia (7% vs 3%, P Ͻ .03; RR, 95% CI 2.2, 1.1-4.4). Women with periodontal disease and CRP Ն 75th percentile were at increased risk for preeclampsia (adjusted RR 5.8, 1.2-26.9), compared to women without periodontal disease and either CRP Ͻ 75th or Ն 75th percentile. CONCLUSION: Maternal periodontal disease with systemic inflammation as measured by C-reactive protein is associated with an increased risk for preeclampsia.

The majority of pregnant women is subjected to regular gynecological examinations and at the same time fails to comply with follow-up examinations of the mouth. Cooperation is needed in the care of pregnant women between the gynecologist and dentist. During pregnancy changes are observed in the periodontis. Periodontal infection by maternal immune response may lead to the production of cytokines and eicosanoids and for the initiation of uterine contractions. The results of cohort studies are showing the relationship between periodontal disease and preterm birth or low birthweight. Despite that many studies were not free from methodological inaccuracies so that the overall results should be treated with caution. To avoid errors in estimating the risk of various conditions and procedures a planned clinical trials should be conducted in accordance with the standards of evidence-based medicine. The introduction of mandatory dental examinations for women in early pregnancy should encourage the dentists to introduce a new approach of prevention services and, therefore, result in closer cooperation with obstetricians in order to reduce the prevalence of preterm labor and premature morbidity and mortality.

Introduction. Since the 1990s, evidence has been raised that there is an association between maternal periodontal disease and undesirable gestational events, for example low birth weight; this issue is controversial. Objective. To evaluate whether there is an association between maternal periodontitis and low birth weight (LBW). Methods. A case-control study was carried out on 951 mothers that had been cared for by the Brazilian Unified Health System in Petrolina-PE and Juazeiro-BA, Brazil. The case group (n = 269) consisted of mothers of newborns with birth weight <2500 g and a control group (n = 682) of mothers of newborns with birth weight ‡2500 g. An interview was realized, using a questionnaire as well as a full mouth examination to diagnose the periodontal condition. Women who had at least four teeth with probing depth ‡4 mm and clinical attachment loss ‡3 mm, with bleeding on probing at the same site, were diagnosed with periodontitis. The birth weight was obtained through the hospital book record. The main association was evaluated using the multivariate regression model, considering confounders. Results. The frequency of periodontitis was 16.4% (case group) and 17.4% (control group). Periodontitis did not show an association with LBW (OR crude = 0.92; 95% CI = 0.63-1.35), even after adjustment for the following confounders: maternal age, pre-gestational body mass index, number of pre-natal consultations, number of pregnancies, maternal schooling level, smoking habit during pregnancy and hypertension (OR adjusted = 1.00; 95% CI = 0.61-1.68). Conclusion. The findings of this study showed no association between maternal periodontal disease and low birth weight, even after appropriate adjustments for confounding factors.

Objectives The aim was to investigate the prevalence of and factors associated with periodontal disease among pregnant Sudanese women. A cross-sectional study was conducted at the Antenatal Care Clinic of Saad Abualila Hospital (Khartoum, Sudan) from August to October 2018. Socioeconomic-demographic information and reproductive history were gathered using a questionnaire. Body mass index was computed from the weight and height. The diagnosis of periodontal disease was performed using criterion that also evaluated bleeding upon probing. Results Four hundred and four women were enrolled in the study, with a mean (SD) gestational age of 30.0 (8.7) weeks. Their mean (SD) age and parity were 27.0 (5.7) years and 1.6 (1.7), respectively. Ninety-seven (24.0%) of these 404 women had periodontal disease, which was mild, moderate and severe in 49 (12.1%), 36 (8.9%) and 12 (3.0%) women respectively, while 307 (76.0%) women had no periodontal disease. In logistic regression, age, parity, educat...

Objective Recent studies have shown that pre-eclamptic women present a high prevalence of periodontitis, suggesting that active periodontal disease may play a role in the pathogenesis of pre-eclampsia. The present study analysed the effect of periodontal disease in the concentrations of serum high-sensitivity C-reactive protein (hs-CRP), and its association with pre-eclampsia. Methods A case-control study was carried out in Cali-Colombia, comprised of 398 pregnant women (145 cases and 253 controls) who were believed to have periodontal disease, between 28 and 36 weeks of gestational age. Pre-eclampsia cases were defined as blood pressure >-140/90 mmHg and proteinuria >-0.3 g/24 h. Controls were pregnant women with normal blood pressure, without proteinuria, matched by maternal age, gestational age and body mass index. Sociodemographic data, obstetric risk factors, periodontal state, subgingival microbial composition and hs-CRP levels were determined in both groups. Results The case and control groups were comparable for sociodemographic characteristics. In women with pre-eclampsia and confirmed periodontal disease (n U 138), hs-CRP levels increased according to the severity of the disease (gingivitis median 4.14 mg/dl; mild periodontitis median 4.70 mg/dl; moderate/severe periodontitis median 8.8 mg/dl; P U 0.01). A similar tendency was observed in controls with periodontal disease (n U 251), but it did not reach statistical significance (gingivitis median 5.10 mg/dl; mild periodontitis median 5.12 mg/dl; moderate/severe periodontitis median 6.90 mg/dl; P U 0.07). A significant difference in hs-CRP levels was observed in pre-eclamptic women with moderate/severe periodontitis compared to controls (P U 0.01). Conclusion These findings suggest that chronic periodontitis may increase hs-CRP levels in pregnant women and lead to complications such as pre-eclampsia.

Objective: To verify a possible association between periodontitis and low birth weight babies. Materials and methods: Two hundred and eighty antepartum women were examined aged between 18 and 37 years. Demographic, medical and clinical histories were taken under obstetrician's guidance. A thorough periodontal examination was done in all the participants with their consent which included bleeding on probing, pocket depth and clinical attachment level. After delivery, gestational age (in weeks) and birth weight of baby (in kg) were collected from hospital records. Infants were placed into following categories by gestational age (WHO) and by birth weight preterm-<37 weeks, term-37 to 42 weeks, post-term-42 weeks completed and above, low birth weight-<2,500 gm, normal birth weight-2,500 to 3,900 gm, high weight->3,900 gm. Results: Based on the findings of the study, a significant correlation was observed between periodontitis and low birth weight and preterm low birth weight (p ≤0.001) and a significant relation was observed between periodontitis and gestational age (p < 0.001). Conclusion: Periodontitis was considered a risk indicator for reduced gestational age and birth weight. Multicentric trials will greatly help to establish the independent role of periodontal disease and their relationship in terms of pregnancy outcomes.

Context : During pregnancy, women are at a greater risk of experiencing poor oral health and this can affect pregnancy outcome. It is important that ante-natal care givers be knowledgeable on possible oral conditions that can affect the pregnant woman so that she can be adequately managed. Objective : To evaluate the sources and quality of knowledge of ante-natal care physicians about oral conditions in pregnancy. Study design, Setting and Subjects : A descriptive cross-sectional study of ante-natal care physicians at the University of Benin Teaching Hospital. Main outcome measures : Information on demographic characteristics, knowledge of oral conditions in pregnancy, effect of oral micro-organisms on mother and child, efficacy of routine scaling and polishing on reduction of oral micro-organisms and sources of respondents&#39; dental information. Result : 81.3% and 30.8% of the respondents knew that gingivitis and periodontal disease respectively were sometimes seen in pregnancy. ...

DOI: 10.21276/sjams.2017.5.12.70 Abstract: Intra-uterine growth restriction (IUGR) is an important perinatal problem giving rise to increased morbidity and mortality in the growth restricted fetus. The aim of fetal medicine today, is to prevent the mere occurrence of IUGR in high risk pregnancies and to deliver the fetuses already afflicted with growth restriction, before they have suffered from the effects of hypoxia. The use of Doppler provides this information, which is not readily obtained from the other conventional tests of fetal wellbeing. The Doppler patterns follow a longitudinal trend in the arterial and venous circulation of the fetus as well as the placental vasculature guiding management decisions regarding the appropriate time of delivery. Progressive knowledge of the fetal circulation and its adaptation when the fetus is subjected to hypoxia has helped us recognize the early signs of IUGR thereby improving the prognosis of these complicated pregnancies. It has therefo...

Background: Although there is increasing evidence to suggest an association between periodontal disease and adverse pregnancy outcomes, the issue remains controversial. Study objective: This study tested the hypothesis that periodontal disease is a risk indicator for preterm delivery of low-birthweight infants. Materials and methods: The study sample comprised 443 pregnant women with a mean (AE standard deviation) age of 24.13 (AE5.30) years. At first visit, maternal oral health status was assessed by the measurement of probing pocket depth and clinical attachment loss, and periodontal status was graded as absent, mild, moderate or severe. An association was sought between pregnancy outcomes and maternal periodontal status. Results: While controlling for other factors, significant associations were found between pregnancy outcomes and maternal periodontal index scores. Conclusion: This study provides further evidence that periodontal disease is a risk indicator for adverse pregnancy outcomes.

Background-Few studies have specifically examined the relationship between periodontal disease and gestational diabetes mellitus (GDM). The objective of this study was to examine whether maternal periodontal disease is associated with GDM. Methods-A case-control study was conducted of 53 pregnant women with GDM and 106 pregnant women without GDM at Woman's Hospital, Baton Rouge, USA. The periodontal examinations were performed by a calibrated dentist who was blinded on the diabetic status of the pregnant women. Periodontitis was defined as the presence of any site with a probing depth (PD) ≥ 4 mm or a clinical attachment loss (CAL) ≥ 4 mm. The severity of periodontal disease was measured in quartiles of PD and CAL. Univariable analysis and multivariable logistic regression were used to examine the relationships between periodontal disease and GDM. Results-The percentage of periodontitis was 77.4% in women with GDM and 57.5% in pregnant non-GDM women, with an odds ratio (OR) and 95% confidence interval (CI) of 2.5 (1.2-5.3). After adjusting for confounding variables of maternal age, parity, race, marital status, education, family income, smoking, alcohol consumption, systemic antibiotics in pregnancy, family history of diabetes, income, dental insurance coverage and body mass index, the adjusted OR (95% CI) was 2.6 (1.1-6.1). The adjusted ORs (95% CIs) of GDM comparing the highest-tolowest quartiles of PD and CAL were 3.8 (1.0-14.0) and 4.5 (1.2-16.9). Conclusion-This study supports the hypothesis of an association between periodontal disease and GDM.