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      A condição periodontal materna e o nascimento de prematuro de baixo peso: estudo caso-controle Translated title: Maternal periodontal status and preterm low birth weight: a case-control study

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          Abstract

          OBJETIVOS: verificar as condições periodontais e necessidade de tratamento fornecidas pelo Registro Periodontal Simplificado (PSR) em puérperas, com o intuito de contribuir ao esclarecimento da relação entre doença periodontal e nascimento de recém-nascidos prematuros de baixo peso. MÉTODOS: foi empregado o PSR em amostra de 40 puérperas, divididas em: grupo 1 (teste), composto pelas mães de recém-nascidos prematuros com peso inferior a 2.500 g (n=20), e grupo 2 (controle), formado por mães de recém-nascidos a termo com peso igual ou superior a 2.500 g (n=20). Os dados coletados foram analisados por meio de estatística descritiva, sendo os resultados do PSR submetidos ao tratamento estatístico para verificar se existem diferenças na condição periodontal e necessidade de tratamento entre as puérperas, sendo empregado o teste de Kolmogorov-Smirnov, em nível de significância de 5%. RESULTADOS: a presença de bolsa periodontal de 3,5 a 5,5 mm foi o achado mais comum entre as puérperas de recém-nascidos de baixo peso (39,17% dos sextantes), ao passo que a presença de sangramento à sondagem e ausência de bolsa periodontal foram os achados mais freqüentes entre as puérperas de recém-nascidos com peso normal (37,50% dos sextantes), havendo diferença significativa na condição periodontal das puérperas (p=0,0494). Quanto à necessidade de tratamento, não houve diferença significativa entre os grupos estudados (p>0,05). CONCLUSÕES: as puérperas de recém-nascidos prematuros com baixo peso apresentaram piores condições periodontais, sugerindo que a infecção periodontal pode estar relacionada ao nascimento de recém-nascidos prematuros de baixo peso.

          Translated abstract

          PURPOSE: to evaluate periodontal conditions and need for treatment supplied by Periodontal Screening and Recording (PSR) in mothers, in order to clarify the relationship between periodontal disease and low birth weight premature newborns. METHODS: PSR was used in a sample of 40 mothers, divided into: test group, consisting of mothers of premature newborns with weight less than 2,500 g (n=20), and the control group, consisting of mothers of term newborns with a weight equal to or over 2,500 g (n=20). The collected data were analyzed by descriptive statistics, and the results of PSR were submitted to statistical analysis in order to verify differences in periodontal condition and need for treatment of the mothers, using the Kolmogorov-Smirnov test, with a significance level of 5%. RESULTS: the presence of periodontal pocket of 3.5 to 5.5 mm was the most common finding among the mothers of newborns with low weight (39.2% of the cases), while the presence of bleeding at probing and absence of a periodontal pocket were the most frequent findings among the mothers of newborns with normal weight (37.5% of the cases). There was a statistically significant difference between periodontal conditions of the mothers of the groups (p=0.0494), but in relation to the need for treatment, there was no significant difference between the studied groups (p>0.05). CONCLUSION: the mothers of preterm newborns with low weight presented worse periodontal conditions, suggesting that periodontal infection may be related to preterm low birth weight newborns.

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          Periodontal therapy may reduce the risk of preterm low birth weight in women with periodontal disease: a randomized controlled trial.

          Recent studies have suggested that periodontal disease is a risk factor for preterm low birth weight (PLBW). A randomized controlled trial was undertaken to help further evaluate the proposed association between periodontal disease and PLBW. Four hundred pregnant women with periodontal disease, aged 18 to 35, were enrolled while receiving prenatal care in Santiago, Chile. Women were randomly assigned to either an experimental group (n = 200), which received periodontal treatment before 28 weeks of gestation or to a control group (n = 200) which received periodontal treatment after delivery. Previous and current pregnancies and known risk factors were obtained from patient medical records and interviews. The primary outcome assessed was the delivery at less than 37 weeks of gestation or an infant weighing less than 2,500 g. Of the 400 women enrolled, 49 were excluded from the analyses for different reasons. The incidence of PLBW in the treatment group was 1.84% (3/163) and in the control group was 10.11% (19/188), (odds ratio [OR] 5.49, 95% confidence interval [CI] 1.65 to 18.22, P= 0.001). Multivariate logistic regression analysis showed that periodontal disease was the strongest factor related to PLBW (OR 4.70, 95% CI 1.29 to 17.13). Other factors significantly associated with such deliveries were: previous PLBW (OR 3.98, 95% CI 1.11 to 14.21), less than 6 prenatal visits (OR 3.70, 95% Cl 1.46 to 9.38), and maternal low weight gain (OR 3.42, 95% CI 1.16 to 10.03). Periodontal disease appears to be an independent risk factor for PLBW. Periodontal therapy significantly reduces the rates of PLBW in this population of women with periodontal disease.
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            Potential pathogenic mechanisms of periodontitis associated pregnancy complications.

            During normal pregnancy, maternal hormones and locally acting cytokines play a key role in regulating the onset of labor, cervical ripening, uterine contraction, and delivery. Maternal infections during pregnancy have been demonstrated to perturb this normal cytokine and hormone-regulated gestation, sometimes resulting in preterm labor, preterm premature rupture of membranes, and preterm low birth weight (PLBW), i.e., < 2,500 g and < 37 weeks of gestation. Our research focus has been to determine whether periodontal infections can provide sufficient challenge to the mother to trigger PLBW. New experiments from 48 case-control subjects have measured gingival crevicular fluid (GCF) levels of PGE(2) and IL-1-beta to determine whether mediator levels were related to current pregnancy outcome. In addition, the levels of 4 periodontal pathogens were measured by using microbe-specific DNA probes. Results indicate that GCF-PGE(2) levels are significantly higher in PLBW mothers, as compared with normal birth weight (NBW) controls (131.4 +/- 21.8 vs. 62.6 +/- 10.3 [mean +/- SE ng/mL], respectively, at P = 0.02). Furthermore, within primiparous PLBW mothers, there was a significant inverse association between birth weight (as well as gestational age) and GCF-PGE(2) levels at P = 0.023. These data suggest a dose-response relationship for increasing GCF-PGE(2) as a marker of current periodontal disease activity and decreasing birth weight. Microbial data indicate that 4 organisms associated with mature plaque and progressing periodontitis--bacteroides forsythus, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Treponema denticola--were detected at higher levels in PLBW mothers, as compared to NBW controls. These data suggest that biochemical measures of maternal periodontal status and oral microbial burden are associated with current PLBW.
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              A review of premature birth and subclinical infection.

              Premature birth causes high rates of neonatal morbidity and mortality. There are multiple causes of preterm birth. This article reviews the evidence linking subclinical infection and premature birth. Although maternal genital tract colonization with specific organisms has been inconsistently associated with preterm birth and/or premature rupture of membranes, some infections have been consistently associated with preterm delivery. The association of histologic chorioamnionitis with prematurity is a consistent finding, but the mechanisms require further study. The relationship between histologic chorioamnionitis infection and the chorioamnionitis of prematurity requires additional research. A varying number of patients in "idiopathic" preterm labor have positive amniotic fluid cultures (0% to 30%), but it is not clear whether infection preceded labor or occurred as a result of labor. Evidence of subclinical infection as a cause of preterm labor is raised by finding elevated maternal serum C-reactive protein and abnormal amniotic fluid organic acid levels in some patients in preterm labor. Biochemical mechanisms for preterm labor in the setting of infection are suggested by both in vitro and in vivo studies of prostaglandins and their metabolites, endotoxin and cytokines. Some, but by no means all, antibiotic trials conducted to date have reported decreases in prematurity. These results support the hypothesis that premature birth results in part from infection caused by genital tract bacteria. In the next few years, research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.
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                Author and article information

                Journal
                rbgo
                Revista Brasileira de Ginecologia e Obstetrícia
                Rev. Bras. Ginecol. Obstet.
                Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (Rio de Janeiro, RJ, Brazil )
                0100-7203
                1806-9339
                July 2005
                : 27
                : 7
                : 382-386
                Affiliations
                [01] São Luis MA orgnameUniversidade Federal do Maranhão Brasil
                Article
                S0100-72032005000700003 S0100-7203(05)02700703
                c88e6063-f2ff-41c5-9e3c-6b1eb52b5f42

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 25 April 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 5
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Recém-nascido de baixo peso,Periodontia,Prematuro,Infant low birth weight,Periodontics,Infant, premature

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