The impact of periodontitis on the risk of preterm birth: Systematic review and meta-analysis

Zhibek Oralkhan 1 * , Gurpreet Singh Walia 2, Gulmira Zhurabekova 1, Akzhenis Berdalinova 1 3, Ibrahim Abdelazim 4, Erasyl Madatuly Kabi 5, Lazzat Bimaganbetova 6
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1 Department of Fundamental Medicine, Al-Farabi Kazakh National University, Almaty Kazakhstan
2 General Medicine, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
3 Department of Histology, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
4 Department of Obstetric and Gynaecology, Ain Shams University, Cairo, Egypt
5 Department of the Consultative and Diagnoses, Atyrau Regional Perinatal Center, Atyrau, Kazakhstan
6 Department of Obstetric and Gynaecology, Kyzylorda Regional Perinatal Center, Kyzylorda, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 20, Issue 3, pp. 56-62. https://doi.org/10.23950/jcmk/13322
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ABSTRACT

Background: Preterm birth (PTB) is one of the most prevalent and serious adverse pregnancy outcomes (APOs) and major health risk for pregnant individuals and their children during pregnancy and throughout their lifespan. Periodontitis has long been regarded as a silent pandemic which happens to favor the pregnant women due to the physical and hormonal changes during pregnancy. Understanding of the association underscores the importance of keeping oral diseases under check and control to predict and even reduce the risk. The aim is to evaluate the association between periodontitis during pregnancy and preterm birth.
Material and methods: A screening and analysis was conducted on studies with comparison data about periodontal infection diseases during pregnancy and preterm birth. The databases include Scopus, PubMed, Elibrary, local databases and the Cochrane library and were searched up to November 20, 2022. The selected studies were included in a random-effects meta-analysis after evaluation of the methodological quality. The summary odds ratios (ORs) with 95% confidence intervals (CI) were calculated with Review Manager software.
Results: The review finally included 29 studies involving 2606589 pregnant women. Compared with healthy oral status in pregnancy, periodontitis was associated with preterm birth [OR=1.81, CI=1.60 to 2.03; p<0.001; I2 = 95%].
Conclusion: Periodontitis as one of the important factors is associated with increased risks of preterm birth. It is important to put the disease under control before and during pregnancy to reduce the preterm birth outcome.

CITATION

Oralkhan Z, Walia GS, Zhurabekova G, Berdalinova A, Abdelazim I, Kabi EM, et al. The impact of periodontitis on the risk of preterm birth: Systematic review and meta-analysis. J CLIN MED KAZ. 2023;20(3):56-62. https://doi.org/10.23950/jcmk/13322

REFERENCES

  • Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018; 52:3-12. https://doi.org/10.1016/j.bpobgyn.2018.04.003
  • Marat A.A., Ukybassova T. The risk factors and pattern of preterm birth in the fetal residents of the Republic of Kazakhstan. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (12): 50-4. (in Russian). https://doi.org/10.18565/aig.2018.12.50-54
  • Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes; Behrman RE, Butler AS, editors. Preterm Birth: Causes, Consequences, and Prevention. Washington (DC): National Academies Press (US); 2007. 10, Mortality and Acute Complications in Preterm Infants. Available from: https://www.ncbi.nlm.nih.gov/books/NBK11385
  • National Guideline Alliance (UK). Developmental follow-up of children and young people born preterm. London: National Institute for Health and Care Excellence (NICE); 2017 Aug.
  • Romero R, Espinoza J, Mazor M, Chaiworapongsa T. The preterm parturition syndrome. In: Critchley H, Bennett P, Thornton S, eds. Preterm Birth, London: RCOG Press, 2004; 28-60.
  • de Castro Silva M, Richardson LS, Kechichian T, Urrabaz-Garza R, da Silva MG, Menon R. Inflammation, but not infection, induces EMT in human amnion epithelial cells. Reproduction. 2020;160(4):627-638. https://doi.org/10.1530/REP-20-0283
  • Ren H, Du M. Role of Maternal Periodontitis in Preterm Birth. Front Immunol. 2017; 8:139. https://doi.org/10.3389/fimmu.2017.00139
  • Zhang Y, Feng W, Li J, Cui L, Chen ZJ. Periodontal Disease and Adverse Neonatal Outcomes: A Systematic Review and Meta-Analysis. Front Pediatr. 2022; 10:799740. https://doi.org/10.3389/fped.2022.799740
  • Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009; 151(4):W65-94. https://doi.org/10.7326/0003-4819-151-4-200908180-00136
  • Iqbal A, Lakkappa L, Chhabra P, Kondreddy K, Kumari S, Raju BM, Francis M. Impact of Chronic Periodontitis on Intrauterine Growth of the Fetus: An Original Research. J Pharm Bioallied Sci. 2022;14(Suppl 1):S280-S282. https://doi.org/10.4103/jpbs.jpbs_731_21
  • Uwambaye P, Munyanshongore C, Rulisa S, Shiau H, Nuhu A, Kerr MS. Assessing the association between periodontitis and premature birth: a case-control study. BMC Pregnancy Childbirth. 2021;21(1):204. https://doi.org/10.1186/s12884-021-03700-0
  • Micu IC, Roman A, Ticala F, Soanca A, Ciurea A, Objelean A, Iancu M, Muresan D, Caracostea GV. Relationship between preterm birth and post-partum periodontal maternal status: a hospital-based Romanian study. Arch Gynecol Obstet. 2020;301(5):1189-1198. https://doi.org/10.1007/s00404-020-05521-6
  • Márquez-Corona ML, Tellez-Girón-Valdez A, Pontigo-Loyola AP, Islas-Zarazúa R, Robles-Bermeo NL, Gonzalez-López BS, Medina-Solís CE. Preterm birth associated with periodontal and dental indicators: a pilot case-control study in a developing country. J Matern Fetal Neonatal Med. 2021;34(5):690-695. https://doi.org/10.1080/14767058.2019.1613363
  • Pérez-Molina JJ, González-Cruz MJ, Panduro-Barón JG, Santibáñez-Escobar LP, Quezada-Figueroa NA, Bedolla-Barajas M. Enfermedad periodontal como factor de riesgo adicional asociado con nacimiento pretérmino en México: un estudio de casos y controles. Gac Med Mex. 2019;155(2):143-148. https://doi.org/10.24875/GMM.18004332
  • Lafaurie GI, Gómez LA, Montenegro DA, De Avila J, Tamayo MC, Lancheros MC, Quiceno J, Trujillo TG, Noriega LA, Grueso ML, Cepeda K. Periodontal condition is associated with adverse perinatal outcomes and premature rupture of membranes in low-income pregnant women in Bogota, Colombia: a case-control study. J Matern Fetal Neonatal Med. 2020; 33(1):16-23. https://doi.org/10.1080/14767058.2018.1484092
  • Blanc V, O'Valle F, Pozo E, Puertas A, León R, Mesa F. Oral bacteria in placental tissues: increased molecular detection in pregnant periodontitis patients. Oral Dis. 2015; 21(7):905-12. https://doi.org/10.1111/odi.12364
  • Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, Mahande MJ, Masenga G. The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci. 2018;18(3):601-611. https://doi.org/10.4314/ahs.v18i3.18
  • Nikolic, L.; Cakic, S.; Perunovic, N.; Colak, E.; Kotur-Stevuljevic, J.; Jankovic, S.; Djuric, M.; Plecas, D. Salivary and plasma inflammatory mediators and secretory status in preterm delivery women with periodontitis-A cross sectional study. Vojnosanit. Pregl. 2020; 77:247-255. https://doi.org/10.2298/VSP171106066N
  • Moncunill-Mira J, Brunet-Llobet L, Cuadras D, Lorente-Colomé N, Pascal R, Rovira C, Nadal A, Miranda-Rius J. Do the clinical criteria used to diagnose periodontitis affect the association with prematurity? Odontology. 2021;109(2):455-463. https://doi.org/10.1007/s10266-020-00562-4
  • Novák T, Németh G, Kozinszky Z, Urbán E, Gorzó I, Radnai M. Could Poor Periodontal Status be a Warning Sign for Worse Pregnancy Outcome? Oral Health Prev Dent. 2020;18(1):165-170. https://doi.org/10.3290/j.ohpd.a43356
  • Montenegro DA, Borda LF, Neuta Y, Gómez LA, Castillo DM, Loyo D, Lafaurie GI. Oral and uro-vaginal intra-amniotic infection in women with preterm delivery: A case-control study. J Investig Clin Dent. 2019;10(2):e12396. https://doi.org/10.1111/jicd.12396
  • Choi SE, Choudhary A, Ahern JM, Palmer N, Barrow JR. Association between maternal periodontal disease and adverse pregnancy outcomes: an analysis of claims data. Fam Pract. 2021;38(6):718-723. https://doi.org/10.1093/fampra/cmab037
  • de Oliveira LJC, Cademartori MG, Schuch HS, Barros FC, Silveira MF, Correa MB, Demarco FF. Periodontal disease and preterm birth: Findings from the 2015 Pelotas birth cohort study. Oral Dis. 2021;27(6):1519-1527. https://doi.org/10.1111/odi.13670
  • Kopycka-Kedzierawski DT, Li D, Xiao J, Billings RJ, Dye TD. Association of periodontal disease with depression and adverse birth outcomes: Results from the Perinatal database; Finger Lakes region, New York State. PLoS One. 2019;14(4):e0215440. https://doi.org/10.1371/journal.pone.0215440
  • Santa Cruz I, Herrera D, Martin C, Herrero A, Sanz M. Association between periodontal status and pre-term and/or low-birth weight in Spain: clinical and microbiological parameters. J Periodontal Res. 2013;48(4):443-51. https://doi.org/10.1111/jre.12024
  • Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, Pere M, Badran Z, Struillou X. Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent. 2022;20(1):363-368. https://doi.org/10.3290/j.ohpd.b3464893
  • Lee YL, Hu HY, Chou SY, Lin CL, Cheng FS, Yu CY, Chu D. Periodontal disease and preterm delivery: a nationwide population-based cohort study of Taiwan. Sci Rep. 2022; 12(1):3297. https://doi.org/10.1038/s41598-022-07425-8
  • Erchick DJ, Khatry SK, Agrawal NK, Katz J, LeClerq SC, Rai B, Reynolds MA, Mullany LC. Risk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort study. BMJ Open. 2020; 10(8):e036515. https://doi.org/10.1136/bmjopen-2019-036515
  • Taniguchi-Tabata A, Takeuchi N, Uchida Y, Ekuni D, Morita M. Association between maternal periodontal status and ultrasonographic measurement of fetal growth: A longitudinal study. Sci Rep. 2020; 10(1):1402. https://doi.org/10.1038/s41598-020-58396-7
  • Basha S, Shivalinga Swamy H, Noor Mohamed R. Maternal Periodontitis as a Possible Risk Factor for Preterm Birth and Low Birth Weight--A Prospective Study. Oral Health Prev Dent. 2015;13(6):537-44. https://doi.org/10.3290/j.ohpd.a34053
  • Wang YL, Liou JD, Pan WL. Association between maternal periodontal disease and preterm delivery and low birth weight. Taiwan J Obstet Gynecol. 2013;52(1):71-6. https://doi.org/10.1016/j.tjog.2013.01.011
  • Govindasamy R, Dhanasekaran M, Varghese SS, Balaji VR, Karthikeyan B, Christopher A. Maternal Risk Factors and Periodontal Disease: A Cross-sectional Study among Postpartum Mothers in Tamil Nadu. J Pharm Bioallied Sci. 2017; 9(Suppl 1):S50-S54. https://doi.org/10.4103/jpbs.JPBS_88_17
  • Trivedi P, Saxena D, Puwar T, Savaliya S, Ganguly P. A cohort study on risk factors for preterm births in rural Gujarat. Indian J Public Health. 2018; 62(2):111-116. https://doi.org/10.4103/ijph.IJPH_337_16
  • Shaggag LM, ALhabardi N, Adam I. The Association between Maternal Periodontitis and Preterm Birth: A Case-Control Study in a Low-Resource Setting in Sudan, Africa. Medicina (Kaunas). 2022;58(5):632. https://doi.org/10.3390/medicina58050632
  • Khan NS, Ashraf RN, Noor S, Mahmood-ur-Rahman, Mashhadi SF, Rashid Z, Sajjad F, Nazar AF, Nazar HS, Syed R. Association of maternal periodontitis with low birth weight in newborns in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2016;28(1):120-5.
  • Kumar A, Basra M, Begum N, Rani V, Prasad S, Lamba AK, Verma M, Agarwal S, Sharma S. Association of maternal periodontal health with adverse pregnancy outcome. J Obstet Gynaecol Res. 2013;39(1):40-5. https://doi.org/10.1111/j.1447-0756.2012.01957.x
  • Macedo JF, Ribeiro RA, Machado FC, Assis NM, Alves RT, Oliveira AS, Ribeiro LC. Periodontal disease and oral health-related behavior as factors associated with preterm birth: a case-control study in south-eastern Brazil. J Periodontal Res. 2014;49(4):458-64. https://doi.org/10.1111/jre.12124
  • Martinez de Tejada B, Gayet-Ageron A, Combescure C, Irion O, Baehni P. Association between early preterm birth and periodontitis according to USA and European consensus definitions. J Matern Fetal Neonatal Med. 2012;25(11):2160-6. https://doi.org/10.3109/14767058.2012.663827
  • Min AM, Saito M, Simpson JA, Kennedy SH, Nosten FH, McGready R. Placental histopathology in preterm birth with confirmed maternal infection: A systematic literature review. PLoS One. 2021;16(8):e0255902. https://doi.org/10.1371/journal.pone.0255902
  • Parhi L, Abed J, Shhadeh A, Alon-Maimon T, Udi S, Ben-Arye SL, Tam J, Parnas O, Padler-Karavani V, Goldman-Wohl D, Yagel S, Mandelboim O, Bachrach G. Placental colonization by Fusobacterium nucleatum is mediated by binding of the Fap2 lectin to placentally displayed Gal-GalNAc. Cell Rep. 2022;38(12):110537. https://doi.org/10.1016/j.celrep.2022.110537
  • Gomes-Filho IS, Cruz SS, Rezende EJC, dos Santos CAST, Sole- dade KR, Magalhães MA, de Azevedo ACO, Trindade SC, Vianna MIP, de Passos SJ, Cerqueira EMM. Exposure measurement in the association between periodontal disease and prematurity/low birth weight. J Clin Periodontol. 2007;34:957-63. https://doi.org/10.1111/j.1600-051X.2007.01141.x