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      Periodontal status during pregnancy and postpartum

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          Abstract

          Objectives

          Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3–6 weeks postpartum in women with initial periodontal alterations.

          Materials and methods

          Ninety-six pregnant women were examined at 8–10 weeks (pregnancy diagnosis, baseline), 21–23 weeks and 34–36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05

          Results

          Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21–23 weeks, 42.6%±0.14; 34–36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0–13). Gingival Index increased (p<0.001) throughout pregnancy (baseline, 56.7%±0.20; 21–23 weeks, 66.36%±0.17; 34–36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (p<0.001) throughout pregnancy (baseline, 2.51±0.05; 21–23 weeks, 2.63±0.053; 34–36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (p<0.001) throughout pregnancy (baseline, 17.6%±0.16; 21–23 weeks, 23.9%±0.17; 34–36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (p<0.02) higher than at baseline.

          Conclusion

          Periodontal status deteriorates during gestation but improves postpartum.

          Related collections

          Most cited references40

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          Maternal periodontitis and prematurity. Part I: Obstetric outcome of prematurity and growth restriction.

          Oral Conditions and Pregnancy (OCAP) is a 5-year prospective study of pregnant women designed to determine whether maternal periodontal disease contributes to the risk for prematurity and growth restriction in the presence of traditional obstetric risk factors. Full-mouth periodontal examinations were conducted at enrollment (prior to 26 weeks gestational age) and again within 48 hours postpartum to assess changes in periodontal status during pregnancy. Maternal periodontal disease status at antepartum, using a 3-level disease classification (health, mild, moderate-severe) as well as incident periodontal disease progression during pregnancy were used as measures of exposures for examining associations with the pregnancy outcomes of preterm birth by gestational age (GA) and birth weight (BW) adjusting for race, age, food stamp eligibility, marital status, previous preterm births, first birth, chorioamnionitis, bacterial vaginosis, and smoking. Interim data from the first 814 deliveries demonstrate that maternal periodontal disease at antepartum and incidence/progression of periodontal disease are significantly associated with a higher prevalence rate of preterm births, BW < 2,500 g, and smaller birth weight for gestational age. For example, among periodontally healthy mothers the unadjusted prevalence of births of GA < 28 weeks was 1.1%. This was higher among mothers with mild periodontal disease (3.5%) and highest among mothers with moderate-severe periodontal disease (11.1%). The adjusted prevalence rates among GA outcomes were significantly different for mothers with mild periodontal disease (n = 566) and moderate-severe disease (n = 45) by pair-wise comparisons to the periodontally healthy reference group (n = 201) at P = 0.017 and P < 0.0001, respectively. A similar pattern was seen for increased prevalence of low birth weight deliveries among mothers with antepartum periodontal disease. For example, there were no births of BW < 1000 g among periodontally healthy mothers, but the adjusted rate was 6.1% and 11.4% for mild and moderate-severe periodontal disease (P = 0.0006 and P < 0.0001), respectively. Periodontal disease incidence/progression during pregnancy was associated with significantly smaller births for gestational age adjusting for race, parity, and baby gender. In summary, the present study, although preliminary in nature, provides evidence that maternal periodontal disease and incident progression are significant contributors to obstetric risk for preterm delivery, low birth weight and low weight for gestational age. These studies underscore the need for further consideration of periodontal disease as a potentially new and modifiable risk for preterm birth and growth restriction.
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            The subgingival microbial flora during pregnancy.

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              Influence of sex hormones on the periodontium.

              Sex hormones have long been considered to play an influential role on periodontal tissues, bone turnover rate, wound healing and periodontal disease progression. The objectives of this review article are to (1) address the link between sex hormones and the periodontium, (2) analyse how these hormones influence the periodontium at different life times and (3) discuss the effects of hormone supplements/replacement on the periodontium. Two autonomous searches were performed in English language utilizing Medline, Premedline and Pubmed as the online databases. Publications up to 2002 were selected and further reviewed. In addition, a manual search was also performed including specific related journals and books. It is certain that sexual hormones play a key role in periodontal disease progression and wound healing. More specifically, these effects seem to differentiate by gender as well as lifetime period. In addition, the influence of sex hormones can be minimized with good plaque control and with hormone replacement. Despite profound research linking periodontal condition with sex hormones kinetics, more definitive molecular mechanisms and therapy still remain to be determined.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 May 2017
                2017
                : 12
                : 5
                : e0178234
                Affiliations
                [001]Department of Periodontology, Faculty of Dentistry, Granada University, Granada, Spain
                Virginia Commonwealth University, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: MGJ LT ARL GGM GM.

                • Data curation: MGJ LT GM.

                • Formal analysis: MGJ LT ARL GM.

                • Investigation: MGJ LT ARL GGM GM.

                • Methodology: MGJ LT ARL GGM GM.

                • Project administration: MGJ LT GM.

                • Resources: MGJ LT GM.

                • Supervision: GM.

                • Validation: MGJ LT GM.

                • Visualization: MGJ LT ARL GGM GM.

                • Writing – original draft: MGJ LT ARL GGM GM.

                • Writing – review & editing: MGJ LT ARL GGM GM.

                Author information
                http://orcid.org/0000-0002-4999-8954
                Article
                PONE-D-16-43509
                10.1371/journal.pone.0178234
                5438174
                28538740
                2939c49f-9875-4c7d-9ff3-08148c53040a
                © 2017 González-Jaranay et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 1 November 2016
                : 30 April 2017
                Page count
                Figures: 2, Tables: 1, Pages: 9
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Oral Medicine
                Oral Diseases
                Periodontal Diseases
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Hemorrhage
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Hemorrhage
                Medicine and Health Sciences
                Vascular Medicine
                Hemorrhage
                Biology and Life Sciences
                Biochemistry
                Hormones
                Lipid Hormones
                Progesterone
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Biology and Life Sciences
                Immunology
                Immune Response
                Inflammation
                Medicine and Health Sciences
                Immunology
                Immune Response
                Inflammation
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Inflammation
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Inflammation
                Biology and Life Sciences
                Biochemistry
                Hormones
                Sex Hormones
                Biology and Life Sciences
                Biochemistry
                Hormones
                Estrogens
                Custom metadata
                All relevant data are within the paper and its Supporting Information file.

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