Just a week after giving birth to her second child, a girl, Mackenzie (Douthit) McKee has received quite a tragic blow - her Oklahoma home burglarized and many of her and her husband's essential possessions stolen. The pretty blonde was advised not to have another child because of her condition, though everything worked out in the end.
The views expressed in the contents above are those of our users and do not necessarily reflect the views of MailOnline. Impaired glucose tolerance (IGT) is a category of higher than normal blood glucose, but below the threshold for diagnosing diabetes. Changes in diet and physical activity related to rapid development and urbanisation have led to sharp increases in the numbers of people developing diabetes.
Pregnant women who are overweight, have been diagnosed with IGT, or have a family history of diabetes are all at increased risk of developing gestational diabetes mellitus (GDM). Brief questionnaires are simple, practical and inexpensive ways to quickly identify people who may be at a higher risk of type 2 diabetes and who need to have their level of risk further investigated.
IDF has developed the Blue Circle Test, an interactive online tool that showcases the risk factors of type 2 diabetes and displays the positive actions that can be taken to reduce a person’s risk. Science, Technology and Medicine open access publisher.Publish, read and share novel research.
Interrelation Between Periodontal Disease and Preterm BirthFernando Oliveira Costa2, Alcione Maria Soares Dutra Oliveira1 and Luis Otavio Miranda Cota2[1] Department of Periodontology, Faculty of Dentistry, Pontific Catholic University of Minas Gerais and Federal University of Minas Gerais, Brazil.[2] Departament of Periodontology, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil1. Varicose veins are gnarled, enlarged veins that can affect any vein but most commonly affects those in your legs and feet.
There are a variety of treatment options available to people who suffer with varicose or spider veins.
The doctor injects a liquid chemical into the vein which causes the vein walls to swell, stick together, and seal shut. Buah buahan untuk ibu hamil muda yang sehat sangat banyak untuk dikonsumsi secara rutin bagi ibu hamil.
Wanita yang sedang hamil memerlukan nutrisi untuk menjaga kesehatannya dan juga perkembangan calon bayinya.
Asam Lemak Omega-3. Asam lemak omega-3 memiliki peran penting terhadap perkembangan otak janin sehingga dapat meningkatkan kecerdasan setelah lahir. Asam Folat. Asam folat juga dikenal sebagai vitamin B9 yang sangat berperan dalam membantu perkembangan calon bayi agar terhindar dari cacat ketika bayi lahir.
Vitamin B1. Vitamin ini berguna untuk melancarkan pencernaan dan mengatasi morning sickness. Vitamin B2. Pada awal kehamilan, vitamin ini sangat dibutuhkan untuk membantu perkembangan embrio. Vitamin B3. Pada kehamilan pertam,vitamin ini sangat penting untuk mengurangi rasa mual dan juga dapat membantu perkembangan otak calon bayi. Vitamin B5. Selain zat besi, vitamin B5 juga dapat menjaga kebutuhan sel darah merah di dalam tubuh ibu hamil. Vitamin B6. Vitamin ini juga bisa disebut dengan nama piridoksin yang dapat membantu sang ibu dalam mengubah lemak menjadi energi dan dapat meningkatkan kekebalan tubuh. Vitamin B12. Vitamin B12 mempunyai fungsi sebagai pengoptimal perkembangan calon bayi dalam membentuk sel-sel darah merah. Vitamin C. Vitamin ini dapat larut dalam air sehingga dapat menjaga kekebalan tubuh sebagai antioksidan alami. Vitamin D. Vitamin ini cukup penting untuk menjaga kesehatan ibu hamil melalui pencegahan hipertensi dalam kehamilan dan diabetes. Vitamin K. Vitamin K disebut juga Koagulasi yang berfungsi untuk mencegah pendarahan pada bayi serta dapat menjaga kepadatan tulang pada ibu hamil. Untuk memenuhi kebutuhan vitamin dan mineral tersebut salah satu makanan yang paling baik adalah buah. Buah angguur mengandung banyak vitamin A, viitamin C, asam folat, fosfor, zat besi, kalsium, dan magnesium.
Buah lemon dapat membantu pencernaan, menghilangkan mual, dan gelaja morning sickness pada masa kehamilan. Leci memiliki kandungan vitamin C yang sangat baik, sehingga dapat meningkatkan fungsi kekebalan tubuh agar terhindar dari berbagai penyakit seperti hipertensi dan jantung serta dapat membantu penyerapan zat besi.
Buah apel mengandung asetilkolin yang berperan dalam mentransmisikan pesan antara sel-sel saraf sehingga dapat mempertajam otak pada janin. Manfaat jeruk mengandung vitamin C yang sangat tinggi, sehingga dapat meningkatkan kekebalan tubuh, menjaga kulit dari kanker dan dapat menghindari varises pada ibu hamil, serta dapat menurunkan kadar kolesterol jahat. Buah pisang mengandung vitamin B6 dan kalsium tinggi sehingga dapat meningkatkan kegiatan sistem saraf pusat janin, membantu memenuhi kebutuhan oksigen janin, serta dapat mengurangi pembengkakan pada tangan maupun kaki ibu hamil.
Buah ini mengandung antosianin, proantosianidin, flavonol, resveratrol, dan tanin yang dapat menghambat berkembanganya sel kanker, membantu mengurangi risiko terkena Alzheimer pada bayi, membantu mencegah infeksi pada saluran kencing ibu hamil, serta dapat menurunkan kadar kolesterol. Buah semangka merupakan sumber buah yang mengandung vitamin A, vitamin C, vitamin B6, magnesium, dan kalium yang dapat mencegah masalah pencernaan, mengurangi pembengkaan pada tangan dan kaki ketika hamil, mengurangi morning sickness, mencegah terjadinya dehidrasi, mengurangi kram pada otot, dan dapat mencegah pigmentasi pada kulit.
Dengan mengonsumsi buah kiwi, dapat mengurangi risiko terjadinya kelainan saraf otak calon bayi. Buah ini memiliki kandungan zat besi dan folat yang cukup tinggi yang dapat mencegah terjadinya kekurangan darah pada ibu hamil dan dapat mengurangi risiko bayi mengalami kecacatan pada saat lahir. Jambu air memiliki kandungan berbagai vitamin seperti vitamin A, vitamin C, dan mineral sehingga dapat mengurangi dehidrasi, melancarkan pencernaan serta dapat meningkatkan kinerja darah putih. Strawberry memiliki kandungan vitamin C, vitamin K, vitamin B5, B6, magnesium, omega-3 dan lain-lain yang dapat digunakan untuk meningkatkan nafsu makan serta dapat membakar lemak ibu hamil, selain itu dapat mencegah prematur dan cacat pada janin.
Buah ini memiliki nutrisi dan berbagai vitamin yang sangat bermanfaat bagi ibu hamil serta calon bayinya.
Manfaat buah pepaya mengandung vitamin A, vitamin A, vitamin B kompleks, vitamin E dan pepain. Buah pir mengandung asam folat dan vitamin B9 yang dapat mengurangi risiko keterbelakangan mental pada calon bayi ketika lahir. Buah ini kaya akan serat dan nutrisi yang baik untuk perkembangan calon bayi dan kesehatan bagi ibu hamil.
However, having a family member with type 1 diabetes slightly increases the risk of developing the disease.
In addition, having been previously diagnosed with gestational diabetes or being of certain ethnic groups puts women at increased risk of developing GDM.
The Finnish Type 2 Diabetes Risk Assessment Form, developed in 2001, is an example of an effective questionnaire that can be used as the basis for developing national questionnaires which take into account local factors. IntroductionPeriodontal diseases are chronic infectious diseases that results in the inflammation of the specialized tissues that both surround and support the teeth. Based on this view, the role of various diseases and systemic conditions in periodontal diseases has been well recognized.
Non-surgical treatments include sclerotherapy, elastic stockings, elevating the legs, and exercise. Ibu hamil harus memenuhi kebutuhan vitamin dan mineral agar bayi dalam kandungannya selalu sehat dan berkembang secara optimal.
Manfaat zat besi berfungsi untuk membentuk sel-sel darah merah yang membawa oksigen ke seluruh bagian tubuh.
Selain untuk janinnya, asam lemak omega-3 juga berguna untuk menjaga kesehatan jantung ibunya.
Selain itu, vitamin B1 mempunyai peran yang sangat penting untuk menyiapkan produksi ASI setelah melahirkan calon bayi. Buah alpukat memiliki kandungan lemak tak jenuh tunggal, minyak, dan kalori tinggi yang berguna untuk menjaga kekuatan ibu hamil dalam beraktivitas dengan meningkatkan energi sang ibu. Buah mangga dapat membantu melancarkan sistem pencernaan melalui kandungan seratnya yang tinggi. Dari beberapa kandungan buah anggur, anggur dapat meningkatkan sistem kekebalan tubuh dan dapat meningkatkan kinerja organ ginjal. Selain itu, lemon juga dapat membantu membersihkan tubuh dari sisa metabolisme yang berupa racun. Selain itu, leci mengandung vitamin B kompleks, flanoid dan phytonutrient yang dapat melindungi sang ibu dari radikal bebas dan juga dapat membantu metabolisme lemak, karbohidrat, dan protein.
Selain itu dengan mengonsumsi buah jeruk dapat menghindari dari pembengkakan bagian tubuh ibu hamil seperti tangan dan kaki serta dapat mencegah gangguan pencernaan.
Selain zat besi, pada manfaat buah naga juga kaya akan karbohidrat yang mampu memberikan energi bagi sang ibu agar tidak mudah lelah. Kandungan yang terdapat dalam buah cherry yang dapat mencegah peradangan, mencegah kanker, dapat menunda penuaan dini, menenangkan syaraf, serta dapat melancarkan peredaran darah ke otak.
Dengan kandungan tersebut buah pepaya dapat mempercepat proses pencernaan protein dalam tubuh.
Dengan kandungan glukosa, sukrosa, vitamin A, vitamin B, lemak, dan protein yang dapat meningkatkan energi bagi ibu hamil, melancarkan pencernaan, menghilangkan rasa gelisah sehingga dapat tidur dengan lelap.
Environmental factors and exposure to some viral infections have also been linked to the risk of developing type 1 diabetes. It has eight scored questions, with the total test score providing a measure of the probability of developing type 2 diabetes over the following 10 years. Similarly, periodontal conditions seem to be able to modify the physiological balance of various organs and systems of the host. Kekurangan zat besi dapat merangsang munculnya anemia yang dapat membuat wanita hamil mudah lelah, lemah, pusing, dan terlihat pucat. Buah mangga juga memiliki kandungan potassium dan kalium yang dapat menjaga keseimbangan cairan dalam tubuh. Selain itu, dengan manfaat apel dapat mencegah ibu hamil terkena asma serta dapat menjaga kesehatan paru-paru. Manfaat buah kiwi tidak hanya untuk sang bayi, buah kiwi juga bermanfaat bagi ibu yang hamil karena dapat memelihara tubuh yang sehat, dan dapat menjaga tekanan darah. Kandungan yang lain adalah anti-koagulan yang berfungsi untuk mencegah terjadinya penggumpalan darah merah pada ibu hamil.
Kandungan papain dalam buah pepaya yang dapat mengubah protein menjadi senyawa asam amino dalam makanan sehingga dapat memperlancar pencernaan dan dapat menghindarkan diri dari tekanan darah tinggi, epilepsi, radang sendi dan penyakit kencing manis. The reverse of the form contains brief advice on what the respondent can do to lower their risk of developing the disease, and whether they should seek advice or have a clinical examination. This tissue destruction is characterized by the formation of periodontal pockets that act as reservoirs for bacterial colonization of the dento-gingival environment [1-2]. Because it is a chronic inflammatory infectious disease, periodotitis can be considered a systemic stimulus of low grade and long duration, a "systemic exposure" potentially harmful to some individuals [23].Regarding the epidemiological aspects, periodontal disease is undoubtedly one of the major health problems regarding prevalence of oral conditions in populations. Calon ibu harus mengetahui bagaimana tanda tanda kehamilan nya supaya dapat mempersiapkan dirinya untuk memberikan yang terbaik untuk calon bayi. Manfaat alpukat untuk ibu hamil juga mengandung asam Folat dan lemak tinggi yang dapat membantu dalam peningkatan fungsi otak dan sumsum tulang belakang.
Selain itu,manfaat anggur bagi ibu hamil dapat mengurangi kadar kolesterol pada ibu yang sedang hamil. Manfaat lain adalah menjaga kesehatan mata, melancarkan pencernaan, menurunkan tekanan darah tinggi, menghambat pertumbuhan sel kanker, dan dapat membuang racun di dalam tubuh.
The test takes only a couple of minutes to complete and can be done online, in pharmacies or at various public campaign events.


It is a multi-factorial disease, affecting individuals at different levels of extent and severity. Studies [3,4] reported prevalence of gingivitis and clinical signs of inflammation around 80% in children and adolescents.
They can be found on the legs and face and can cover either a very small or very large area of skin. Kekurangan zat besi pada masa kehamilan dapat meningkatkan risiko bayi terkena anemia setelah ia lahir serta dapat meningkatkan risiko bayi terlahir dengan kondisi prematur atau terlahir dengan berat badan yang kurang. Dengan antioksidan yang ada dalam vitamin C dapat melindungi tubuh ibu hamil terhadap serangan penyakit kanker serta dapat melawan radikal bebas. Current concepts on etiology support bacterial infection as the primary cause of periodontal diseases.
Manfaat mangga untuk ibu hamil juga dapat meningkatkan stamina dan energi untuk tetap beraktivitas melalui sukrosa dan karbohidrat yang ada di dalamnya.
Buah pir memiliki kandungan sekitar 100 kalori yang dapat memberikan energi dan dapat mengenyangkan.
Periodontitis is presented as different clinical forms: chronic periodontitis, aggressive periodontitis, and periodontitis as a manifestation of systemic diseases.
Although bacterial dental bio?lms are necessary for disease development, they are not suf?cient to produce the disease. Chronic periodontitis usually has a course of slow progression, while aggressive periodontitis presents a rapid rate of progression [3]. A susceptible host is required, and the host response, through release of a broad spectrum of proin?ammatory mediators, is responsible for much of the periodontal tissue destruction observed in the disease. The study on tea growers in Sri Lanka and demonstrated that 5 to 20% of individuals were affected by rapidly progressive periodontitis [24]. Different models of the pathogenesis of periodontal diseases have been proposed [5] pointing to the involvement of cellular and molecular mechanisms of the host and an important participation of neutrophils, cytokines and inflammatory mediators.
Therefore, as a chronic inflammatory infectious disease, it can be considered a long-term low-grade systemic stimulus that can affect different parts of the body, a "systemic exposure" potentially harmful to some individuals. Studies among adults in the United States foud prevalence rates of periodontitis ranging from 44% to 64% [4,17].A number of epidemiological studies conducted during the 70's and 80’s showed that periodontitis may be associated with risk factors that predispose and modulate the development of periodontal changes. Indeed, the association of oral infections and systemic events were present in remote medical records [6]. Changes in periodontal status of women during pregnancyAn increase in the incidence of gingivitis and an exaggerated gingival response to dental biofilm among pregnant women has been extensively reported on in previous literature suggesting that hormonal changes can have varied manifestations in periodontal tissues. Therefore, further clarification about the risk association between periodontal disease and pregnancy complications can bring new opportunities and strategies for the prevention of these complications.2. Problem statementThe aim this chapter is to explore the putative association between periodontal disease and preterm birth, the underlying mechanisms of this association, as well as the current scientific evidence from different study designs such as cross-sectional, case-control, longitudinal, and intervention studies.
In this manner, the text will be divided in sections that will describe the changes that occur in periodontal status of women during pregnancy, the risk factors associated with periodontal disease and preterm birth, the biological plausibility of periodontal infection inducing preterm birth, the surrogate microbiological, immunological and biochemical markers for periodontal status and preterm birth, and data from animal and human studies, as well as a critical analysis of the current scientific evidence, the influence study findings on the current practice of Periodontology and Obstetrics and the implications for future research.3.
It has been established that pregnant women have a tendency to develop clear signs of inflammation in the presence of relatively little plaque [33].
In addition, another study [34] observed changes in periodontal clinical parameters, such as bleeding on probing (BOP) and probing depth (PD), and reported an increase in clinical attachment loss (CAL) among pregnant women during gestation.Studies [35,36] showed that high concentrations of female sex hormones stimulate the production of prostaglandin E2 and may exacerbate the inflammatory response of periodontal tissues.
Conceptual aspectsThe periodontium, also called attachemnt apparatus, is formed by the supporting tissues of the teeth. The main function of the periodontium is to insert the teeth in the jaws and maintain the integrity of the masticatory mucosal surface of the oral cavity [1].The term periodontal disease is a generic term used to identify an infectious inflammatory process affecting the tissues around the teeth. Periodontal disease initially starts as gingivitis, which is characterized by inflammation of the gingival marginal portion, a reversible and non-destructive gingival inflammation related to a non-specific bacterial challenge. Association between oral infections and systemic conditionsSince the most remote medical scriptures, oral infections have been reported as a cause of systemic diseases. When persistent, it can progress to periodontitis, which are destructive inflammatory changes that affect the supporting tissues of the teeth, leading to loss of periodontal ligament, cementum and and alveolar bone [16,17].This tissue destruction is characterized by the formation of periodontal pockets that act as reservoirs for bacterial colonization of the dento-gingival environment [18,19]. There are documentary reports on this subject in ancient civilizations, in the middle ages, and in modern times.
Current evidence [20,21] demonstrated a specific group of gram negative anaerobic bacteria including Aggregatibacter Actinomycetemcomitans, Tannerella forsythia, Campylobacter rectus, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis as the main microorganisms involved in periodontitis process. Hence, periodontitis is considered a specific inflammatory process.It was demonstrated that bacterial species exist in 5 major complexes in subgingival plaque. In Dentistry, a large number of extractions were a result of the popularity of this theory. The 1rst complex, determined to be the red complex, consists of the tightly related group of Tannerella forsythia, Porphyromonas gingivalis and Treponema denticola. From the second half of century XX, this type of therapy begins to decline in the face of new scientific evidence, revealing that teeth infections could be treated and maintained without necessarily becoming focal points of infection. This complex was related strikingly to clinical measures of periodontal disease, particularly pocket depth and bleeding on probing.
Recently, advances in several areas of the sciences have provided a more realistic and appropriate analysis of the importance of focal infection in the oral cavity for the rest of the body [5,6]. The 2nd complex, determined to be the orange complex, consists of a tightly related group including Fusobacterium nucleatum, Prevotella intermedia, Eubacterium nodatum, Campylobacter rectus and Parvimonas micra.
Although this concept is highly controversial, it has gained attention by the scientific community in recent years. Because it is a chronic inflammatory disease, PD may be considered a systemic stimulus of low intensity and long duration which represents a potentially deleterious systemic exposure. The 4th complex was comprises especially by Eikenella corrodens and Aggregatibacter actinomycetemcomitans serotype a. Consequently, some studies have shown that the DP seem to put the host at greater risk for cardiovascular diseases, stroke, diabetes mellitus, lung infections, as well as adverse pregnancy outcomes such as preterm birth (PTB), low birth weight (LBW), intrauterine growth restriction (IUGR) and preeclampsia (PEC) [8-10,15]. The 5th complex consists of Veillonella parvula and Actinomyces odontolyticus.Virulence factors of most periodontal pathogens mainly involve enzymes with potential to evade or interfere with host defenses and to disintegrate periodontal tissues. The main periodontal bacteria and respective virulence factors and pathogenic mechanisms are presented in Table 1.Periodontitis is a multi-factorial disease, affecting individuals at different levels of extent and severity. Periodontal inflammation is initiated and sustained by the presence of dental biofilm, but the host immune defense mechanisms play an important role in the pathogenesis. In addition to a great increase in the chance of death during perinatal period, it can result in severe disabilitating disorders, such as neurological problems, lung and respiratory problems, blindness, as well as anomalies and complications due to neonatal intensive care.
Preeclampsia, which affects around 10% of pregnant women remains among the most important disorders in obstetrics.
It can lead to deterioration of various organs and systems, as well as maternal and fetal death [11,13]. Different models of the pathogenesis of periodontal diseases have been proposed [23] pointing to the involvement of cellular and molecular mechanisms of the host and an important participation of neutrophils, cytokines and inflammatory mediators such as interleukin-1 ? (IL-?), interleukin-8 (IL-8), tumor necrosis factor-? (TNF-?), prostaglandin E-2 (PGE-2). Among pregnancy complications related to periodontitis, intrauterine growth restrictioin (IUGR) can be defined as a decrease in fetal growth observed in at least two medical evaluations at different times which can indicates uterine problems. Therefore, the inflammatory and immune responses basically modulate homeostasis in the dento-gingival region between changes in bacterial aggression or in host defense mechanisms. There are several risk factors associated with the PTB, LBW, and IUGR, including maternal and fetal factors. Special attention should be given to the occurrence of these events in previous gestations. Thus, factors or conditions modifying homeostasis of the host can also modify the extent and course of periodontitis, as well as the response to therapy [5]. The detection and subsequent study of the relationship between periodontitis and various systemic diseases can improve health care, either as a preventive or interventional therapy. Therefore, further clarification about the risk association between periodontitis and adverse pregnancy outcomes can bring new opportunities and strategies for the prevention of these complications.Some studies failed to demonstrate significant associations between maternal periodontal infections and adverser pregnancy outcomes, while others showed significant associations with a very wide variation in reported risk estimates.
A review on the main topic for adverse pregnancy outcomes will be presented considering conceptual aspects, epidemiology, risk factors, and major studies with different methodological designs.5. Conceptual aspectsSince March 1935, after a meeting in Chicago – USA, the American Academy of Pediatrics defined as preterm infants all newborn infants weighing 2,500 grams (g) or less [45]. Some time later, however, it became apparent that there were differences between gestational age and birth weight due IUGR. Because of this, in 1961, the World Health Organization (WHO) [46] defined gestational age as a criterion of prematurity.
Preterm infants were then defined as all newborn infants with less than 37 completed weeks of gestation, distinguishing PTB from LBW.
Although related, weight and gestational age can be exchange, as well as fetal maturity can be advanced or delayed, independently of both. Epidemiological aspectsPTB is one of the most severe perinatal problems, persisting as a major cause of perinatal morbidity and mortality. PTB and LBW infants represent a major challenge to public health, as well as a social and economic problem, accounting for almost 50% of severe neurological diseases in short and long periods [13,48,49] The incidence of PTB reported in the literature is varied because it is a multifactorial problem that is influenced by the geographic and socioeconomic factors, racial characteristics, age, and quality of prenatal care offered to pregnant women. According to these authors, PTB occurs in approximately 8-10% of pregnancies in developed countries while in Latin America it may reach 43%. In all populational groups, although a consequence of complexes interactions, birth weight is the most important determinant of the chances of a newborn to survive, grow, and develop healthily [48,50]. Although great advances in prenatal care have occurred, the prevalence of PTB has remained relatively constant over the past 40 years.
One of the best single risk factors in predicting PTB in multiparous women is the previous history of PTB, which can rise up the risk to three times.
The authors showed that the translocation of bacterial products and tissue inflammation, with large amounts of cytokines and other inflammatory mediators present in the placenta, are the causal agents capable of inducing changes in fetal development, uterine contractions, and miscarriage. Such mediators, especially, prostaglandin E2 (PGE-2) and interleukin 1? (IL-1?) would be locally produced or transported to the placenta throught the bloodstream.
For Goldenberg [55], genitourinary tract infection is one of the most important factors related to maternal exposure involved in PTB.
For this author, this type of infection at any time during pregnancy has the ability to promote the upward migration of bacteria and inflammatory products from the vagina into the coriodecidual space.Thus, maternal infections may lead to a systemic inflammatory response resulting in inflammation of the fetal-placental unit, including the uterus, chorioamniotic membranes, placenta, and amniotic fluid. This inflammatory stimulus induces a state of activity of uterine smooth muscle by increasing contractility, cervical dilatation, and triggering labor.
Infections and inflammation may also induce damage in the placenta, leading to reduced fetal perfusion, IUGR, and fetal distress. Periodontitis as a risk factor for preterm birth and low birth weightThe current concept of pathogenesis of periodonitiss ponts to the involvement of cellular and molecular mechanisms of the host and an important participation of neutrophils, cytokines, and inflammatory mediators such as interleukin-1 ? (IL-?), interleukin-8 (IL-8), tumor necrosis factor-? (TNF-?), prostaglandin E-2 (PGE-2) In this manner, periodontitis results in an increase of proinflammatory molecules that can directly or indirectly lead to uterine contractions and cervical dilatation [23]. It should be emphasized that these studies mostly pointed PD as a risk factor for adverse pregnancy outcomes although with varied risk estimates, as previously mentioned.The first study [23] on the association between periodontitis and adverse pregnancy outcomes was indicated that maternal periodontitis represents a clinically significant risk factor for PTB and LBW. All variables of interest regarding pregnancy, medical history, and characterization of the patients were collected from medical records.
Periodontal status was assessed in the postpartum period throught manual periodontal probing with record of probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP).
The maternal periodontal status was characterized by mean CAL and the extension of periodontitis by the percentage of sites with CAL ? 2mm, ? 3mm, ? 4mm. Cases of PTB and LBW presented worse periodontal status when compared to controls with adequate gestational age and birth weight.
In this study, DP was determined to be an independent risk factor for adverse pregnancy outcomes.Davenport et al.


Maternal periodontal status was established by the CPITN (Community Periodontal Index of Treatment Needs) index and general data of interest were collected from medical records. A preliminary analysis of data showed a prevalence of CPITN level 4 of 49% in the population, and none of the participants presented CPITN level 0.
Periodontal examination was conducted with manual probe, and PD, CAL, BOP, and CPITN were recorded.
Thus, authors do not believe that strategies to improve maternal periodontal health can be used to optimize pregnancy outcomes.In Brazil, one study [58] compared three case groups with a control group (n = 393) composed by women who did presented PTB and LBW. The extent of periodontitis did not increase the risk for PTB and LBW according to 15 different measurements of periodontitis.
The controlled variables were age, diabetes, heart disease, socioeconomic status, medical history, genitourinary infection, antenatal care, drugs, smoking, body mass index, and ethnicity. Of the total 227 women in the study sample, 66 were diagnosed with periodontitis and 161 were periodontally healthy. The controlled variables were: age, smoking, diabetes, alcohol, socioeconomic status, race, hypertension, previous periodontal treatment, and antenatal care.
Animal studiesPeriodontitis induced by subcutaneous injections of periodontopathogens in an animal model (pregnant hamsters) lead to an increase in inflammatory mediators levels such as prostaglandin E2 (PGE2) and tumoral necrosis factor-? (TNF-?) in the amniotic fluid. Authors found that lipopolissacaryde (LPS) from Porphyromonas gingivalis caused a significant reduction in the weight of the pups, fetal death, and malformations in association with increased levels of TNF and PGE-2. Periodontitis induced by cotton ligature around the upper second molars of adult rats did not promote changes during pregnancy thath resulted in LBW [59].In the study of Yeo et al. The results showed that infected females presented a greater number of IUGR when compared to females in the control group.Offenbacher et al.
Birth weight was not affected by exposure to Campylobacter rectus, but mortality was 3.9 times higher after a week. The periodontal examination was performed in the postpartum and PD, BOP, and CPITN were recorded. The mean maternal age, socioeconomic status, educational level, history of infection, placental abnormalities, previous pregnancies, prenatal care, type of delivery, and sex of the newborns were similar between case and control groups.
Furthermore, it was observed an increased in the prevalence of altered PD in the group of women with newborns of lower weight and lower gestational age, suggesting a strong risk association between maternal periodontitis and these adverse pregnancy outcomes.
In 2005, a cross-sectional study [60] in a Brazilian sample of 152 women divided into three groups: periodontally healthy, gingivitis, and periodontitis.
Although there was no statistically significant difference in PTB rates between groups, there was difference between birth weight of newborns among healthy women when compared to women with periodontitis over 25 years of age. Therefore, authors concluded that women with periodontitis were more likely to have LBW infants when compared to women with gingivitis and healthy. The control group consisted of 1042 mothers of term infants and appropriate weight, while the PTB group was composed of 238 mothers of newborns whose gestational age was less than 37 weeks, the LBW group was composed of 235 mothers of newborns weighing less than 2500 g, and the IUGR group was composed of 77 women who had infants with fetal growth restriction. Periodontitis was defined as the presence of at least four teeth with one or more sites with PD = 4mm and CAL = 3mm.
LBW was associated with smoking habits, ethnicity, systemic diseases, previous LBW, complications of pregnancy, and delivery type. PTLBW was associated with maternal age, prenatal care, systemic diseases, previous LBW, complications of pregnancy, and type of delivery. Authors pointed the need for further studies since a modest association between periodontitis and PTB was stablished. However, another case-control study was conducted in Jordan [68], comprising 148 women who had PTLBW and 438 women with term delivery without vaginal complications, and it was concluded that both the extent and severity of PD was associated with a greater chance of PTLBW.In 2010, Guimaraes et al.
The author?s evaluated 1686 women aged 14-46 years and used two different definitions for maternal periodontitis. The fisr definition considered the presence of four or more teeth with one or more sites with PD ? 4mm and CAL ? 3mm.
Of the 1686 women examined in the sample, 479 were excluded based on the following criteria: multiple gestations, congenital anomalies, pregnancy from in vitro fertilization, prematurity due to interruption of pregnancy by preeclampsia, heart disease, neuropathy, and placental, uterine or cervical defects. Thus, the control group (G1) was composed by 1046 women with adequate gestation period (? 37 weeks), and the PTB group was composed by 146 women with gestation period between 32 and 36 weeks (G2).
Another group, composed by 15 women with gestation period < 32 weeks, was determined to be extreme preterm birth (G3). The influence of these different definitions on odds ratio (OR) estimates for adverse pregnancy outcomes was very well established in the study by Manau et al. Microbiological and immunological studiesThere are also some studies that also monitored microbiological and immunological parameters, or both.
In general, most of these studies supported the main clinical findings previously presented. The maternal inflammatory response was shown to be an important effector mechanism of the PTB, and maternal periodontitis was an infectious challenge sufficient to result in preterm labor.
The percentage of sites with NIC ? 4mm was used as indicator of extension of periodontitis. Samples of gingival crevicular fluid were collected and concentrations of PGE-2 and IL-1? were evaluated by the immunoenzymatic method.
Samples of subgingival biofilm were analyzed by DNA probe for identification of periodontal pathogens. Crevicular levels of IL-1? were increased in the case group, but without statistical significance when compared to the control group. Mothers of LBW and PTB infants showed a two times higher increase of crevicular PGE-2, when compared to controls. Primiparous mothers with higher concentrations of PGE-2 produced the smallest and most premature newborns. Therefore, the authors suggested an inverse relationship between crevicular PGE-2 and gestational age and birth weight, as well as a positive association between these indicators with IUGR. Microbiological analysis showed higher levels of Tannerella forsythia, Porphyromonas gingivalis, Treponema denticola and Aggregatibacter actinomycetencomitans in the case group.In a prospective study [72] of 812 women, was tested the hypothesis that systemic dissemination of periodontal pathogens, which could translocate to the fetal-placental unit, are capable of inducing a response of the mother and the fetus leading to PTB.
Authors identified Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Campylobacter rectus, Fusobacterium nucleatum, Micromonas micra, Prevotella nigrescens, and Prevotella intermedia in samples of maternal dental plaque and determined serum levels of maternal IgG and fetal levels of IgM to these same pathogens.
Authors concluded that a direct involvement of the fetus with maternal periodontal microorganisms, as measured by fetal IgM response, provided biological evidence for the association between periodontitis and adverse pregnancy outcomes. They also stressed that maternal immune response appears to protect the fetus from exposure to pathogens and the absence of this protection is associated with systemic dissemination of oral microorganisms, resulting in prematurity.Dasanayake et al. The authors concluded that maternal serum levels of immunoglobulins against periodontal pathogens during pregnancy can significantly predict LBW. Moreover, elevations in serum level of IL-8 and IL1-? appear to result in premature uterine contractions. The results showed worse clinical condition with higher levels of IL-8 and IL-1? among women with PPT when compared to those without adverse pregnancy outcomes. The periodontal examination was performed by manual probing and assessment of PGE-2 and IL-1? levels in gingival crevicular fluid and plasma by ELISA. In case group, it was also observed gingival crevicular levels of PGE-2 and IL-1? significantly higher.A recent study [76] was conducted to investigate the presence of Fusobacterium nucleatum in chorionic tissues of pregnant women and the effects of this microorganism in chorio-derived human cells. Fusobacterium nucleatum was detected in all samples of oral and chorionic tissues of high-risk pregnant women, and it was absent in low-risk pregnant women.
It was suggested that Fusobacterium nucleatum induces IL-6 and corticotrophin production.Therefore, some studies reported that the presence of periodontalpathogenic bacteria such as Porphyromonas gingivalis, Fusobacterium nucleatum in the amniotic fluid, placenta, and membranes of pregnant women were associated with adverse pregnancy outcomes, including preterm labor and premature rupture of membranes. They provided biological evidence of the association between periodontitis and na increased risk for PTB, since amniotic infection is one of the main risk factors for preterm labor [55]. Intervention studiesSeveral of the authors previously presented, who conducted cross-sectional and case-control studies, suggested the need for confirming their findings by intervention studies.
Again, despite of some divergences among them, most of these studies support some degree of association between maternal PD and adverse pregnancy outcomes since periodontal therapy in pregnant women appears to reduce the risk for PTB and LBW.Lopez et al. The criteria used to define the presence of periodontitis were four or more teeth with one or more sites with PD ? 4mm and CAL ? 3mm, at the same site. The authors also evaluated whether maternal periodontal health maintenance after the 28th week of gestation reduce the risk for PTB and LBW in a sample of 639 women. All patients who did not meet the criteria for periodontitis definition or presented BOP in more than 25% of sites were diagnosed with gingivitis or mild periodontitis. In this manner, they finished the gestational period periodontally healthy and were determined to be the control group - G1.
Another group, composed by 233 women diagnosed with periodontitis received treatment after the gestational period, and was determined to be the case group - G2.
Pregnancy without periodontal treatment was associated with a significant increase in PD, plaque index, and levels of interleukin-6 and interleukin-1? in gingival crevicular fluid [81].A study [82] evaluated a sample of 450 pregnant women in a prenatal care program in Brazil. Women with risk factors such as systemic alterations (ischemic heart disease, hypertension, tuberculosis, diabetes, cancer, anemia, seizures, psychopathology, urinary tract infection, sexually transmitted diseases, asthma, and human immunodeficiency virus), as well as alcohol, tobacco and other drugs users were excluded from the study. Data related to age, socioeconomic level, race, marital status, number of previous pregnancies, and previous PTB were also evaluated. Initially, the sample was divided in two groups: G1 – with 122 healthy women, and G2 – with 328 women with periodontitis. After delivery, gestational age and birth weight of all infants were recorded and analyzed. Educational level, previous PTB and maternal PD were significantly associated with current PTB. Periodontal treatment was performed on 200 pregnant Indian women diagnosed with periodontitis [83]. Authors concluded that periodontal treatment can reduce the risk for PTB in women with periodontitis.
A group of 74 pregnant women (G1) received oral prophylaxis during pregnancy, and a group of 90 patients (G2) received no prenatal periodontal care.
Randomly selected women received periodontal treatment before 21 weeks of gestation (n = 413) or after delivery (n = 410).
Birth outcomes were available for 812 women and periodontal follow-up data for 722, including 75 whose pregnancies ended in less than 37 weeks. The distribution of gestational age at labor and mean birth weight (3,295 g versus 3,184 g, p = 0.11) did not differ significantly between women with and without progression of periodontitis.
Gestational age and birth weight were not associated with changes in the percentage of sites with BOP when compared to study entry.Oliveira et al. In the study, 246 eligible women were randomly divided in two groups: intervention group (122 women with periodontitis undergoing non-surgical periodontal treatment during pregnancy) and controls (124 women without periodontitis with no periodontal treatment during pregnancy). There was no significant difference between groups for the occurrence of PTB, LBW, and PTLBW.
Sistematic reviews and meta-analysisFinally, it wil be presented evidence from some systematic reviews published on the subject. Failing to accomplish these assessments, gestational age should be made by the pediatrician through physical examination.



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