Association Of Maternal Periodontitis And Adverse Pregnancy Outcomes:A Prospective Cohort Study

Objective:The aim of the present study was to describe the prevalence of maternal periodontitis in Chengde city,and to analyze the influencing factors of maternal periodontitis, and to investigate the relationship between maternal periodontitis and adverse pregnancy outcomes.Methods:The research field of the present study was in the Affiliated Hospital of Chengde Medical College. Pregnant women were recruited when they came to the hospital for prenatal health care between September 2014 and August 2015. Pregnant women were enrolled when they reached the following criteria: living in Chengde for at least 5 years; singleton pregnancy; gestational age between 11 and 26 weeks; getting prenatal heath care in the hospital regularly and cooperating with the following-up; normal language expression ability and understood the questionnaire and communicated with the investigators fluently; signed the informed consent. Pregnant women were excluded when they suffered from systemic diseases such as hypertension, diabetes, kidney disease, liver disease, thyroid disease, mental disease and so on; or they could not cooperate with the following-up; or they had smoking or drinking behaviors. Information was collected by questionnaires at each following-up visit, including demographic characteristics, pregnancy history, medical history, the information of the current pregnancy, personal exposure history, height and weight of the pregnant women before pregnancy. Two dentists did the oral examination to the pregnant women to diagnose the periodontitis. Pregnancy outcomes were collected by checking the medical records or by telephone survey. At the end of March 1, 2016, 560 pregnant women delivered or terminated their pregnancy. SX ? and the constituent ratio were used to describe the demographic characteristics, clinical features of pregnant women. The prevalence was used to describe the periodentitis. Chi-square test and multiple logistic regression analysis were performed to examine the risk factors of maternal periodontitis and the association between maternal periodontitis and adverse pregnancy outcomes.Results:560 pregnant women with singleton pregnancy were recruited. 536 cases of them had the complete information, of which 24 women(4.3%) were lost to follow-up. Among the 536 women, 50, 2, 1, and 7 suffered from gestational diabetes mellitus, placental abruption, placenta previa and birth defects. 476 pregnant women were included in the final analysis.The study showed that the age of 476 pregnant women were 27.9±3.9 years. 53.2% of them had jobs and 47.9% of them got high school and technical secondary school education level. 95.6% of the pregnant women had ≥2000 yuan per capita income level. The mean height of the pregnant women was 1.62±0.05 m and the mean body mass index before pregnancy was 21.90±3.33kg/m2. Among those women, 12.8% of them were overweight, 46.0% of them were the first pregnancy, 28.8% of them had history of delivery, 42.0% of them had history of abortion, 32.6% of them had history of vaginal bleeding early pregnancy, 11.6% of them had vaginitis during the current pregnancy.The study showed that the prevalence rate of periodontitis was 35.5%. The prevalence rate of periodontitis was significantly different for different age women(χ2=12.388,P=0.015), the women older than 35 years had the highest prevalence rate(60.0%). There were no significantly differences between employments and un-employments(χ2=0.539, P=0.463), the women with different education level(χ2=4.621, P=0.202) and different income level(χ2=1.408, P=0.235). The women with the history of pregnancy had the significantly higher prevalence rate than those without pregnancy history(40.1% vs 30.1%, χ2=5.103, P=0.024). The prevalence rate of periodontitis was significantly higher for multipara than primipara(43.1% vs 32.4%, χ2=4.803, P=0.028). There were no significantly differences for women with different body mass index before pregnancy(χ2=1.760, P=0.624).Multiple logistic regression analysis showed that the history of pregnancy was an independent risk factor for maternal periodontitis( a OR=1.480; 95%CI: 1.065~2.057).The incidence of adverse pregnancy outcomes was 29.4% and there was no significantly difference between the periodontitis group and the non-periodontitis group(31.9% vs 28.0%,χ2=0.815, P=0.367).There were significantly differences for the PB(10.1% vs 4.9%, χ2=4.652, P=0.031), LBW(7.7% vs 2.3%, χ2=7.932, P=0.005), PLBW(7.1% vs 1.6%, χ2=9.477, P=0.002) of the periodontitis group and the non-periodontitis group. However, there were no significantly difference of the two groups about the incidence of gestational hypertension(7.1% vs 6.2%, χ2=0.149, P=0.700), PE(4.7% vs 4.2%, χ2=0.064, P=0.800), abortion(0% vs 2.0%, χ2=3.345, P=0.067)and PROM(20.1% vs 19.5%, χ2=0.023, P=0.880). Multile logistic regression analysis showed that maternal periodontitis might increase the risk of PB(a RR=2.121; 95%CI: 1.010 ~ 4.456), LBW(a RR=3.593; 95%CI: 1.357~9.514), PLBW(a RR=6.610; 95%CI: 2.019~21.648).Conclusions:The maternal periodontitis prevalence rate was 35.5%, periodontitis was associated with older age, the history of pregnancy and delivery. The history of pregnancy was an independent risk factor for maternal periodontitis. The maternal periodontitis was an independent risk factor for PB, LBW, PLBW. There were no associations of maternal periodontitis and gestational hypertension, PE, abortion and PROM were found in the current study.