ASSOCIATION OF MATERNAL PERIODONTITIS WITH LOW BIRTH WEIGHT IN NEWBORNS IN A TERTIARY CARE HOSPITAL
Abstract
Background: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in newborns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects.Methods: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynae B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (<2,500 g), the 80 controls were mothers of normal weight babies (≥2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination.Results: Periodontitis was more in the cases than in the controls (OR: 4.167, 95% CI: 2.142-8.109, p=0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95% CI: 1.429-7.047, p=0.005). Other significant risk factors were educational level (aOR: 3.408, 95% CI: 1.452-7.996, p=0.005), socioeconomic status (aOR: 3.173, 95% CI: 1.366-7.368, p=0.007), maternal nutrition (aOR: 3.071, 95% CI: 1.392-6.778, p=0.005) and moderate/severe anaemia (aOR: 3.035, 95% CI: 1.052-8.756, p=0.040).Conclusions: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad.Keywords: Low birth weight infant, Periodontitis, Risk Factors.Background: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. Methods: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics-B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (<2,500 g), the 80 controls were mothers of normal weight babies (≥2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. Results: Periodontitis was more in the cases than in the controls (OR: 4.167, 95% CI: 2.142–8.109, p=0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95% CI: 1.429–7.047, p=0.005). Other significant risk factors were educational level (aOR: 3.408, 95% CI: 1.452–7.996, p=0.005), socioeconomic status (aOR: 3.173, 95% CI: 1.366-7.368, p=0.007), maternal nutrition (aOR: 3.071, 95% CI: 1.392-6.778, p=0.005) and moderate/severe anaemia (aOR: 3.035, 95% CI: 1.052–8.756, p=0.040). Conclusions: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad.Keywords: Low birth weight infant, Periodontitis, Risk FactorsReferences
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Valero de Bernabé J, Soriano T, Albaladejo R, Juarranz M, Calle MaE, Martı́nez D, et al. Risk factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol 2004;116(1):3–15.
Siqueira FM, Cota LO, Costa JE, Haddad JP, Lana AM, Costa FO. Intrauterine growth restriction, low birth weight, and preterm birth: adverse pregnancy outcomes and their association with maternal periodontitis. J Periodontol 2007;78(12):2266–76.
Singh G, Chouhan R, Sidhu K. Maternal factors for low birth weight babies. Med J Armed Forces India 2009;65(1):10–2.
Jacob PS, Nath S. Periodontitis among poor rural Indian mothers increases the risk of low birth weight babies: a hospital-based case control study. J Periodontal Implant Sci 2014;44(2):85–93.
Cruz SS, Costa Mda C, Gomes‐Filho IS, Barreto ML, Dos Santos CAS, Martins ÂG, et al. Periodontal therapy for pregnant women and cases of low birthweight: an intervention study. Pediatr Int 2010;52(1):57–64.
López NJ, Uribe S, Martinez B. Effect of periodontal treatment on preterm birth rate: a systematic review of meta‐analyses. Periodontol 2000;67(1):87–130.
Shah M, Muley A, Muley P. Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review. J Materna Fetal Neonatal Med 2013;26(17):1691–5.
Harchandani N. Oral health challenges in Pakistan and approaches to these problems. Pak Oral Dent J 2012;32(3).
Ali TB, Abidin KZ. Relationship of periodontal disease to pre-term low birth weight infants in a selected population--a prospective study. Community Dent Health 2012;29(1):100–5.
Souza LM, Cruz SS, Gomes-Filho IS, Barreto ML, Passos-Soares JS, Trindade SC, et al. Effect of maternal periodontitis and low birth weight—A case control study. Acta Odontol Scand 2016;74(1):73–80.
Noack B, Klingenberg J, Weigelt J, Hoffmann T. Periodontal status and preterm low birth weight: a case control study. J Periodontal Res 2005;40(4):339–45.
Farrell S, Ide M, Wilson RF. The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers. J Clin Periodontol 2006;33(2):115–20.
Michalowicz BS, Hodges JS, Novak MJ, Buchanan W, DiAngelis AJ, Papapanou PN, et al. Change in periodontitis during pregnancy and the risk of pre‐term birth and low birthweight. J Clin Periodontol 2009;36(4):308–14.
Lopez NJ, Da Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. J Periodontol 2005;76(11 Suppl):2144–53.
Task Force on Periodontal Treatment of Pregnant Women American Acadmey of Periodontology. American Academy of Periodontology statement regarding periodontal management of the pregnant patient. J Periodontol 2004;75(3):495.
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Mughal AR, Sadiq M, Hyder SN, Qureshi AU, A Shah SS, Khan M, et al. Socioeconomic status and impact of treatment on families of children with congenital heart disease. J Coll Physicians Surg Pak 2011;21(7):398–402.
Ricalde AE, Velásquez-Meléndez G, Tanaka AC, de Siqueira AA. Mid-upper arm circumference in pregnant women and its relation to birth weight. Rev Saude Publica 1998;32(2):112–7.
Word Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. 2011.
Moliterno LF, Monteiro B, Figueredo CM, Fischer RG. Association between periodontitis and low birth weight: a case-control study. J Clin Periodontol 2005;32(8):886–90.
Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996;67(10 Suppl):1103–13.
Vogt M, Sallum AW, Cecatti JG, Morais SS. Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women. Reprod Health 2010;7(1):29.
Haerian-Ardakani A, Eslami Z, Rashidi-Meibodi F, Haerian A, Dallalnejad P, Shekari M, et al. Relationship between maternal periodontal disease and low birth weight babies. Iran J Reprod Med 2013;11(8):625–30.
Marakoglu I, Gursoy UK, Marakoglu K, Cakmak H, Ataoglu T. Periodontitis as a risk factor for preterm low birth weight. Yonsei Med J 2008;49(2):200–3.
Usin MM, Menso J, Rodríguez VI, González A, Tabares S, Parodi R, et al. Association between maternal periodontitis and preterm and/or low birth weight infants in normal pregnancies. J Mater Fetal Neonatal Med 2016;29(1):115–9.
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.
Mobeen N, Jehan I, Banday N, Moore J, McClure E, Pasha O, et al. Periodontal disease and adverse birth outcomes: a study from Pakistan. Am J Obstet Gynecol 2008;198(5):514.e1–e8.
Baig SA, Khan N, Baqai T, Fatima A, Karim SA, Aziz S. Preterm birth and its associated risk factors. A study at tertiary care hospitals of Karachi, Pakistan. J Pak Med Assoc 2013;63(3):414–8.
Silk H, Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. AM Fam physician 2008;77(8):1139–44.
Williams CE, Davenport ES, Sterne JA, Sivapathasundaram V, Fearne JM, Curtis MA. Mechanisms of risk in preterm low‐birthweight infants. Periodontol 2000;23(1):142–50.
Sanz M, Kornman K. Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 2013;84(4 Suppl):S164–9.
Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes–systematic review. J Clin Periodontol 2013;40(s14):S181–94.
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