Impact of Chronic Periodontitis on Intrauterine Growth of the Fetus: An Original Research.

Introduction: The human body goes through a roller coaster of hormonal changes during pregnancy. The periodontal pathologies may alter and may bring about different/altered responses to normal stimuli. Hence, in our study, we assessed the relation between the chronic periodontitis and its impact on the intrauterine growth of the fetus. Material and Method: We conducted a retrospective observational study, where the data was collected from the institutional records. We included 200 pregnant subjects and grouped them equally as those with and without periodontal pathologies. We compared the groups for various parameters of the subject and the new born, and measured the significance deliberating P < 0.05 as significant.
Results: We observed that among the various clinical parameters, the female subjects were exponentially prone to "vulvo-vaginitis, premature rupture of membranes" and the new born had restricted growth.
Conclusion: Oral health affects the general health. The periodontal disease specifically has an adverse impact among pregnant women. Hence care should be given to oral hygiene maintenance. Copyright:

INTRODUCTION

Pregnancy is a very critical yet most memorable phase in the life of a woman. The body goes through many alterations during this phase. There is an increased or altered hormonal level and chemical changes/responses in the system. Various stimuli may bring about an array of responses.[123]

Oral health has been associated with general health. Periodontal diseases, specifically periodontitis, is caused due to the altered immunological responses to the bacterial products released in the oral tissues. The host response to these stimuli is seen as the inflammatory responses that are manifested as chronic periodontitis (CP).[34] The CP is manifested as increased sulcular depths, pockets, calculus, bleeding, and mobility of the tooth. Many cytokine and hormonal responses are altered and exaggerated in the diseased phase, specifically among pregnant women.[456] Most studies have reported the association between oral health and the impact on pregnant women and the new born, yet were inconclusive.[45678] Hence in our study we assessed the relation between chronic periodontitis and its impact on the intrauterine growth of the fetus.

MATERIALS AND METHODS

We piloted a retrospective study among pregnant women who attended the department of obstetrics and also had a periodontal evaluation at the dental department. Data was collected from the institutional records from 2015 to 2020. Only those subjects who had both dental, and prenatal and postnatal records were included in the study. All the subjects who had any other medical condition or the habit of smoking and consuming alcohol were excluded from the study. The institutional ethics clearance was obtained and the subjects' consent was taken prior to the study. We evaluated the maternal, gestational, delivery and newborn parameters.

Through random sampling, we selected 200 subjects for the study. We divided them into two equal groups: with CP (case) and without CP (control). The observations thus made were compared and analyzed for the statistical significance deliberating P < 0.05 as significant.

RESULTS

We observed that among the 200 subjects, no significant age variation was seen. Majority had normal delivery. Among the clinical parameters observed for the pregnant subjects, only the vulvovaginitis and premature rupture of membranes were significantly different. All the observed parameters of the subjects are shown in Table 1.

Table 1

Comparison of various demographic and clinical parameters among the groups

Parameter	Control	Case	P
Mean Age	24±2.3	22±1.3	0.512
Type of delivery
Normal	74%	69%	0.422
Cesarean	26%	31%	0.458
Premature rupture of the membrane	14%	30%	0.048
Eclampsia	2%	2%	0.483
Pre-eclampsia	4%	3%	0.225
3rd trimester bleeding	6%	11%	0.546
Vulvovaginitis	16%	17%	0.021
Urinary tract infection	16%	17%	0.126

We observed a significant difference between the groups for the restricted growth of the neonate. All the observed parameters of the neonate are shown in Table 2.

Table 2

Comparison of various clinical parameters of the new born among the groups

Variable	Control	Case	P
Neonatal death	4	2	0.51
Neonatal infection	2	3	0.89
Neonatal hospitalization	8	10	0.78
Apgar 1st min (< 7)	10	13	0.89
Small for gestational age	18	23	0.73
Fetal growth restriction	2	9	0.042
Prematurity	4	7	0.189
Low birth weight	4	10	0.158

DISCUSSION

The oral microbiome is altered during pregnancy. The new microbiome are pathogenic and implicated in various diseases of the periodontium.[345678] In our study, the subjects were age-matched, with majority having normal vaginal delivery, and single live birth. Significant difference was seen for the vulvovaginitis and premature rupture of membranes parameters of the subjects, while the restricted growth for the neonate. Our study is in agreement with previous studies of Ananth et al., and Chanomethaporn et al.[13] Other comparative studies also showed a significant difference for the other clinical observations. Many authors have suggested a need for health professionals to advocate for oral health and its significance during pregnancy.[4] There were few limitations in our study as it was retrospective. The socioeconomic and nutritional status of the patients was not evaluated, which might have impacted the outcome.

CONCLUSIONS

Oral health affects general health. Periodontal disease specifically has an adverse impact among pregnant women. Hence, care should be given to oral hygiene maintenance. We suggest women be motivated for oral hygiene maintenance before planning and during pregnancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.