Periodontal Disease and Preterm Birth

A universal mid-trimester transvaginal cervical length screening program and its associated reduced preterm birth rate

Reduction in preterm birth among COVID-19–vaccinated pregnant individuals in the United States

Objective: To determine whether preterm birth in a twin pregnancy increases the risk of subsequent preterm birth (PTB) in a singleton pregnancy and to identify predictors for singleton PTB in women with previous twin PTB.Method: A retrospective cohort study of women with prior twin birth followed by a singleton birth in two tertiary referral centres between 2000 and 2016 was conducted. Rate of PTB in subsequent singleton pregnancy was compared between women who experienced previous preterm versus term twin birth. Analysis was further stratified by gestational age at twin and singleton birth, etiology for PTB and chorionicity in the twin pregnancy.Results: A total of 378 women met the inclusion criteria, of whom 252 (66.7%) experienced PTB in the index twin pregnancy. The overall rate of PTB in the subsequent singleton pregnancy was 11.6% (44/378). Women with prior twin PTB had a higher rate of PTB in the subsequent singleton pregnancy compared with women with prior term twin birth (17.5 versus 6.3%, p = .003, or 3.12, 95%-CI 1.42–6.85), mainly due to a higher rate of late singleton preterm birth (13.1 versus 4.0%, p = .005). Findings of higher odds of PTB in the subsequent singleton pregnancy was limited to women who gave birth before 340/7 weeks in the twin pregnancy and was related to the degree of prematurity (prior twin PTB at 300/7–336/7 weeks: OR 3.09, 95%-CI 1.12–8.51; prior twin PTB at <300/7 weeks: OR 5.8, 95%-CI 2.46–13.68). The association between previous twin PTB and subsequent singleton PTB was limited to women with prior spontaneous twin PTB (OR 3.34, 95%-CI 1.50–7.45).Conclusion: Women with a history of spontaneous PTB in a twin pregnancy are at increased odds of PTB in subsequent singleton pregnancies compared to women with prior term twin birth, and the risk is related to the severity of prematurity in the index twin pregnancy.

BackgroundPreterm birth is the leading cause of death in children under five. A recent Cochrane review found a 42% reduction in early preterm birth (< 34 weeks’ gestation) and 11% reduction in preterm birth (< 37 weeks’ gestation) with omega-3 fatty acid supplementation. To assist in the development of implementation strategies to increase pregnant women’s omega-3 fatty acid intake, we assessed the awareness of Australian pregnant women about preterm birth, their nutrition and supplementation behaviours during pregnancy, and intentions to increase omega-3 fatty acid intake.MethodsA ten-minute survey was conducted online to assess the knowledge, attitudes, behaviours, and intentions of Australian pregnant women across three domains: (1) preterm birth; (2) nutrition and supplementation during pregnancy; and (3) omega-3 fatty acid consumption to prevent preterm birth. Participants were recruited from Survey Sampling International’s research panels.ResultsOf the 763 women who completed the survey, less than two-thirds had heard of preterm birth. Over 55% of respondents had changed their diet during pregnancy and a prenatal dietary supplement was consumed by 82% of the women surveyed. Respondents’ main source of information about preterm birth and nutrition during pregnancy was from a health professional. When asked about their intentions to increase their omega-3 fatty acid intake following a health professional’s recommendation, the vast majority of participants indicated they would increase their omega-3 fatty acid intake (90%). When a hypothetical scenario was presented of an omega-3 fatty acid supplement being offered from a health service at no cost, the number of respondents who selected they would increase their intake through supplementation increased from 54 to 79%.ConclusionsThe main information source for women about preterm birth and dietary supplementation recommendations during pregnancy is their health professional. Therefore, informing women about ways to prevent preterm birth, including the role of omega-3 fatty acids, should occur during antenatal visits. The results from our study are useful for clinicians caring for pregnant women and for the next stage of translation of the Cochrane review findings – the design of implementation strategies to increase the intake of omega-3 fatty acids during pregnancy where needed.

While a number of studies have explored the link between periodontal disease and adverse pregnancy outcomes, both epidemiological studies and intervention trials have reached contradictory results with relatively small sample sizes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. Utilizing large-scale claims data, we aim to investigate the association between maternal periodontal disease and adverse pregnancy outcomes. Using de-identified claims data from a national commercial insurer in the USA, records of all observed pregnancies from 2015 to 2019 were included in this retrospective cohort study. Adverse pregnancy outcomes, including low birthweight (LBW) of the newborn, preterm birth (PTB) and spontaneous abortion, were primary outcomes. To evaluate the association between periodontal disease and pregnancy outcomes, logistic mixed-effect model was estimated with periodontal disease status, age, existing clinical conditions of mothers and geographic location as covariates. Out of 748 792 observed pregnancy records, 18.66% resulted in adverse pregnancy outcomes; 5.92% in LBW, 14.46% in PTB and 2.22 % in spontaneous abortion. Adjusting for individual-level risk factors, periodontal disease was significantly associated with maternal complications with odds ratios of 1.19 (95% CI:1.15, 1.24) for any adverse pregnancy outcomes, 1.10 (95% CI:1.03, 1.17) for LBW, 1.15 (95% CI:1.10, 1.19) for PTB and 1.34 (95% CI:1.23, 1.46) for spontaneous abortions. Maternal periodontal disease may be associated with an increased risk of maternal complications and neonatal morbidity. A timely diagnosis and treatment of periodontal disease during pregnancy should be encouraged by considering oral health as part of routine prenatal care.

A reduction in preterm births has been observed in Haguenau (Eastern France) during a 12-year intervention study with a program for prevention of preterm deliveries. The Perinatal Study of Haguenau was an observation tool used in a stable population, and it allowed measurement of the way women have progressively responded to the new proposals in prenatal care. It also allowed measurement of the results of the interventions: low birth weight (less than 2,500 g) and preterm birth rates (less than 37 weeks of gestation) among single live births. The total duration of the study was divided into three periods of four years (1971 through 1974, 1975 through 1978, and 1979 through 1982), for which the numbers of single live births are 5,763, 4,957, and 5,919, respectively. For the same periods, the low-birth-weight rates, 4.6%, 4.0%, and 3.8%, respectively, showed a significant decrease (P less than .001). Following a similar pattern, the rates of preterm birth were 5.4%, 4.1%, and 3.7% (a significant reduction with P less than .001). These improvements in pregnancy outcome do not disappear after standardization of mother's age, high blood pressure, or social class distribution. These findings, which concur with the results of others, enhance the hypothesis of a direct relationship between a prevention program and a reduction in preterm birth rates.

Preterm birth is a heterogeneous condition with multiple underlying causes, and periodontal diseases are one of them. Approximately 900000 preterm births are reported in Pakistan each year. Oral infections such as periodontitis during pregnancy are associated with adverse pregnancy outcomes such as low birth weight and preterm births. However, different studies have reported contradictory findings. We conducted a cross-sectional study to assess the association of preterm birth with oral infection in pregnancy. We conducted a cross-sectional analytical study on 400 postpartum pregnant women in Khyber Teaching Hospital, Peshawar. Only women within the age bracket of 18‒40 years were recruited. Data were collected by an interview-based structured questionnaire. The extent and severity index were used to assess the periodontal health of participants. Frequency tables were generated, and the chi-squared test was used to determine associations between different categorical variables. The mean age of the participants was 25.8±4.9 years. Approximately 87.5% of the women had generalized periodontitis. Approximately 68% of mothers had moderate severity of periodontitis. The extent index showed no notable difference between the preterm and full-term birth groups. In contrast, the severity index displayed a statistically significant difference between the preterm and full-term birth groups. The majority of women had generalized periodontitis. The severity index demonstrated a significant association between maternal periodontitis and preterm births. There was no association between the age of mothers and preterm births. Complications in pregnancy were not associated with preterm births.

Nationwide studies described a reduction in preterm birth (PTB) during the Coronavirus disease 19 (COVID-19) pandemic, but this was not confirmed in others. Very few data are available on the trend of PTBs over a longer period, including the post-pandemic period, and on potential risk factors, especially those associated with social disparities. To investigate the trend in PTB rates and the influence of maternal risk factors in Italy from January 2018 to December 2022, based on 12 Regional Birth Registries covering 86.1% of Italian births. PTB trend was investigated by an interrupted time series analysis. We assessed the associations of potential risk factors with PTB (Poisson regressions) and calculated their population impact fractions (PIFs). We studied 1,762,422 births; 7.25% were PTB. Before the pandemic, we observed a monthly decrease in PTB rate [-0.2% (95% CI: -0.3; -0.1)]; from July 2020 onwards, the average monthly level of PTBs was 5% lower than before (95% CI: -7.3; -2.7), with a flat trend until December 2022 [-0.02% (95% CI: -0.5; 0.5)]. Socio-economic maternal risk factors (low education, unemployment) and foreign nationality, whose risk ratios were 1.14 (95% CI: 1.04; 1.24), 1.08 (1.05; 1.12), and 1.17 (1.14; 1.21), respectively, showed a decreasing trend after pandemic; their impact on the decrease in PTBs was modest (PIFs between -2.4‱ and -4.2‱). The COVID-19 pandemic changed the pattern of PTB rates in Italy, lowering their average frequency and interrupting a previous decreasing trend. Changes in the trend of socio-economic maternal risk factors marginally explained this pattern.

Purpose: Preterm delivery and low birth weight is becoming the foremost crunch in India and is the most prevailing public health issue in developed and developing countries. To prove the confederacy between preterm labour (PTL) or low birth weight (LBW) and maternal periodontitis, a case control study was conducted among 30 puerpera women in rural population. Methods: The study sample was grouped into cases and controls based on the pregnancy outcomes, cases include 15 mothers with preterm birth and low birth weight babies and controls includes 15 mothers with normal term (greater than or equal to 37 weeks) gestation and normal birth weight babies (more than or equal to 2500 grams), in accordance with postnatal records regarding the gestation weeks and baby weight. Within 48 hours of parturition, periodontal status of the puerperal was examined by Community Periodontal Index. Statistical analysis used: Epi Info 7 Software. Results: Pregnant women with periodontal disease are 56 times risk of preterm labour and low birth weight babies and Chi-square value = 16.425 (p =0.000). Conclusions: This study shows that there is a strong statistical association between the preterm labour and birth type of babies with maternal periodontitis. Maternal periodontitis are 56 times risk of preterm labour and low birth weight. Hence, pregnant mothers should be educated about the risk of periodontal disease and motivated to maintain the oral hygiene by proper oral hygiene instruction measures with periodic dental visits.

Background: Periodontal disease, particularly periodontitis, is a chronic inflammatory condition that can adversely affect systemic health. There is increasing evidence suggesting a potential link between periodontal disease and gestational diabetes mellitus (GDM), a common pregnancy complication characterized by hyperglycemia. GDM poses significant risks to both maternal and fetal health, including preeclampsia, preterm birth, and type 2 diabetes. However, the relationship between maternal periodontal disease and GDM, particularly in the Indian population, remains underexplored. Aim: This study aims to evaluate the association between maternal periodontal disease and the development of GDM, as well as the impact of this association on adverse pregnancy outcomes, such as preterm birth, low birth weight, and preeclampsia. Methods: A prospective case-control study was conducted, enrolling 200 pregnant women. Periodontal status was assessed using clinical parameters, including gingival index, probing pocket depth, and clinical attachment loss. GDM was diagnosed using a 75-gram oral glucose tolerance test, with follow-ups to assess adverse pregnancy outcomes postpartum. Results: Preliminary findings suggest that women with periodontal disease have a significantly higher incidence of GDM compared to healthy controls. Moreover, those with both periodontal disease and GDM exhibited increased risks of adverse pregnancy outcomes, such as preterm birth and preeclampsia. Conclusion: The study underscores the potential role of periodontal disease as a modifiable risk factor for GDM and adverse pregnancy outcomes. Addressing periodontal health in pregnant women may help reduce the incidence of GDM and improve maternal-fetal outcomes.

ObjectiveThe COVID-19 lockdown impacted interactions with the health care system and societal stress levels. Previous US-based studies suggest that pandemic lockdowns may have lowered preterm birth rates although there are mixed findings from different settings. We evaluated the impact of COVID-19 on preterm birth and low birthweight rates at two San Francisco hospitals.MethodsWe compared rates of preterm birth (< 37 weeks) and low birthweight (< 2500 g) in San Francisco at a safety net hospital and an academic medical center during two time periods early in the COVID-19 pandemic compared with the same months from the prior year: from March to May 2019 and 2020 and August to December 2019 and 2020. We calculated crude rates for preterm birth and low birth weight as well as compared maternal and infant birth demographics and health characteristics during these same time periods using descriptive statistics. Secondly using a cross-sectional study design, we used logistic and linear regression models to evaluate risk for preterm birth, gestational age at birth, and low birthweight adjusting for confounders comparing the lockdown period with the pre-COVID year. All analyses were conducted using Stata 15.0.ResultsFrom August to December 2019 to 2020, the preterm birth rate decreased from 13.20 to 7.96% in the combined hospital data (p < 0.01), and the low birthweight rate decreased from 11.33 to 9.70% during the same time period (p = 0.13). We did not find a comparable reduction from March to May 2019 to 2020. Maternal age at delivery was significantly younger during the lockdown period, August to December, than in the prior year (36.29 ± 5.69 versus 37.15 ± 5.68 years p < 0.01) and parity was greater (0.83 ± 1.15 versus 0.74 ± 1.04, p = 0.03) but there were no other significant differences in race or ethnicity, infant sex or type of delivery (vaginal versus Cesarean section) from 2019 to 2020. In a logistic and linear regression model adjusting for maternal age and infant sex and other confounders, the lockdown period from August to December was protective against preterm birth (OR 0.65, 95%CI 0.51–0.82) and associated with overall longer gestational duration (Coeff 0.23, 95%CI 0.07–0.39). The August to December lockdown period was also associated with greater birthweight (Coeff 43.76, 95%CI 2.19–85.34).ConclusionsIn San Francisco, COVID-19 lockdowns lowered the preterm birth and increased gestational duration in infants comparing 2019 with 2020 for August to December. The reduced in preterm birth rates may be related to the overall strict lockdown measures that San Francisco implemented compared with other US cities.What this Study Adds to the Clinical Work?This study suggests that COVID-19 lockdowns lowered the preterm birth rate in August -December 2020 compared with the same months in 2019 in two hospitals in San Francisco. San Francisco had strict lockdowns compared with other areas of the country and fewer deaths. The stay-at-home measures could possibly have reduced stress for pregnant women or had other positive benefits that reduced the preterm birth rate.

BackgroundTwo vitamin D pregnancy supplementation trials were recently undertaken in South Carolina: The NICHD (n=346) and Thrasher Research Fund (TRF, n=163) studies. The findings suggest increased dosages of supplemental vitamin D were associated with improved health outcomes of both mother and newborn, including risk of preterm birth (<37 weeks gestation). How that risk was associated with 25(OH)D serum concentration, a better indicator of vitamin D status than dosage, by race/ethnic group and the potential impact in the community was not previously explored. While a recent IOM report suggested a concentration of 20ng/mL should be targeted, more recent work suggests optimal conversion of 25(OH)D–1,25(OH)2D takes place at 40ng/mL in pregnant women. ObjectivePost-hoc analysis of the relationship between 25(OH)D concentration and preterm birth rates in the NICHD and TRF studies with comparison to Charleston County, South Carolina March of Dimes (CC-MOD) published rates of preterm birth to assess potential risk reduction in the community. MethodsUsing the combined cohort datasets (n=509), preterm birth rates both for the overall population and for the subpopulations achieving 25(OH)D concentrations of ≤20ng/mL, >20 to <40ng/mL, and ≥40ng/mL were calculated; subpopulations broken down by race/ethnicity were also examined. Log-binomial regression was used to test if an association between 25(OH)D serum concentration and preterm birth was present when adjusted for covariates; locally weighted regression (LOESS) was used to explore the relationship between 25(OH)D concentration and gestational age (weeks) at delivery in more detail. These rates were compared with 2009–2011 CC-MOD data to assess potential risk reductions in preterm birth. ResultsWomen with serum 25(OH)D concentrations ≥40ng/mL (n=233) had a 57% lower risk of preterm birth compared to those with concentrations ≤20ng/mL [n=82; RR=0.43, 95% confidence interval (CI)=0.22,0.83]; this lower risk was essentially unchanged after adjusting for covariates (RR=0.41, 95% CI=0.20,0.86). The fitted LOESS curve shows gestation week at birth initially rising steadily with increasing 25(OH)D and then plateauing at ∼40ng/mL. Broken down by race/ethnicity, there was a 79% lower risk of preterm birth among Hispanic women with 25(OH)D concentrations ≥40ng/mL (n=92) compared to those with 25(OH)D concentrations ≤20ng/mL (n=29; RR=0.21, 95% CI=0.06,0.69) and a 45% lower risk among Black women (n=52 and n=50; RR=0.55, 95% CI=0.17,1.76). There were too few white women with low 25(OH)D concentrations for assessment (n=3). Differences by race/ethnicity were not statistically significant with 25(OH)D included as a covariate.Compared to the CC-MOD reference group, women with serum concentrations ≥40ng/mL in the combined cohort had a 46% lower rate of preterm birth overall (n=233, p=0.004) with a 66% lower rate among Hispanic women (n=92, p=0.01) and a 58% lower rate among black women (n=52, p=0.04). ConclusionsIn this post-hoc analysis, achieving a 25(OH)D serum concentration ≥40ng/mL significantly decreased the risk of preterm birth compared to ≤20ng/mL. These findings suggest the importance of raising 25(OH)D levels substantially above 20ng/mL; reaching 40ng/mL during pregnancy would reduce the risk of preterm birth and achieve the maximal production of the active hormone.

The incidence of preterm birth in the United States varies by race/ethnicity and socioeconomic status. Given the unsatisfactory reduction in preterm birth with interventions directed at single risk factors, we examined the preconceptional health of childbearing-aged women of different racial/ethnic groups to understand the risk prior to pregnancy. To evaluate the preconceptional health of childbearing-aged women by examining specific health factors implicated in preterm birth in light of racial/ethnic and socioeconomic factors. We tested the hypothesis that subgroups with historically high levels of preterm birth would have poorer preconceptional health compared to other groups and that the economic influence would be similar across groups. We performed a secondary analysis of cross-sectional population-based data from the National Health and Nutrition Examination Survey 2001-2002 and 2003-2004 data sets, including 1,497 of 2,108 eligible White, African American, and Mexican American women. We measured health using select indicators of cardiovascular and metabolic disorders, infectious disease, and sexual and substance-use behaviors associated with increased risk for preterm birth and conducted comparisons within and across racial groups. We used adjusted logistic regression by race. In addition to increased rates of preterm birth shown in the literature, childbearing-aged African American women have poorer overall preconceptional health than the other groups. Measures of socioeconomic status affect preconceptional health differently for each racial/ethnic group. Racial/ethnic subgroups with higher rates of preterm birth experience poorer health preconceptionally. Clinicians should address preconceptional health risks for preterm birth in all childbearing-aged women, paying attention to racial/ethnic-specific risks identified here.

The impact of mitigation measures on perinatal outcomes during the first nine months of the COVID-19 pandemic: A systematic review with meta-analysis

Cerclage placement in twin pregnancies with short or dilated cervix does not prevent preterm birth: a fragility index assessment