Periodontal disease in pregnant women: pregnancy and childbirth consequences

Abstract

Periodontal diseases affect the support tissue (gingival), as well as the sustentation tissue (cementum, periodontal ligament and bone).They are induced by the alteration of the oral microflora, leading to the activation of the immune and inflammatory response. The hormones estrogen and progesterone have receptors on gingival tissue. During pregnancy, women are exposed to high levels of steroid hormones produced by the placenta. These hormones accumulate in the tissue and gingival fluid, constituting important growth factors of harmful bacteria to the oral health of the woman. In periodontal disease, these microorganisms responsible for stimulating the immunoinflammatory response lead to the increased of cytokine and pharmacologically active mediators - among which it is possible to highlight interleukin 1-beta, IL-6, tumor necrosis factor - alpha and prostaglandin. It is known that cytokines, as well as the infectious agents, can spread systemically through the bloodstream, since they do not remain stocked in the gingival tissue. This spread suggests an association between the disease and the increased of the risk of systemic changes, including premature childbirth for pregnant women (which may result in the birth of a low weight newborn). Some inconclusive studies have already essayed to establish the link between periodontal disease and the increase of the risk of gestational diseases; such as preeclampsia. Given this scenario, it is proposed an analogy between the periodontal disease and the pregnancy and childbirth consequences including preeclampsia and others. The objective is to study the correlation between the presence of periodontal disease and or presence of caries during prenatal period and gestational and childbirth conditions of the pregnant women, in Botucatu (SP), pregnant women and births in the period 2012-2014.Method: From diagnosis of oral diseases previously made in 142 pregnant women living in Botucatu, with samples from all healthcare units, it is intended to raise secondary data from medical records from the Botucatu Clinics Hospital as well as the Live Births Declaration, through The System of Information on Live Births (SINASC, the Portuguese language acronym), in order to obtain data from gestational and childbirth condition. A database will be prepared using Microsoft Office Excel 2007 (Washington, USA), and will be analyzed by the Statistical Analysis System (SAS, North Carolina, USA), version 9.2.The chi-square test will be used to evaluate the association among variables. The significance level considered will be 5% (alpha = 0.05) for rejection of the null hypothesis. In the multivariable analysis, a logistic regression model was used to investigate periodontal disease a dependent variable in relation to other variables of interest. For multivariable analyses, p-value, calculated by Wald test, will be considered significant for p d 0.05. To determine the effect of each variable on periodontal disease, odds ratios with 95% confidence intervals will be calculated using the logistic regression model with k explanatory variables [36]. Results are presented in tables and graphs. The project was forwarded to evaluation and consent from the Ethics Committees Research and was approved on September/2015, thus the survey of numbers of medical records of pregnant women and their newborns for subsequent collection of data records started in October 2015.It is expected to obtain data that may relate (or not) the periodontal diseases and gestational and childbirth consequences.