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
Sharma MK, Kumar D, Huria A, Gupta P. Maternal risk factors of low birth weight in Chandigarh, India. Internet J Health. 2009;9.
Wardlaw TM. Low Birthweight: Country, regional and global estimates: UNICEF; 2004.
UNICEF D. Nutrition: low birth weight 2015 [cited 2015 10th November]. Available from: http://data.unicef.org/nutrition/low-birthweight.html.
UNICEF UNCsF. The State of the World's Children 2015 New York, USA2015. Available from: www.unicef.org/publications/.../SOWC_2015_Summary_and_Tables.pdf.
Badshah S, Mason L, McKelvie K, Payne R, Lisboa PJ. Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health. 2008;8(1):197.
Valero de Bernabé J, Soriano T, Albaladejo R, Juarranz M, Calle MaE, Martı́nez D, et al. Risk factors for low birth weight: a review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 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. Journal of periodontology. 2007;78(12):2266-76.
Singh G, Chouhan R, Sidhu K. Maternal factors for low birth weight babies. Medical Journal 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. Journal of Periodontal and Implant Science. 2014;44(2):85-93.
Cruz SS, Costa MdCN, 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. Pediatrics International. 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. Periodontology 2000. 2015;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. The Journal of Maternal-Fetal & Neonatal Medicine. 2013;26(17):1691-5.
Harchandani N. Oral health challenges in Pakistan and approaches to these problems. Pakistan Oral & Dental Journal. 2012;32(3).
Ali T, Abidin KZ. Relationship of periodontal disease to pre-term low birth weight infants in a selected population--a prospective study. Community dental health. 2012;29(1):100-5.
Souza LM, Cruz SSd, 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 odontologica Scandinavica. 2015(ahead-of-print):1-8.
Noack B, Klingenberg J, Weigelt J, Hoffmann T. Periodontal status and preterm low birth weight: a case control study. Journal of periodontal research. 2005;40(4):339-45.
Farrell S, Ide M, Wilson RF. The relationship between maternal periodontitis, adverse pregnancy outcome and miscarriage in never smokers. Journal of clinical periodontology. 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. Journal of clinical periodontology. 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. Journal of periodontology. 2005;76(11-s):2144-53
.
Task Force on Periodontal Treatment of Pregnant Women AAoP. American Academy of Periodontology statement regarding periodontal management of the pregnant patient. Journal of periodontology. 2004;75(3):495.
Obstetricians ACo, Gynecologists. Oral health care during pregnancy and through the lifespan. Obstetrics and gynecology. 2013;122:417-22.
Centers for Disease Control and Prevention (CDC). CDC-Epi Info 7 2014 [cited 2014 2 Oct]. Available from: http://wwwn.cdc.gov/epiinfo/7/.
Parveen Z. Birth weight percentiles by gestational age: a hospital based study. Journal of Ayub Medical College, Abbottabad: JAMC. 2000;13(2):22-7.
Mughal AR, Sadiq M, Hyder SN, Qureshi AU, Khan M, Nasir J. Socioeconomic status and impact of treatment on families of children with congenital heart disease. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2011;21(7):398-402.
Ricalde AE, Velásquez-Meléndez G, Tanaka ACdA, de Siqueira AA. Mid-upper arm circumference in pregnant women and its relation to birth weight. Revista de saude publica. 1998;32(2):112-7.
Organization WH. 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. Journal of clinical periodontology. 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. Journal of periodontology. 1996;67(10s):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. Reproductive health. 2010;7(1).
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. Iranian journal of reproductive medicine. 2013;11(8):625.
Marakoglu I, Gursoy UK, Marakoglu K, Cakmak H, Ataoglu T. Periodontitis as a risk factor for preterm low birth weight. Yonsei medical journal. 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. The journal of maternal-fetal & neonatal medicine. 2014(0):1-5.
Wang Y-L, Liou J-D, Pan W-L. Association between maternal periodontal disease and preterm delivery and low birth weight. Taiwanese Journal of Obstetrics and Gynecology. 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. American journal of obstetrics and gynecology. 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. JPMA The Journal of the Pakistan Medical Association. 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. Periodontology 2000. 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. Journal of periodontology. 2013;84(4 Suppl):S164-9.
Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes–systematic review. Journal of clinical periodontology. 2013;40(s14):S181-S94.1. Sharma MK, Kumar D, Huria A, Gupta P. Maternal risk factors of low birth weight in Chandigarh, India. Internet J Health 2009;9:10–2.
Wardlaw TM. Low Birthweight: Country, regional and global estimates: UNICEF; 2004.
UNICEF STATISTICS [Internet]. [cited 2015 Nov 10]. Available from: http://data.unicef.org/nutrition/low-birthweight.html.
UNICE. The State of the World’s Children reports. The State of the World’s Children. [Internet]. [cited 2015 Nov 10]. Available from: http://www.unicef.org/sowc/
Badshah S, Mason L, McKelvie K, Payne R, Lisboa PJ. Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health 2008;8(1):197.
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.
American College of Obstetricians and Gynecologists Women’s Health Care Physicians, Committee on Health Care for Underserved Women. Committee Opinion No. 569: oral health care during pregnancy and through the lifespan. Obstet Gynecol 2013;122(2 Pt 1):417–22.
Centers for Disease Control and Prevention. CDC-Epi Info TM 7 [Internet]. [cited 2014 Oct 2]. Available from: http://wwwn.cdc.gov/epiinfo/7/
Parveen Z. Birth weight percentiles by gestational age: a hospital based study. J Ayub Med Coll Abbottabad 2000;13(2):22–7.
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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