Precision Periodontal Disease Subtypes are Associated With Pre-Term Birth

Objectives: Studies examining the association between periodontal disease and adverse pregnancy outcomes have been inconclusive. We posit that a reappraisal of the exposure using a precision periodontal phenotyping system is likely to be informative in elucidating this important oral-systemic health link. To this end, we sought to: 1) quantify the association between maternal periodontal disease as defined by the Periodontal Profile Class (PPC) system and pre-term birth, and 2) investigate associations between levels of systemic IgG antibody responses to periodontal pathogens and pre-term birth within PPC disease subtypes.
Methods: The analytical sample comprised 1,020 pregnant women <26 weeks’ gestation who were participants of a prospective, observational study of Oral Conditions and Pregnancy. All women underwent comprehensive periodontal examinations and provided subgingival plaque, blood samples prepartum and postpartum, which were analyzed for pre- and post-partum levels of periodontal pathogens and IgG antibodies. Fetal cord blood was drawn postpartum. Preterm birth was defined as delivery before the 37^th week. Bivariate testing methods and logistic regression modeling estimating odds ratios (OR) and 95% confidence intervals (CI) were used to quantify the association between PPC-Stage periodontal diagnoses, level of periodontal pathogens, and microbial antibody levels.
Results: Women with Mild disease (PPC-Stage-II), Severe disease (PPC-Stage-IV) and extensive gingival inflammation (PPC-Stage-V) had elevated biofilm oral pathogen levels and high IgG antibody levels compared to periodontally-healthy women—including the classic pathobionts P. gingivalis, P. intermedia, and F. nucleatum. Among these classes, Mild disease and Severe disease presented with significantly elevated pre-term delivery risk compared to those who were periodontally-healthy: OR=2.1, 95% CI=1.0-4.1; and OR=7.5, 95% CI=3.8-14.7, respectively.
Conclusions: Taken together, this study’s findings including higher pre-term delivery risk among women with distinct periodontal disease subtypes and elevated levels of periodontal pathogens and antibodies, illustrate the utility of using a precise periodontal disease classification system to investigate oral-systemic health associations.