Maternal Periodontitis and Prematurity. Part II: Maternal Infection and Fetal Exposure
- 1 December 2001
- journal article
- research article
- Published by Wiley in Annals of Periodontology
- Vol. 6 (1), 175-182
- https://doi.org/10.1902/annals.2001.6.1.175
Abstract
Clinical data from the first 812 deliveries from a cohort study of pregnant mothers entitled Oral Conditions and Pregnancy (OCAP) demonstrate that both antepartum maternal periodontal disease and incidence/progression of periodontal disease are associated with preterm birth and growth restriction after adjusting for traditional obstetric risk factors. In the current study we present measures of maternal periodontal infection using whole chromosomal DNA probes to identify 15 periodontal organisms within maternal periodontal plaque sampled at delivery. In addition, maternal postpartum IgG antibody and fetal exposure, as indexed by fetal cord blood IgM level to these 15 maternal oral pathogens, was measured by whole bacterial immunoblots. The potential role of maternal infection with specific organisms within 2 bacterial complexes most often associated with periodontitis, conventionally termed "Orange" (Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros, Prevotella nigrescens, and Prevotella intermedia) and "Red" (Porphyromonas gingivalis, Bacteroides forsythus, and Treponema denticola) complexes, respectively, to prematurity was investigated by relating the presence of oral infection, maternal IgG, and fetal cord IgM, comparing full-term to preterm (gestational age < 37 weeks). The prevalence of 8 periodontal pathogens was similar among term and preterm mothers at postpartum. There was a 2.9-fold higher prevalence of IgM seropositivity for one or more organisms of the Orange or Red complex among preterm babies, as compared to term babies (19.9% versus 6.9%, respectively, P = 0.0015, chi square). Specifically, the prevalence of positive fetal IgM to C. rectus was significantly higher for preterm as compared to full-term neonates (20.0% versus 6.3%, P = 0.0002, as well as P. intermedia (8.8% versus 1.1%, P = 0.0003). A lack of maternal IgG antibody to organisms of the Red complex was associated with an increased rate of prematurity with an odds ratio (OR) = 2.2; confidence interval (CI) 1.48 to 3.79), consistent with the concept that maternal antibody protects the fetus from exposure and resultant prematurity. The highest rate of prematurity (66.7%) was observed among those mothers without a protective Red complex IgG response coupled with a fetal IgM response to Orange complex microbes (combined OR 10.3; P < 0.0001). These data support the concept that maternal periodontal infection in the absence of a protective maternal antibody response is associated with systemic dissemination of oral organisms that translocate to the fetus resulting in prematurity. The high prevalence of elevated fetal IgM to C. rectus among premature infants raises the possibility that this specific maternal oral pathogen may serve as a primary fetal infectious agent eliciting prematurity.Keywords
This publication has 9 references indexed in Scilit:
- Maternal Periodontitis and Prematurity. Part I: Obstetric Outcome of Prematurity and Growth RestrictionAnnals of Periodontology, 2001
- Fetal syphilis: clinical and laboratory characteristicsPublished by Wolters Kluwer Health ,2001
- Association of maternal IgM concentrations above the median at 15–19 weeks of gestation and early preterm deliveryThe Lancet, 1999
- Microbial complexes in subgingival plaqueJournal of Clinical Periodontology, 1998
- Estimation of serum antibody to subgingival species using checkerboard immunoblottingOral Microbiology and Immunology, 1997
- Antenatal diagnosis of congenital toxoplasmosis: evaluation of the biological parameters in a cohort of 286 patientsBJOG: An International Journal of Obstetrics and Gynaecology, 1996
- Efficacy of the Placental Barrier for Immunoglobulins: Correlations between Maternal, Paternal and Fetal Immunoglobulin LevelsInternational Archives of Allergy and Immunology, 1994
- PRENATAL DIAGNOSIS OF CONGENITAL RUBELLAThe Lancet, 1984
- Campylobacters as placental pathogensPlacenta, 1983