Introduction:

Despite
of many advancements in field of Maternal and fetal health care, the preterm
births and  delivery of low birth weight
babies has now become a noticeable health issue in various communities of the
world.1

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Periodontal
disease in its various clinical entities is the second biggest oral health problem
globally. It is estimated that gingivitis affects ~ 40–85% of the adult
population around the world and periodontitis ~ 11%.2

Low
birth weight is associated with unfavorable socioeconomic conditions,
inadequate nutrition, twinning, primiparity, smoking habit and alcohol consumption
during pregnancy, extremes of age, low body mass index (BMI) before pregnancy
and complications during pregnancy, including other factors which contribute to
the decrease in infant birth weight . Despite numerous studies on low weight
live births, its determinants are not completely clear. About 20% of the causes
that lead to intrauterine growth retardation are unknown in developing
countries.2

 In 1996, maternal periodontal disease was
first proposed as one of the risk factors for preterm birth and low birth
weight.4
But still the various epidemiological surveys and intervention trials have led
to contradictory results.5
Therefore,  more research is needed in order
to confirm or discard this association.3
The controversial results lead to two new ideas : 1 – PTB and LBW babies are
induced by severe and/or generalized periodontitis and 2 – Periodontitis only
induces PTB and LBW babies in those pregnant females who are young, infected
with HIV, preeclampsia, pre-pregnancy obesity or susceptible genotypes.5

A
large group of microbes and inflammatory mediators are responsible for PTB and
LBW babies, for which the diseased maternal periodontium act as a reservoir. An
Animal study was conducted which concluded that preterm birth (PTB) was induced
by infection in maternal periodontium / periodontal pathogens / periodontal
pathogen byproducts. The levels of IL-1?, IL-6, IL-8, IL-17, COX-2, IFN-? and
TNF-? were also elevated in blood and apoptosis in placental tissues/cells was
also induced during the high load of microbes in the maternal periodontium.5

 

The
Preterm births and Low birth weight babies are one of the major causes of death
and long-term human potential loss amongst the survivors around  all communities and societies of the world.6
The preterm birth Being born preterm also increases a baby’s risk of dying due
to other causes, especially from neonatal infections7
with preterm birth estimated to be a risk factor in at least 50% of all
neonatal deaths.8

Neonatal
deaths is the single, largest direct complication of Preterm birth, responsible
for 35% of the world’s 3.1 million deaths a year, and the second most common
cause of under-5 deaths after pneumonia. In almost all high- and middle-income countries
of the world, preterm birth is the leading cause of child death.6

In
addition to its significant contribution to mortality, the long term effects of
Preterm birth on survivors are : Specific physical effects(Hearing and visual
impairment, Chronic lung disease of prematurity, Long term CV-diseases, Higher
risk of Non-communicable diseases) Neuro-developmental/behavioral
impairment(Increased risk of cerebral palsy, Mild disorders of executive
functioning, Moderate to servere Global developmental delay, physiachiatric and
behavioral sequlae) and Family- Socioeconomic effects( Impact on family and
health service, Intergenerational effects).6, 9

Hence
the PTB and LBW babies have adverse effects on family in specific, and
socioeconomic and health conditions of society in general. As it’s a global
health issue, it has become a burden on global health communities all around the
world leading to high mortality rates and significant risk factor of impairment
throughout the life of survivors.9-11

Each
year, about 15 million infants worldwide are born preterm (before 37 weeks
of gestation), and these preterm babies typically have low birth weight (LBW,
<2,500 g).12 The study carried out in vicinities of Abbottabad, Pakistan concluded the prevalence of preterm births and LBW babies as approximately 32 percent while in other parts of the world it has been reported as 16 percent.18 Maternal Periodontal disease is found to be an independent and clinically significant risk factor for Preterm birth and low birth weight babies,1, 18 which in turn  play a significant role in mortality and morbidity of neonates and infant as well as greater risk for developing cardiovascular problems and other non-communicable diseases.19    Since periodontal disease is characterized by a relapsing/remitting pattern, identifying active disease may be an important factor in establishing associations with other disease states such as preterm labor. The population from which the subjects were recruited is also high risk for premature delivery. The city where this study was performed has one of the highest rates of preterm birth in Canada with 10% of births in 2004 occurring before 37 weeks (unpublished local data). The population is predominately Caucasian (81%) with Chinese (6%), South Asian (4%), Aboriginal (2%) and Black (1.5%) comprising the other main ethnic groups.20               Key words: Periodontitis, Low birth weight babies(LBW), Preterm birth(PTB), maternal periodontitis       References: 1.            Alves RT, Ribeiro RA. Relationship between maternal periodontal disease and birth of preterm low weight babies. Brazilian oral research 2006;20(4):318-23. 2.            Souza LM, Cruz SSd, Gomes-Filho IS, et al. Effect of maternal periodontitis and low birth weight—A case control study. Acta odontologica Scandinavica 2016;74(1):73-80. 3.            Agueda A, Echeverría A, Manau C. Association between periodontitis in pregnancy and preterm or low birth weight: Review of the literature. Med Oral Patol Oral Cir Bucal 2008;13(9):E609-15. 4.            Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. Journal of periodontology 1996;67(10s):1103-13. 5.            Ren H, Du M. Role of Maternal Periodontitis in Preterm Birth. Frontiers in immunology 2017;8. 6.            Blencowe H, Cousens S, Chou D, et al. Born too soon: the global epidemiology of 15 million preterm births. Reproductive health 2013;10(1):S2. 7.            Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S. 3.6 million neonatal deaths—what is progressing and what is not? Paper presented at: Seminars in perinatology, 2010. 8.            Lawn JE, Cousens S, Zupan J, Team LNSS. 4 million neonatal deaths: when? Where? Why? The lancet 2005;365(9462):891-900. 9.            Behrman R, Butler A. Preterm Birth: Causes Consequences and Prevention. Committee on Understanding Premature Birth and Assuring Health Outcomes, Institute of Medicine of the National Academies: National Academies Press: Washington DC; 2006. 10.          Blencowe H, Lee AC, Cousens S, et al. Preterm birth–associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatric research 2013;74(Suppl 1):17. 11.          Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet 2013;380(9859):2197-223. 12.          Zi MYH, Longo PL, Bueno-Silva B, Mayer MPA. Mechanisms involved in the association between periodontitis and complications in pregnancy. Frontiers in public health 2015;2:290. 13.          Langhoff-Roos J, Kesmodel U, Jacobsson B, Rasmussen S, Vogel I. Spontaneous preterm delivery in primiparous women at low risk in Denmark: population based study. Bmj 2006;332(7547):937-39. 14.          Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2007. National vital statistics reports 2010;59(1):1-72. 15.          Thompson J, Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio?economic status and the implications for preterm birth. Paediatric and perinatal epidemiology 2006;20(3):182-87. 16.          Martin JA, Hamilton BE, Ventura SJ, et al. Births: final data for 2009. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 2011;60(1):1-70. 17.          Blencowe H, Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The lancet 2012;379(9832):2162-72. 18.          Khan NS, Ashraf RN, Noor S, et al. Association of Maternal Periodontitis with Low Birth Weight in Newborns in a Tertiary Care Hospital. Journal of Ayub Medical College Abbottabad 2016;28(1):120-25. 19.          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. 20.          Wood S, Frydman A, Cox S, et al. Periodontal disease and spontaneous preterm birth: a case control study. BMC pregnancy and childbirth 2006;6(1):24.