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,