Introduction:Despiteof many advancements in field of Maternal and fetal health care, the pretermbirths and  delivery of low birth weightbabies has now become a noticeable health issue in various communities of theworld.1Periodontaldisease in its various clinical entities is the second biggest oral health problemglobally.

It is estimated that gingivitis affects ~ 40–85% of the adultpopulation around the world and periodontitis ~ 11%.2Lowbirth weight is associated with unfavorable socioeconomic conditions,inadequate nutrition, twinning, primiparity, smoking habit and alcohol consumptionduring pregnancy, extremes of age, low body mass index (BMI) before pregnancyand complications during pregnancy, including other factors which contribute tothe decrease in infant birth weight . Despite numerous studies on low weightlive births, its determinants are not completely clear. About 20% of the causesthat lead to intrauterine growth retardation are unknown in developingcountries.

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2 In 1996, maternal periodontal disease wasfirst proposed as one of the risk factors for preterm birth and low birthweight.4But still the various epidemiological surveys and intervention trials have ledto contradictory results.5Therefore,  more research is needed in orderto confirm or discard this association.3The controversial results lead to two new ideas : 1 – PTB and LBW babies areinduced by severe and/or generalized periodontitis and 2 – Periodontitis onlyinduces PTB and LBW babies in those pregnant females who are young, infectedwith HIV, preeclampsia, pre-pregnancy obesity or susceptible genotypes.5Alarge group of microbes and inflammatory mediators are responsible for PTB andLBW babies, for which the diseased maternal periodontium act as a reservoir. AnAnimal study was conducted which concluded that preterm birth (PTB) was inducedby infection in maternal periodontium / periodontal pathogens / periodontalpathogen byproducts. The levels of IL-1?, IL-6, IL-8, IL-17, COX-2, IFN-? andTNF-? were also elevated in blood and apoptosis in placental tissues/cells wasalso induced during the high load of microbes in the maternal periodontium.5 ThePreterm births and Low birth weight babies are one of the major causes of deathand long-term human potential loss amongst the survivors around  all communities and societies of the world.

6The preterm birth Being born preterm also increases a baby’s risk of dying dueto other causes, especially from neonatal infections7with preterm birth estimated to be a risk factor in at least 50% of allneonatal deaths.8Neonataldeaths is the single, largest direct complication of Preterm birth, responsiblefor 35% of the world’s 3.1 million deaths a year, and the second most commoncause of under-5 deaths after pneumonia.

In almost all high- and middle-income countriesof the world, preterm birth is the leading cause of child death.6Inaddition to its significant contribution to mortality, the long term effects ofPreterm birth on survivors are : Specific physical effects(Hearing and visualimpairment, Chronic lung disease of prematurity, Long term CV-diseases, Higherrisk of Non-communicable diseases) Neuro-developmental/behavioralimpairment(Increased risk of cerebral palsy, Mild disorders of executivefunctioning, Moderate to servere Global developmental delay, physiachiatric andbehavioral sequlae) and Family- Socioeconomic effects( Impact on family andhealth service, Intergenerational effects).6, 9Hencethe PTB and LBW babies have adverse effects on family in specific, andsocioeconomic and health conditions of society in general.

As it’s a globalhealth issue, it has become a burden on global health communities all around theworld leading to high mortality rates and significant risk factor of impairmentthroughout the life of survivors.9-11Eachyear, about 15 million infants worldwide are born preterm (before 37 weeksof gestation), and these preterm babies typically have low birth weight (LBW,<2,500 g).12Thestudy carried out in vicinities of Abbottabad, Pakistan concluded theprevalence of preterm births and LBW babies as approximately 32 percent whilein other parts of the world it has been reported as 16 percent.18Maternal Periodontal disease is foundto be an independent and clinically significant risk factor for Preterm birthand low birth weight babies,1, 18 which in turn play a significant role in mortality and morbidity of neonates andinfant as well as greater risk for developing cardiovascular problems and othernon-communicable diseases.19  Since periodontal disease is characterized bya relapsing/remitting pattern, identifying active disease may be an importantfactor in establishing associations with other disease states such as pretermlabor. The population from which the subjects were recruited is also high riskfor premature delivery. The city where this study was performed has one of thehighest rates of preterm birth in Canada with 10% of births in 2004 occurringbefore 37 weeks (unpublished local data).

The population is predominatelyCaucasian (81%) with Chinese (6%), South Asian (4%), Aboriginal (2%) and Black(1.5%) comprising the other main ethnic groups.20       Keywords: Periodontitis, Low birth weight babies(LBW), Pretermbirth(PTB), maternal periodontitis   References:1.

            Alves RT, Ribeiro RA. Relationshipbetween 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 birthweight—A case control study. Acta odontologica Scandinavica 2016;74(1):73-80.3.            Agueda A,Echeverría A, Manau C.

Association between periodontitis in pregnancy andpreterm or low birth weight: Review of the literature. Med Oral Patol Oral CirBucal 2008;13(9):E609-15.4.

            OffenbacherS, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor forpreterm low birth weight. Journal of periodontology 1996;67(10s):1103-13.5.            Ren H, DuM. Role of Maternal Periodontitis in Preterm Birth.

Frontiers in immunology2017;8.6.            BlencoweH, Cousens S, Chou D, et al. Born too soon: the global epidemiology of 15million preterm births. Reproductive health 2013;10(1):S2.

7.            Lawn JE,Kerber K, Enweronu-Laryea C, Cousens S. 3.

6 million neonatal deaths—what isprogressing 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? Thelancet 2005;365(9462):891-900.9.            Behrman R,Butler A.

Preterm Birth: Causes Consequences and Prevention. Committee onUnderstanding Premature Birth and Assuring Health Outcomes, Institute ofMedicine of the National Academies: National Academies Press: Washington DC;2006.10.          Blencowe H,Lee AC, Cousens S, et al. Preterm birth–associated neurodevelopmentalimpairment estimates at regional and global levels for 2010. Pediatric research2013;74(Suppl 1):17.

11.          Murray CJ,Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseasesand injuries in 21 regions, 1990–2010: a systematic analysis for the GlobalBurden 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 associationbetween periodontitis and complications in pregnancy. Frontiers in publichealth 2015;2:290.

13.          Langhoff-RoosJ, Kesmodel U, Jacobsson B, Rasmussen S, Vogel I. Spontaneous preterm deliveryin primiparous women at low risk in Denmark: population based study. Bmj2006;332(7547):937-39.14.

          Martin JA,Hamilton BE, Sutton PD, et al. Births: final data for 2007. National vitalstatistics reports 2010;59(1):1-72.15.          Thompson J,Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio?economic statusand the implications for preterm birth. Paediatric and perinatal epidemiology2006;20(3):182-87.16.

          Martin JA,Hamilton BE, Ventura SJ, et al. Births: final data for 2009. National vitalstatistics reports: from the Centers for Disease Control and Prevention,National Center for Health Statistics, National Vital Statistics System2011;60(1):1-70.17.          Blencowe H,Cousens S, Oestergaard MZ, et al. National, regional, and worldwide estimatesof preterm birth rates in the year 2010 with time trends since 1990 forselected countries: a systematic analysis and implications. The lancet2012;379(9832):2162-72.

18.          Khan NS,Ashraf RN, Noor S, et al. Association of Maternal Periodontitis with Low BirthWeight in Newborns in a Tertiary Care Hospital. Journal of Ayub Medical CollegeAbbottabad 2016;28(1):120-25.

19.          Badshah S,Mason L, McKelvie K, Payne R, Lisboa PJ. Risk factors for low birthweight inthe public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health2008;8(1):197.20.          Wood S,Frydman A, Cox S, et al. Periodontal disease and spontaneous preterm birth: acase control study. BMC pregnancy and childbirth 2006;6(1):24.