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Specific oral pathogens linked to premature delivery.

PHOENIX, ARIZ. -- Preterm labor in women with periodontitis was associated with specific oral pathogens in a recent study, a finding that adds to the growing body of evidence linking periodontitis with premature delivery, Dr. Manuel Vallejo said.

On admission to the labor suite at Magee-Womens Hospital in Pittsburgh, 53 pregnant women were assigned to one of three groups on the basis of a periodontal examination. Oral pathogens were present in 58% of those with periodontitis and a term delivery, in 60% of those with periodontitis and preterm delivery (< 37 weeks), and in 33% of those with healthy gums who were delivering at term, he said at the annual meeting of the Society for Obstetric Anesthesia and Perinatology.

The only organism detected in significantly more women with periodontitis than with healthy gums was Fusobacterium nucleatum. There were no significant differences between groups in women who had Prevotella intermedia alone or a combination of both organisms, but that may have been due to the small number of patients in each group. (See box.)

These Findings suggest that F. nucleatum, alone or combined with P. intermedia, is associated with preterm labor in parturients with periodontitis, Dr. Vallejo said. Both organisms are gram-negative anaerobes commonly isolated from dental plaque and from patients with gingivitis or periodontitis. F. nucleatum can appear on its own or adhere to other organisms found on plaque.

The average age in all three groups was 30 years, and the average gestation among the women who delivered prematurely was 35.3 weeks. Gingival sulcus samples were obtained from all of the patients and were DNA tested for periodontal pathogens.

In a related study of 75 pregnant women, Dr. Vallejo and his colleagues found evidence of oral pathogens in cord blood from virtually all of the patients, regardless of periodontal status or gestational age. In an analysis of placental tissue taken from these patients, 40% of samples from women with periodontitis and premature labor tested positive for oral pathogens, compared with 33% of samples from women with periodontitis and term labor, and 23% of samples from women with no gum disease and term labor.

The prevalence of gum disease is about 37% in pregnant women and 49% in women who enter labor prematurely, according to previous studies he and his associates have conducted, vs. a prevalence of 15% in healthy, nonpregnant women.

The mechanism by which periodontitis may increase the risk of premature birth has not been established, but it could be related to bacteremia that occurs whenever a person with gum disease chews food. Prostaglandins and interleukins released by gingival organisms may also play a role in inducing labor prematurely.
Oral Pathogens by Periodontal and Pregnancy Status

 Fusobacterium Prevotella F. nucleatum and
Study Group nucleatum intermedia P. intermedia

Periodontitis and
term pregnancy (n=19) 69% 69% 54%

Periodontitis and
preterm pregancy (n=10) 83% 100% 83%

Healthy gums and
term pregnancy (n=24) 25% 50% 12%

Note: Percentages shown are of the total number of women testing
positive for some type of oral pathogen upon hospital admission
for labor.

Source: Dr. Manuel Vatlejo
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Title Annotation:Ubiquitous In Cord Blood
Author:MacReady, Norra
Publication:OB GYN News
Date:Aug 1, 2003
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