Associação entre doença periodontal materna e intercorrências gestacionais: parto pré-termo, baixo peso ao nascimento e pré-eclâmpsia

Abstract

The aim of the present study was to evaluate the potential association between maternal periodontal disease and adverse pregnancy outcomes: preterm birth (PTB), low birth weight (LBW) and preeclampsia. A nested case control study was conducted in a public hospital at Belo Horizonte MG, Brazil. 733 systemically healthy women, with single gestation, who had a newborn by term delivery or spontaneous preterm delivery (spontaneous preterm labour or preterm pre-labour rupture of membranes) were enrolled. The exclusion criteria included multiplegestation, in vitro fertilization, indicated preterm deliveries undertaken for maternal or fetal reasons (except preeclampsia), heart diseases, renal dysfunction, placental, cervical and uterine abnormalities. Maternal, obstetric and pediatric data were collected from medical records. Manual full mouth periodontal assessment, in the post-partum, included probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) in 73.884 sites on 18.471 teeth. Periodontal disease was defined as the presence of at least one site with PD = 4 mm e CAL = 4mm(AAP, 2000a). Groups were divided as following: 1) control group 479 women with no pregnancy hypertensive disorders, who delivered an infant with 37 completed weeks of gestation or more weighing 2.500 g or more; 2) adverse pregnancy outcomes group 254 women with the related adverse pregnancy outcomes: PTB, LBW and preeclampsia; 3) preterm birth and/or low birth weight group 149 women who delivered an infant with less than 37 completed weeks of gestation and/orweighing less than 2.500g; 4) preterm birth group 107 women who delivered an infant with less than 37 completed weeks of gestation; 5) low birth weight group 111 women who delivered an infant weighing less than 2.500g; 6) preeclampsia group 109 women with blood pressure level exceeding 140/90 mmHg and proteinuria after the 20th week of gestation. Statistical analyses included an univariate and multivariate (step wise backward logistic regression) analyses foreach group comparison. After controlling for confounders in the multivariate final model, the results showed that: a) variables associated with pregnancy adverse outcomes were chronic hypertension (adjusted OR = 3.7), previous PTB (adjusted OR = 2.0), prenatal visits (adjusted OR = 0.9) and maternal periodontal disease (adjusted OR = 1.9); b) variables associated with PTB/LBW were first gestation (adjusted OR = 1.9), previous PTB (adjusted OR = 1.7) and prenatal visits (adjusted OR = 0.8); c) variables associated with PTB were prenatal visits (adjusted OR =0.8) and maternal periodontal disease (adjusted OR = 2.0); d) variables associated with LBW were previous PTB (adjusted OR = 2.3) and prenatal visits (adjusted OR = 0.8); e) variables associated with preeclampsia were chronic hypertension (adjusted OR = 3.4) and maternal periodontal disease (adjusted OR = 2.8). In conclusion, the study showed that: a) maternal periodontal disease has a positiveassociation with pregnancy adverse outcomes, being an independent risk factor for PTB and preeclampsia; b) the severity of maternal periodontal disease has a positive impact on the association with adverse pregnancy outcomes.