Doença periodontal materna e parto prematuro: estudo longitudinal de base populacional

Abstract

Preterm birth is one of the main causes of infant morbidity and mortality when delivery occurs before 37 weeks of gestation. Periodontal disease is a inflammatory chronic disease which affects teeth´s supporting tissues. Periodontal disease occurrence and progression is a consequence of a host response in front of bacterial biofilm, being this response influenced by genetic and behavioral factors. Researchers have been made efforts to elucidate the presence of an association between periodontal disease and preterm birth. Difficulties in clarify this question are related to methodological questions, mainly the way in which interest variables were collected and categorized. Thus, the aim of this thesis was to assess the association of periodontal disease and preterm birth in a population-based cohort from Pelotas, Brazil. This study was developed in two phases: Prenatal phase, when all pregnant women with deliveries planned to occur in 2015 in Pelotas, Brazil, were dental examined and interviewed and; Perinatal phase, when mothers from all children from Pelotas 2015 birth cohort were interviewed after delivery. The main outcome considered was preterm birth, categorized from gestational age as follows: a) early preterm birth (between 24 and 33wk+6 days); b) late preterm birth (between 34 and 36wk +6 days); c) early ≥term birth (between 37 and 38wk+6 days); d) term birth (between 39 and 40wk +6 days); e) late term birth (between 41 and 41wk +6 days) and; f) post term birth (more than 42 wk.). Exposure variable was periodontal disease defined using American Academy of Periodontology criteria and classified as mild, moderate and severe. Data analysis was performed using Stata 12.0. Analysis of association were performed using multivariate models adjusting for potential confounders. A total of 2474 women participated on the study. Prevalence of periodontitis was 14.6% and gingivitis was 21.7%. Periodontitis was positively associated with smoking habits, presence of dental calculus and lower educational level. Presence gingivitis was associated with lower educational level and presence of dental calculus. Presence of periodontitis (≥ mild) was associated with an odds almost two times higher of having early preterm birth compared with healthy pregnant women, even after controlling for confounders (OR 1.84; 95% CI 1.06-3.20). No association was found when late preterm birth was considered as cutoff point. The findings of the present thesis reveal periodontal conditions of pregnant women from Pelotas and confirm the association between periodontitis and early preterm birth in a population-based sample.