Serum inflammatory mediators in pregnancy: changes after periodontal treatment and association with pregnancy outcomes

Abstract

Background: The purposes of this study were to determine: 1) if periodontal treatment in pregnant women before 21 weeks of gestation alters levels of inflammatory mediators in serum; and 2) if changes in these mediators are associated with birth outcomes.

Methods: A total of 823 pregnant women with periodontitis were randomly assigned to receive scaling and root planing before 21 weeks of gestation or after delivery. Serum obtained between 13 and 16 weeks, 6 days (study baseline) and 29 to 32 weeks of gestation was analyzed for C-reactive protein; prostaglandin E(2); matrix metalloproteinase-9; fibrinogen; endotoxin; interleukin (IL)-1 beta, -6, and -8, and tumor necrosis factor-alpha. Cox regression, multiple linear regression, and the t, chi(2), and Fisher exact tests were used to examine associations among the biomarkers, periodontal treatment, and gestational age at delivery and birth weight.

Results: A total of 796 women had baseline serum data, and 620 women had baseline and follow-up serum and birth data. Periodontal treatment did not significantly alter the level of any biomarker (P >0.05). Neither baseline levels nor the change from baseline in any biomarker were significantly associated with preterm birth or infant birth weight (P >0.05). In treatment subjects, the change in endotoxin was negatively associated with the change in probing depth (P <0.05).

Conclusions: Non-surgical mechanical periodontal treatment in pregnant women, delivered before 21 weeks of gestation, did not reduce systemic (serum) markers of inflammation. In pregnant women with periodontitis, levels of these markers at 13 to 17 weeks and 29 to 32 weeks of gestation were not associated with infant birth weight or a risk for preterm birth.

Figure 1

Samples sizes for analyses of baseline serum data, 29–32 week serum data and change from baseline. PTB = Live preterm birth.

Figure 2

Birthweight versus Baseline Serum Biomarkers. None of the adjusted slopes (adjusted for clinic, race/ethnicity, age and body-mass index) differed significantly from zero (P > 0.05, see Table 5, column 1 for P values).

Figure 2

Birthweight versus Baseline Serum Biomarkers. None of the adjusted slopes (adjusted for clinic, race/ethnicity, age and body-mass index) differed significantly from zero (P > 0.05, see Table 5, column 1 for P values).

Figure 3

Change in the Percent of Tooth Sites with a Probing Depth >= 4mm versus Change in the Serum Biomarker. A negative value on the horizontal axis indicates a reduction, or improvement, in the percentage of tooth sites with probing depths >= 4mm. A negative value on the vertical axis indicates a reduction in the biomarker level from baseline to 29–32 weeks. X’s denote treatment group participants, dots denote controls. The blue line is the regression slope for treatment group women; the red line is for controls. See text for P values.

Figure 3

Change in the Percent of Tooth Sites with a Probing Depth >= 4mm versus Change in the Serum Biomarker. A negative value on the horizontal axis indicates a reduction, or improvement, in the percentage of tooth sites with probing depths >= 4mm. A negative value on the vertical axis indicates a reduction in the biomarker level from baseline to 29–32 weeks. X’s denote treatment group participants, dots denote controls. The blue line is the regression slope for treatment group women; the red line is for controls. See text for P values.

Figure 3

Change in the Percent of Tooth Sites with a Probing Depth >= 4mm versus Change in the Serum Biomarker. A negative value on the horizontal axis indicates a reduction, or improvement, in the percentage of tooth sites with probing depths >= 4mm. A negative value on the vertical axis indicates a reduction in the biomarker level from baseline to 29–32 weeks. X’s denote treatment group participants, dots denote controls. The blue line is the regression slope for treatment group women; the red line is for controls. See text for P values.