Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS).

OBJECTIVE: The purpose of this study was to test whether treating periodontal disease (PD) in pregnancy will reduce the incidence of spontaneous preterm delivery (SPTD) at < or = 35 weeks of gestation. STUDY DESIGN: A multicenter, randomized clinical trial was performed. Subjects with PD were randomized to scaling and root planing (active) or tooth polishing (control). The primary outcome was the occurrence of SPTD at <35 weeks of gestation. RESULTS: We screened 3563 subjects for PD; the prevalence of PD was 50%. Seven hundred fifty-seven subjects were assigned randomly; 378 subjects were assigned to the active group, and 379 subjects were assigned to the placebo group. Active treatment did not reduce the risk of SPTD at <35 weeks of gestation (relative risk, 1.19; 95% confidence interval [CI], 0.62-2.28) or composite neonatal morbidity (relative risk, 1.30; 95% CI, 0.83-2.04). There was a suggestion of an increase in the risk of indicated SPTD at <35 weeks of gestation in those subjects who received active treatment (relative risk, 3.01; 95% CI, 0.95-4.24). CONCLUSION: Treating periodontal disease does not reduce the incidence of SPTD.

Periodontal disease and adverse pregnancy outcomes: is there an association?

OBJECTIVE: We assessed the risk of adverse pregnancy outcomes (preterm birth [PTB], preeclampsia [PRE], fetal growth restriction [FGR], or perinatal death) in women with periodontal disease (PD) compared to those without. STUDY DESIGN: A multicenter prospective cohort study enrolled women from 3 sites between 6 and 20 weeks' gestation. The presence of PD was defined as periodontal attachment loss > or = to 3 mm on 3 or more teeth. The primary binary composite outcome included PRE, PTB, FGR, or perinatal death. Multivariable logistic regression (MVLR) was used to control for confounders. RESULTS: Three hundred eleven patients with and 475 without PD were included. There was no association between PD and the composite outcome, PRE, or PTB in unadjusted analyses. There was no association between PD and the composite outcome (adjusted odds ratio [AOR], 0.81; 95% confidence interval [CI], 0.58-1.15; P = .24), preeclampsia (AOR, 0.71; 95% CI, 0.37-1.36; P = .30), or preterm birth (AOR, 0.77; 95% CI, 0.49-1.21; P = .25) after adjusting for relevant confounders. CONCLUSION: Despite the body of literature suggesting an association between PD and adverse pregnancy outcomes in urban populations, this large prospective study failed to demonstrate an association.

Characteristics and pregnancy outcomes of pregnant women asymptomatic for bacterial vaginosis.

STUDY DESIGN: To determine the clinical, behavioral or demographic factors associated with asymptomatic bacterial vaginosis (BV) and to examine if women with asymptomatic BV had a higher risk of a variety of pregnancy outcomes compared to symptomatic BV positive women. For this study, 1916 pregnant women who were 12 weeks' gestation or less were enrolled. Interviewers facilitated vaginal swab collection for BV assessment, and completed the baseline questionnaire. BV was identified by Gram stain. RESULTS: Forty percent of pregnant women screened positive for BV and a substantial proportion of BV positive pregnant women were asymptomatic (67%). Asymptomatic BV positive women reported lower stress scores (RR = 0.78, 95% CI: 0.67-0.89), slightly more prior STD's (RR = 1.03, 95% CI: 1.01-1.07), and a higher quantity of Mobiluncus (RR = 1.04 95% CI: 1.01-1.07) compared to symptomatic BV positive women. We did not find an increase in adverse pregnancy outcomes related to BV symptomatology. CONCLUSION: Among first trimester pregnant women, only stress, STD history, and quantity of Mobiluncus were associated with symptom reports among BV positive pregnant women. We also found that women with asymptomatic BV did not have an increased risk of a variety of adverse pregnancy outcomes compared to symptomatic BV positive women.

A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth.

OBJECTIVE: The rarer of 2 alleles of a polymorphism in the promoter of the tumor necrosis factor alpha gene (TNF) has been associated with spontaneous preterm birth following preterm premature rupture of the fetal membranes in some populations. The aim of this study was to assess if the presence of symptomatic bacterial vaginosis amplifies the risk of spontaneous preterm birth in those with a "susceptible" TNF genotype. STUDY DESIGN: A case-control study was performed at our institution. Cases (n=125) were defined as women who delivered before 37 weeks as a result of ruptured membranes or preterm labor, while control subjects (n=250) were defined as women who delivered after 37 weeks. DNA was collected from maternal blood and analyzed for the TNF genotype. Information on symptomatic bacterial vaginosis and other risk factors for preterm birth was obtained by review of the antenatal record. Multiple logistic regression was also used to test the interaction between bacterial vaginosis, the TNF genotype, and preterm birth. RESULTS: Maternal carriers of the rarer allele (TNF-2) were at a significantly increased risk of spontaneous preterm birth [odds ratio (OR) 2.7, 95% CI 1.7-4.5]. The association between TNF-2 and preterm birth was modified by the presence of bacterial vaginosis, such that those with a "susceptible" genotype and bacterial vaginosis had increased odds of preterm birth compared with those who did not (OR 6.1, 95% CI 1.9-21.0). CONCLUSION: This study provides preliminary evidence that an interaction between genetic susceptibilities (ie, TNF-2 carriers) and environmental factors (ie, bacterial vaginosis) is associated with an increased risk of spontaneous preterm birth.

Duration of antibiotic therapy after preterm premature rupture of fetal membranes.

OBJECTIVE: This study was undertaken to compare the efficacy of 3 days versus 7 days of ampicillin in prolonging gestation for at least 7 days in women with preterm premature rupture of membranes (PPROM). STUDY DESIGN: We performed a randomized clinical trial comparing 3 days of ampicillin with 7 days ampicillin in patients with PPROM. Our primary outcome was the prolongation of pregnancy for at least 7 days. Secondary outcomes included rates of chorioamnionitis, postpartum endometritis, and neonatal morbidity and mortality. RESULTS: Forty-eight patients were randomly selected. There was no statistically significant difference in the ability to achieve a 7-day latency (relative risk 0.83, 95% CI 0.51-1.38). In addition, there was no statistically significant difference in the rates of chorioamnionitis, endometritis, and our composite neonatal morbidity. CONCLUSION: In patients with PPROM, length of antibiotic therapy does not change the rate of a 7-day latency or affect the rate of chorioamnionitis, postpartum endometritis, or neonatal morbidity.