Transcript Week 4

Discomforts, Lifestyle & Oral Health
2011
• Discomforts
– Nausea and vomiting
– Heartburn
• Lifestyle concerns with nutritional
implications:
– alcohol
– caffeine
– smoking
– Illicit drugs
– Non-nutritive sweeteners
– physical activity
• oral health
Nausea & Vomiting:
Cochrane Intervention Review, 2010
Quinlan et al, Am Fam Phys, 2003
Background
• 70-85% of women experience nausea
with pregnancy
• ~ ½ experience vomiting
• 35% of women with employment lose
time from work due to nausea – an
average of 62 hours
• Almost 50% of women report that their
work efficiency is reduced by n&v
Stress Associated with N&V
•Lack of understanding and support from others
• Inability to take vitamins or eat healthy
• Taking medications perceived as risky
• Missing out on the “fun” of being pregnant
• Loss of a “normal” pregnancy
• Lost work days or quitting work
• Putting life “on hold”
• Longing to eat and drink normally
• Money expended on care and support
• Lack of energy, fatigue
• Irritability and lack of enjoyment of life
• Memory loss or inability to think clearly
• Burden of care and time on others
• Lack of socialization, isolation
cont…
• Inability to prepare for birth and arrival of baby
• Inability to care for family and home
•Wanting pregnancy over or to end the misery
• Others’ perception that hyperemesis is only in her mind
• Reluctance of doctors to treat because of cost or liability
• Weight loss or inadequate weight gain for gestational age of
baby
• Sense of inadequacy and failure at being unable to cope or
function
• Difficulty bonding with infant
• Lack of energy and socialization with other children
• Lack of excitement about infant’s arrival
Etiology
• Unknown – appears to have some
association with rising levels of human
chorionic gonadotropin (hCG) or
estrogens
– Nausea less common in those who
subsequently experience miscarriage
– More common in twin pregnancies
Hyperemesis Gravidarum
• Severe nausea and vomiting
• Affects one in 200 pregnancies
• Most common reason for hospitalization in early
pregnancy
• Clinical features: Persistent vomiting, dehydration,
ketonuria, electrolyte disturbances, weight loss
• 159 per million pregnant women died in England
between 1931-1940 (before IV fluid replacement
therapy was available)
• (Charlotte Bronte died of hyperemesis in her fourth
month of pregnancy)
Use of non-pharmacological
treatments
• Commonly recommended by health
professionals without evidence of
effectiveness
• Safety unknown and unregulated
– “women and professionals are more likely
to underestimate their possible risks”
Cochrane 2010
• Interventions for nausea and vomiting in
early pregnancy
• 27 studies with 4041 women included
– 22 studies excluded
Acupressure
Comparison & studies
Results
P6 vs vitamin B6
– one study, 66 women
No sig difference, but more
“satisfied” with P6
P6 vs “Placebo”
No sig differences
–4 studies- 408 women
Auricular (metal balls taped to
point on ear) vs “placebo”
No sig difference
–I study, 90 women
Acustimulation (low-level
Data “not simple to interpret”
nerve stimulation therapy over
the volar aspect of the wrist at
the P6 point) vs placebo
–one study, 230 women
Acupuncture
• Acupuncture versus placebo (sham
acupuncture and no treatment)
• two studies with 648 women
• No sig difference or data not
interpretable
Ginger
Comparison & studies
Ginger versus placebo
–4 studies, 283 women
Ginger versus vitamin B6
Results
Studies suggest benefit, but
meta-analysis that controlled
for study deficits found no
benefit
Pooled results show no benefit
–4 studies, 624 women
Ginger versus Dimenhydrinate
(Dramamine)
–1 study, 170 women
Data not “easily interpreted”
Vitamin B6 versus placebo
• 2 studies, 416 women
• Results favored vitamin B6 for reduction
in nausea after three days
• Comparing the number of patients
vomiting post-treatment, there was no
strong evidence that vitamin B6 reduced
vomiting
Anti-emetic medication versus
placebo
• 6 studies, 803 women
• Hydroxyzine, Debendox (Bendectin)
Thiethylperazine,FluphenazinePyridoxine
• Review found substantial
methodological problems with most
studies and could not reach meaningful
conclusion
Adverse Outcomes
• Acupressure: reports of pain,
numbness, soreness and hand-swelling
• Ginger: few studies reported adverse
impacts, one statement about heartburn
• Antiemetic drugs: primary complaint
was drowsiness.
Summary Statements
• No acceptable studies of dietary or other lifestyle
interventions
• Limited evidence regarding acupressure –
acupuncture not effective
• “The use of ginger products may be helpful to
women, but the evidence of effectiveness was
limited and not consistent.”
• “There was only limited evidence from trials to
support the use of pharmacological agents
including vitamin B6, and anti-emetic drugs to
relieve mild or moderate nausea and vomiting.”
Cochrane Conclusions:
“Given the high prevalence of nausea and vomiting in
early pregnancy, health professionals need to provide
clear guidance to women, based on systematically
reviewed evidence. There is a lack of high-quality
evidence to support that advice. The difficulties in
interpreting the results of the studies included in this
review highlight the need for specific, consistent and
clearly justified outcomes and approaches to
measurement in research studies.”
Nausea and vomiting of pregnancy: an
evidence-based review
(Davis, J Perinat Neonatal Nurs. 2004)
• First step is dietary & lifestyle changes
American Gastroenterological Association
Institute Medial Position Statement on the Use
of Gastrointestinal Medication in Pregnancy (2006)
• Metoclopramide, prochlorperazine,
promethazine, trimethobenzamide and
ondansetron* are considered low-risk
drugs based on studies in pregnant
women and can be used for nausea and
vomiting and for hyperemesis
gravidarum. Granisetron and
dolasetron have not been studied in
human pregnancies.”
*Reglan, Compazine , Phenergan , Tebamide, Zofran
Interventions for Heartburn in Pregnancy
Cochrane, 2008
• Up to 80% of women in third trimester
• Not well understood – pregnancy
hormones influence
• Lower esophageal sphincter
• Gastric clearance
• 3 studies, 286 women
• “little information to draw conclusions about the
overall effectiveness of interventions to relieve
heartburn in pregnancy.”
The management of heartburn in
pregnancy (Richter, 2005. Alimentary
Pharmacology & Therapeutics)
• Staged approach:
• Lifestyle modification: Smaller meals,
no late night eating, elevate head of
bed, avoiding foods/mediations causing
heartburn
• Discuss risk/benefits of drug TX (RCTs
not done)
The management of heartburn in
pregnancy (Richter, 2005. Alimentary
Pharmacology & Therapeutics)
Adverse effects of substance
use determined by:
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Timing
Dosage
Duration
Number of substances
Environment (nutrition, health status)
Individual susceptibility
Effects of substance abuse
include:
• Increased health problems, including
risk of AIDS
• Compromised nutritional status/weight
gain
• Higher rates of OB complications
• Psychosocial/economic/legal problems
• Parenting difficulties
• Higher rates of child abuse/neglect
Alcohol: Background
 Per capita alcohol consumption has risen
through the second half of this century in the
US
 70% of individuals between the ages of 20
and 34 consume alcohol
 Alcohol consumption peaks in the 20-40 year
old group
Percentage of women aged 18--44 years who reported
any alcohol use or binge drinking, by pregnancy status
--- Behavioral Risk Factor Surveillance System
(BRFSS) surveys, United States
MMWR: May 22, 2009 / 58(19);529-532
Alcohol: Background, cont.
 Women are at disadvantage because less
gastric first pass metabolism due to lower
levels of alcohol dehydrogenate in intestinal
mucosa
 Fetus has no alcohol dehydrogenase activity
 Alcohol crosses placenta easily by passive
diffusion – fetal levels mimic maternal levels
 The amniotic fluid acts as a reservoir for
alcohol.
FAS Diagnostic Criteria- Fetal Alcohol Study Group
of the Research Society on Alcoholism
• Prenatal and/or postnatal growth retardation
(<10th % ca)
• Central nervous system involvement
(neurologic abnormality, developmental delay
or intellectual impairment)
• Characteristic facial dysmorphology with at
least 2 of these 3 signs:
 Microcephally ( OFC < 3rd %ile)
 Micoopthalmia and/or short palpevral fissures
 Poorly developed philtrum, thin upper lip, and or
flattening of the maxillary area
FAS, cont.
Other organ systems often involved.
Some with nutritional implications:
 Cleft palate
 Eustachian tube dysfunction
 Array of cardiac, renal, and skeletal defects that
may require surgical repair
FAE – Fetal Alcohol Effects or
PFAE
• Exhibit some components of FAE, but
not all
• Most common sign is retarded growth
both pre and postnatal
• Can have significant developmental and
behavioral components
Fetal Alcohol Spectrum Disorders
(FASD)
• Surgeon General’s Advisory (2005)
– “FASD is the full spectrum of birth defects caused
by prenatal alcohol exposure.”
– “The spectrum may include mild and subtle
changes, such as a slight learning disability and/or
physical abnormality, through full-blown Fetal
Alcohol Syndrome, which can include severe
learning disabilities, growth deficiencies, abnormal
facial features, and central nervous system
disorders.”
FAS/FAE Incidence
 FAS – 1.9 per 1000 births, 25 per 1000
among women who drink heavily
 FAE – 3 to 5 per 1000 births, 90 per 1000
among women who drink heavily
 FASD is leading cause of mental retardation
in the western world
Pathophysiology
• Combination of
– Toxic effects of ethanol and its derivatives
– Nutritional factors
– Genetic predisposition
Toxic effects
• Both alcohol and derivative acetaldehyde
directly damage developing and mature
nervous systems
• Impair nucleic acid synthesis
• Disrupts protein synthesis
• Cell membrane narcosis
• High maternal alcohol levels associated with
dehydration, fetal hypoxia and acidosis,
placental pathology and dysfunction, and
endocrine disturbances.
Nutrition Related Effects of
Alcohol
• Poor nutritional status of mother
• Reduced placental transfer of zinc and folic
acid associated in animal models
• Alcohol impairs absorption, utilization, and
metabolism of nutrients
• Poor zinc status has been associated with
adverse effects of alcohol in many studies
Surgeon General’s Advisory
(2005)
• Science:
– Alcohol consumed during pregnancy increases the risk
of alcohol related birth defects, including growth
deficiencies, facial abnormalities, central nervous
system impairment, behavioral disorders, and impaired
intellectual development.
– No amount of alcohol consumption can be considered
safe during pregnancy.
– Alcohol can damage a fetus at any stage of pregnancy.
Damage can occur in the earliest weeks of pregnancy,
even before a woman knows that she is pregnant.
– The cognitive deficits and behavioral problems resulting
from prenatal alcohol exposure are lifelong.
– Alcohol-related birth defects are completely preventable
Surgeon General’s Advisory
(2005)
Recommendations:
1.
2.
3.
4.
5.
A pregnant woman should not drink alcohol during
pregnancy.
A pregnant woman who has already consumed alcohol
during her pregnancy should stop in order to minimize
further risk.
A woman who is considering becoming pregnant should
abstain from alcohol.
Recognizing that nearly half of all births in the United
States are unplanned, women of child-bearing age
should consult their physician and take steps to reduce
the possibility of prenatal alcohol exposure.
Health professionals should inquire routinely about
alcohol consumption by women of childbearing age,
inform them of the risks of alcohol consumption during
pregnancy, and advise them not to drink alcoholic
beverages during pregnancy.
Caffeine
• History:
– Rat based studies with high levels of caffeine
found adverse pregnancy outcomes
– Early 1980s US FDA issued advisory about
adverse effects of caffeine in pregnancy
– Further research found little association, FDA
concludes that no strong evidence, urges
moderation
– 1996 IOM review for WIC advised removing
excessive caffeine intake from WIC risk criteria
– 1998 - USDA removed as WIC risk criteria
The Effects of Caffeine on Pregnancy
Outcome Variables (Hinds et al. Nutrition Review,
1996)
• Consumption:
– In US 70-95% of pregnant women
consume caffeine - average intake is 99185 mg/day
– 5-30% of pregnant women consume >300
mg/day
– Heavy caffeine intake more likely in women
who smoke and those with lower education
levels
The Effects of Caffeine on Pregnancy
Outcome Variables (Hinds et al. Nutrition Review,
1996)
• Metabolism
– methylxantines cross the placenta to the
fetus where an equilibrium is achieved
between maternal and fetal plasma
– half-life of caffeine in pregnancy changes
from 5.2 to 18.1 hours in T2 and T3 and
returns to non-pg levels a few weeks pp
Caffeine Metabolism, Genetics and
Perinatal Outcomes (Ann Epidemiol 2005)
• Wide individual variation in caffeine
metabolism
– Due to variation in CYP1A2 enzyme
activity
• “Measuring maternal, fetal and neonatal
caffeine metabolites may allow for a more
precise measure of fetal caffeine exposure.”
Coffee and Health: A Review of Recent
Human Research (Higdon and Frei; Crit
Rev Food Sci and Nutrition, 2006)
Conception
• Many studies find > 300 mg/d associated with
delay in time to conception (some do not find
this effect)
• Author’s conclusions: “it may be prudent for
women who are having difficulty conceiving to
limit caffeine consumption to less than 300
mg/d in addition to eliminating tobacco use
and decreasing alcohol consumption.”
Spontaneous Abortion
• Conflicting studies
• Women who decrease Caffeine due to N&V,
more likely to have viable pregnancies.
• “Most studies that observed significant
associations between self-reported coffee or
caffeine consumption and the risk of
spontaneous abortion did so at intake levels
of at least 300 mg/d of caffeine.”
Fetal Growth
• “Several studies found that maternal caffeine
intakes ranging from 200-400 mg/d were
associated with decreases in mean birth
weight of about 100 g.”
• “A meta-analysis that combined the results of
eight epidemiological studies found that
maternal caffeine consumption greater than
150 mg/d increased the risk of low birth
weight by approximately 50%.”
Preterm Delivery
• “Most epidemiological studies have not
found coffee or caffeine consumption to
be associated with the risk of preterm
delivery.”
Birth Defects
• “At present, there is no convincing
evidence from epidemiological studies
that maternal caffeine consumption
ranging from 300-1000 mg/d increases
the risk of congenital malformations in
humans.”
Coffee and Health: A Review of Recent
Human Research (Higdon and Frei; crit
rev food sci and nutrition, 2006)
• “Currently available evidence suggests
that it may be prudent for pregnant
women to limit coffee consumption to 3
cups/d providing no more than 300
mg/d of caffeine to exclude any
increased probability of spontaneous
abortion of impaired fetal growth.”
Smoking
• 25-30% of US women smoke during
pregnancy; down from 40% in 1967
• Cochran review found that 30 trials of
intensive intervention programs in
pregnant women lead to smoking
cessation in 6.6-9.2% of women.
Trends in Smoking Before, During, and
After Pregnancy, MMW; May 29, 2009
Trends in Smoking Before, During, and
After Pregnancy, MMW; May 29, 2009
Trends in Smoking Before, During, and
After Pregnancy, MMW; May 29, 2009
Trends in Smoking Before, During, and
After Pregnancy, MMW; May 29, 2009
Adverse Outcomes of Maternal Smoking
• Cigarette smoking is the single most important
factor affecting birthweight in developed
countries (DiFranza, Pediatrics, 2004)
– Twice the risk of LBW
– Lower birthweight (~200g)
• Perinatal: Moderately increased risk of
preterm delivery, perinatal mortality,
spontaneous abortion
• Long term: modest reduction in long term
growth and intellectual development of fetus.
Nutritional Risks Associated
with Smoking
• No breakfast (38% of smokers vs. 18%
of non-smokers)
• Lower dietary intakes of fruits and
vegetables, protein, zinc, riboflavin,
thiamin, iron
Nutritional Risks Associated
with Smoking, cont.
• Smoking appears to:
– decrease the availability of dietary energy
– increase requirement for iron
– reduce availability of B12, amino acids,
vitamin C, folate, and zinc
• Lower serum vitamin C, B6, E, folate,
beta carotene
Norkus et al. FASEB, 1989 and Ann
NY Acad Sci 1987
Smokers
Non-Smokers
Cord vit. C (mg/dl)
0.61
1.68
Placental vit. C
10.1
20.9
(mg/dl)
0.2
0.3
Maternal plasma
carotene (g dl
Cord carotene
19
44
7
20
(mg/dl)
Cord vit. E
(g dl
Vitamin C and PROM
• PROM occurs in 8-10 % of all
pregnancies
• Vitamin C is required for collagen
synthesis
• Maternal plasma and placental vitamin
C is lower in women with PROM
Nutritional Risks Associated
with Smoking, cont.
• Increased carboxyhemoglobin in
smokers blood leads to requires
increased cutoff point for anemia in
smokers.
• Women who smoke may have lower
prepregnancy weights and may have
lower pregnancy weight gains.
Maternal smoking during pregnancy and
child overweight: systematic review and
meta-analysis (Oken, 2008)
Maternal smoking during pregnancy and
child overweight: systematic review and
meta-analysis (Oken, 2008)
• “The pooled estimate from unadjusted
odds ratios (OR 1.52, 95% CI: 1.36,
1.69) was similar to the adjusted
estimate, suggesting that
sociodemographic and behavioral
differences between smokers and
nonsmokers did not explain the
observed association.”
Maternal smoking during pregnancy and
child overweight: systematic review and
meta-analysis (Oken, 2008)
• In parts of the world undergoing the
epidemiologic transition, the continuing
increase in smoking among young
women could contribute to spiraling
increases in rates of obesity-related
health outcomes in the 21st century.
Illicit Drugs: Nutritional
Implications
• Estimates of 4-10% of US newborns
exposed to one or more illicit drugs in
utero
• Illicit drug use strongly associated with
inadequate maternal weight gain,
anemia, poor dietary habits
• Knight et al. (FASEB, 1992) found lower
serum ferritin, folate, vitamin C and B12
levels in women when cord blood
reflected illicit drugs
Illicit Drug Use & Infant Outcomes:
March of Dimes fact sheet
• In utero: Slowed fetal growth, reduced
head circumference
• Perinatal: higher risk of CP, placental
abruption
• Infancy: difficult to sooth and feed
Illicit drug use and adverse birth
outcomes: is it drugs or context?
(Schempf & Stobino, J Urban Health, 2008)
• In unadjusted results, marijuana, cocaine, and
opiates were related to increased odds of LBW.
• No drug was significantly related to LBW when
adjusted for Social, psychosocial, behavioral, and
biomedical factors.
• About 70% of the unadjusted effect of cocaine use on
continuous birth weight was explained by surrounding
psychosocial and behavioral factors, particularly
smoking and stress.
• Most of the unadjusted effects of opiate use were
explained by smoking and lack of early prenatal care.
Illicit Drugs: Nutritional
Implications
• Cocaine:
– associated with fewer meals, increased
alcohol and caffeine and fat intake
– 32% also classified as eating disordered
• Methadone
– Higher birthweights than women who
continue to use heroine
– diarrhea, constipation, nausea, anorexia,
and dry mouth
• Heroin
– altered glucose tolerance - delayed
glucose response
Position of the American Dietetic Association:
Use of nutritive and nonnutritive sweeteners
(2004)
• Toxicity testing during reproduction is
required for FDA approval.
• “The consumption of acesulfame
potassium,aspartame, saccharin,
sucralose,and neotame within
acceptable daily intakes is safe during
pregnancy.”
Exercise
• Benefits:
– improved or maintained fitness
– reduces anxiety and depression
– eases pregnancy discomforts such as
constipation, backache, fatigue and
varicose veins
Exercise
• Contraindications
– previous experience of preterm labor
– ob complications including vaginal
bleeding, incompetent cervix, ruptured
membranes, compromised fetal growth
– Hx of medical problems (hypertension,
heart disease, etc.) requires health care
provider approval
Exercise
• Changes with pregnancy
– tolerance for strenuous exercise decreases
as pregnancy progresses
• work of breathing increases as enlarging uterus
crowds the diaphragm
• oxygen needs increase
– if lying flat on back after the 4th month, risk
of compression of vena cava with dizziness
and interference with blood flow to the
uterus
Exercise
Changes with pregnancy, cont.
– may have increased efficiency of heat
dissipation
– altered sense of balance with shift in center
of gravity
– high hormonal levels associated with lax
connective tissue and increased joint
susceptibility
Postpartum
• Physiological changes persist 4 to 6
weeks postpartum
• Return to vigorous exercise should be
gradual
• Return to physical activity may be
protective against postpartum
depression if exercise is stress
relieving- not inducing
Cochrane: Aerobic Exercise for
Women During Pregnancy (2006)
• 11 trials involving 472 women
• “The trials were not of high methodologic quality.”
• Results:
– Regular aerobic exercise during pregnancy appears to
improve (or maintain) maternal physical fitness
– Non significant, but concerning increased risk of preterm
birth in exercise groups. From 7 trials: Pooled RR 1.82 (95%
CI 0.35-9.57).
– Data insufficient to infer important risk or benefits for mother
or infant
Continuous, Strenuous, Vigorous
Activity Throughout Pregnancy
(Gunderson, Clin Obstet gynecology, 2003)
• Can reduce birth weight & length of
gestation
• Additional carbohydrate recommended
before activity
• Increased need for B vitamins
• Careful screening for nutritional &
herbal supplements
• Athletes at higher risk for Fe depletion.
Oral Health & Pregnancy:
Major Concepts (Academy of General Dentistry)
• Increased risk for gingivitis (red,swollen,
tender gums that are more likely to bleed)
associated with increased estrogen and
progesterone
• Frequent consumption of high cho foods may
be used to combat nausea
• Cariogenic bacteria may be passed from
mother to infant
• Periodontal disease is associated with
preterm birth
Position of the American Dietetic Association:
Oral Health and Nutrition, 2009
• Periodontal Disease: nutrient deficiencies increase
susceptibility & compromise systemic response to
inflammation & infection
• Primary determinants of cariogenic, cariostatic, and
anticariogenic properties of the diet:
– food form (liquid, solid or sticky, slowly dissolving)
– frequency of consumption of sugar and other fermentable
Carbohydrates
– nutrient composition,
– potential to stimulate saliva,
– sequence of food intake, and combinations of foods
Pregnancy Gingivitis
• 30-75% of women experience gingival
changes such as edema, hyperplasia,
redness, and bleeding
• Hormonal changes cause greater
reaction to dental plaque
• Women who are plaque and
inflammation-free at beginning of
pregnancy have only 0.03 chance of
gingivitis
Periodontitis
• Definition: an infection caused by specific
bacterial plaque that involves loss of bone,
fiber, and gum tissue attachment for the tooth.
• Smoking associated with increased
prevalence and severity of periodontitis
• Periodontal infections caused by gramnegative pathogens are associated with
increase in preterm delivery and/or PROM one mediating factor is prostaglandin
production triggered by bacterial products.
• Women with diabetes are at higher risk
Periodontitis (cont.)
• Pathogens and bacterial products may
translocate and inhibit normal clearance
of enteric organisms from genitourinary
tract.
• Overgrowth of gram negative bacteria
and infection can be associated with
preterm birth.
Can preterm birth be prevented
by periodontal treatment?
• NIDCR funded two large RCT – women
assigned to treatment or no treatment
– Oral Therapy to Reduce Obstetric Risk
(OPT) – results published in 2006
– Maternal Oral Therapy to Reduce Obstetric
Risk (MOTOR) – results published in 2009
• Other large trial results published in
2010
OPT: Treatment of Periodontal
Disease and the Risk of Preterm Birth
(Michalowicz et al. NEJM, Nov. 2006)
• 823 women with periodontal disease, enrolled
between 13-17 weeks gestation, randomized
to:
– Scaling and root planing before 21 weeks; monthly
polishings
– Scaling and root planing after delivery
• Major Outcomes:
– no difference in rates of preterm birth or low
birthweight
– no adverse outcomes associated with treatment
MOTOR: Effects of periodontal therapy on rate
of preterm delivery: a randomized controlled
trial (Offenbacker et al, Obstet Gynecol, 2009)
• 3 site RCT, 1,760 women with
periodontal disease, assigned to:
– Scaling, root planing early in T2
– Treatment after delivery
• No significant differences with regard to
adverse events or major obstetric and
neonatal outcomes
2 Recent Trial Reports
• Australia RCT, 1,000 women (Newnham et al, Evid Based
Dent. 2001):
– No differences in preterm birth, fetal growth restriction,
preeclampsia
– Periodontal tx not hazardous to women or pregnancies
• US Periodontal Infections and Prematurity Study
(PIPS), 750 women (Macones et al, Am J Obstet
Gynecol, 2010)
– TX did not reduce risk of spontaneous preterm delivery
(SPTD)
– “Suggestion” of increased risk in SPTD < 35 weeks with
active tx (RR 3.01, 95% CI, 0.95-4.42)
All Periodontal Treatment
Impacts are not the Same:
• Periodontal infection and preterm birth:
successful periodontal therapy reduces
preterm birth (Parry et al, BJOG, 2010)
– At 20 week FU treated women categorized
as successful (no periodontal disease) or
not successful (ongoing disease)
– Successful treatment protected against
preterm birth (OR 6.02, 95% CI 2.5714.03)
American Academy of Periodontology
Statement Regarding Periodontal
Management of the Pregnant Patient (2004)
• Achieve a high level of oral hygiene prior to
becoming pregnant and throughout
pregnancy
• Periodonal treatment (eg; scaling and root
planing) is usually scheduled in second
trimester
• Emergencies such as acute infection and
abcess may require immediate treatment
regardless of stage of pregnancy)
• Consultation with prenatal care provider
Oral Health:
Recommendations
• Frequent dental cleanings (3 to 6 months)
• Daily oral care routines including brushing
and flossing at least twice daily and after
eating
• Use of toothpastes and rinses with fluoride
• Consider cariogensis in food choices and
patterns.
• Offer smoking cessation programs
Improving Access to Perinatal Oral Health Care:
Strategies & Considerations for Health Plans
(Issue Brief July 2010)
• National Institute for Health Care
Management Foundation
– http://nihcm.org/pdf/NIHCM-OralHealth-Final.pdf
“Research has exhibited an association between
periodontal disease in pregnant women and adverse birth
outcomes, such as low birth weight, preterm birth,
preeclampsia and gestational diabetes. Because studies
have shown conflicting results on the relationship between
periodontal disease and birth outcomes, and there is no
general consensus on this association, further research is
needed to explore and confirm this possible correlation.
However, research does universally support the safety of
dental treatment during pregnancy and confirms that
maintaining good oral health prior Improving Access to
Perinatal Oral Health Care: Strategies & Considerations for
Health Plans to and during pregnancy remains a key factor
in achieving overall health and well-being for women and
their infants.”
“Mother-to-child transmission of bacteria is the
primary vehicle through which children first acquire
dental caries, the disease process that causes
cavities. These bacteria are transmitted through
saliva that is passed from a caregiver’s mouth to a
child’s. The healthier the mother’s mouth, and the
longer the initial transmission of caries-causing
bacteria is delayed, the more likely children are to
establish and maintain good oral health.”