Relationship between Periodontitis and Preterm labour - Correlation with C reactive protein levels

INTRODUCTION: Preterm birth complicates 12% of all births. A birth is considered premature if the fetus is born before 37 weeks. Preterm labour and low birth weight represent major public health problems because of their associated mortality economic burden and long term disability. The weight of the fetus at birth is the most important variable as far as the survival, growth and healthy development of a child is concerned. In cases of premature birth, the baby's vital organs are immature and incapable of readily adapting to the start of life outside the uterus. The number of days spent in hospital and the costs of intensive neonatal therapy units are high. This cost to society goes beyond the financial cost because it permeates the psycho-emotional situation of the families involved. AIM OF STUDY: 1. To study the relationship between periodontitis and preterm labour. 2. To investigate whether C Reactive Protein is the possible mediator of the association between periodontitis and preterm labour. MATERIALS AND METHODS: The study is a retrospective case–control study conducted amongst the post-natal women who delivered at the ISO and Govt. KG Hospital, Chennai during the period from April 2007 to April 2008. The study received ethical clearance from the board. The hospital birth register was scrutinized each day to identify all cases of preterm delivery, defined as those mothers who delivered an infant before 37 weeks gestation. The control (mothers who delivered an infant after 37 weeks gestation) was selected daily from the birth register at the same time as the cases. A written consent of the women was obtained before their enrolment in the study and all data was collected within 72 h of delivery. During the period of study a total of 200 post partum mothers were included for the study 100 cases( Pre-term deliveries) and 100 controls (term deliveries). The case-control ratio was 1:1. Inclusion Criteria: Cases were Primiparous /Multiparous women who delivered a single live infant before 37 weeks of gestation and after achieving viability. • Controls were either primiparous / multiparous women who delivered a single live infant at 37 completed weeks of gestation. • Women who have had no medical/surgical illness which could have been a predisposing factor for preterm labour. • No evidence of infection elsewhere at present. Exclusion Criteria: Women with genito-urinary tract infections, • Medical /surgical illness which might predispose to preterm labour, • Women who had therapeutic induction of labour, • Women who delivered multiple fetuses /still born infants, • Women who had only a localized form of periodontitis. A detailed history was elicited from the patients regarding the presence of any symptoms pertaining to dental infections, history of abnormal vaginal discharge, and history regarding their previous deliveries. Additional information was also obtained from the maternal case sheet. SUMMARY AND CONCLUSION: The study concludes that there is a significant association between periodontitis and pre term labour. The odds ratio for developing pre term labour in women with periodontitis was calculated to be 4.78. Moderate and severe varieties of periodontitis were associated with lower gestational age at delivery when compared to mild periodontitis. The CRP value was found to be elevated in those with periodontitis when compared to those women who were periodontally healthy. There was significant correlation between increased CRP levels, increasing severity of periodontitis and prematurity. CRP could be the biologic mediator between the periodontiotis and preterm labour. The present study provides evidence to support the need for collaborative initiatives among health care providers in medicine and dentistry