Bobetsis Yiorgos A, Barros Silvana P, Offenbacher Steven
Center for Oral and Systemic Diseases, Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, N.C. 27599-7455, USA.
J Am Dent Assoc. 2006 Oct;137 Suppl:7S-13S. doi: 10.14219/jada.archive.2006.0403.
Increasing evidence suggests that maternal gingivitis and periodontitis may be a risk factor for preterm birth and other adverse pregnancy outcomes.
To clarify the possible mechanisms behind the association between periodontal disease and preterm delivery, the authors reviewed studies of the effect of infection with periodontal pathogens in animal models on pregnancy outcomes including fetal growth, placental structural abnormalities and neonatal health. After the first report, in 1996, of a potential association between maternal periodontal disease and delivery of a preterm/low-birth-weight infant in humans, many case control and prospective studies were published. This review summarizes these, as well as early studies involving periodontal intervention to reduce risk.
Although there are some conflicting findings and potential problems regarding uncontrolled underlying risk factors, most of the clinical studies indicate a positive correlation between periodontal disease and preterm birth. Recent studies also have shown that there are microbiologic and immunological findings that strongly support the association. The studies indicate that periodontal infection can lead to placental-fetal exposure and, when coupled with a fetal inflammatory response, can lead to preterm delivery. Data from animal studies raise the possibility that maternal periodontal infections also may have adverse long-term effects on the infant's development.
Education for patients and health care providers regarding the biological plausibility of the association and the potential risks is indicated, but there is insufficient evidence at this time for health care policy recommendations to provide maternal periodontal treatments for the purpose of reducing the risk of adverse pregnancy outcomes.
越来越多的证据表明，孕妇牙龈炎和牙周炎可能是早产及其他不良妊娠结局的一个风险因素。
为阐明牙周疾病与早产之间关联背后的可能机制，作者回顾了动物模型中牙周病原体感染对妊娠结局（包括胎儿生长、胎盘结构异常和新生儿健康）影响的研究。1996年首次报道孕妇牙周疾病与人类早产/低体重儿分娩之间可能存在关联后，发表了许多病例对照研究和前瞻性研究。本综述总结了这些研究以及早期涉及牙周干预以降低风险的研究。
尽管在未控制的潜在风险因素方面存在一些相互矛盾的发现和潜在问题，但大多数临床研究表明牙周疾病与早产之间存在正相关。近期研究还表明，有微生物学和免疫学发现有力地支持了这种关联。这些研究表明，牙周感染可导致胎盘 - 胎儿暴露，并且与胎儿炎症反应相结合时，可导致早产。动物研究数据提出了孕妇牙周感染也可能对婴儿发育产生不良长期影响的可能性。
需要对患者和医疗保健提供者进行关于这种关联的生物学合理性及潜在风险的教育，但目前没有足够的证据支持医疗保健政策建议为降低不良妊娠结局风险而对孕妇进行牙周治疗。
