Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
Front Immunol. 2019 Nov 7;10:2624. doi: 10.3389/fimmu.2019.02624. eCollection 2019.
Periodontal disease is associated with adverse pregnancy outcome, but the underlying pathophysiologic mechanism is still unknown. In this prospective, longitudinal, non-interventional case-control study, 45 women with preterm premature rupture of membranes and 26 controls with uncomplicated pregnancies were examined at three time-points (T1: 20-34 weeks of gestations; T2: within 48 h after delivery; T3: 4-6 weeks post partum). Examinations included subgingival, blood, vaginal, and placenta sampling for microbiologic, cytokine, and histology assessment. Objective of this study was to test the hypothesis that systemic inflammatory changes and not specific bacteria are predominantly involved in the association between periodontal disease and adverse pregnancy outcome. Demographic data and gestational age at T1 were comparable between groups. While there was no correlation between vaginal and gingival fluid microbiome, cytokine levels in the assessed compartments differed between cases, and controls. Vaginal smears did not show a higher rate of abnormal flora in the cases at the onset of preterm premature rupture of membranes. Number and variety of bacteria in the case group placental membranes and vagina were higher, but these bacteria were not found in membranes at birth. On the basis of our results we speculate that an inflammatory pathway sequentially involving periodontal tissue, maternal serum, and finally vaginal compartment contributes to the underlying pathomechanism involved in preterm premature rupture of membranes associated with periodontitis.
牙周病与不良妊娠结局有关，但潜在的病理生理机制尚不清楚。在这项前瞻性、纵向、非干预性病例对照研究中，45 名早产胎膜早破患者和 26 名无并发症妊娠患者在三个时间点（T1：妊娠 20-34 周；T2：分娩后 48 小时内；T3：产后 4-6 周）进行了检查。检查包括龈下、血液、阴道和胎盘取样，用于微生物、细胞因子和组织学评估。本研究的目的是检验以下假设：系统炎症变化而不是特定细菌主要参与牙周病与不良妊娠结局之间的关联。两组在 T1 时的人口统计学数据和胎龄相当。虽然阴道和龈下液微生物组之间没有相关性，但在评估的部位中，病例组和对照组的细胞因子水平不同。在早产胎膜早破开始时，病例组阴道涂片未显示更高的异常菌群率。病例组胎盘膜和阴道中的细菌数量和种类较高，但这些细菌在出生时的胎膜中未发现。基于我们的结果，我们推测，炎症途径依次涉及牙周组织、母体血清，最终涉及阴道，这有助于解释与牙周炎相关的早产胎膜早破的潜在发病机制。
