Pregnancy

Pregnant women with periodontal (gum) disease are more likely to develop gestational diabetes mellitus than pregnant women with healthy gums

ScienceDaily (Mar. 25, 2008) — A study by a New York University dental research team has discovered evidence that pregnant women with periodontal (gum) disease are more likely to develop gestational diabetes mellitus than pregnant women with healthy gums.

The study, led by Dr. Ananda P. Dasanayake, a professor of epidemiology & health promotion at the NYU College of Dentistry, followed 256 women at New York's Bellevue Hospital Center through their first six months of pregnancy. Twenty-two women developed gestational diabetes. Those women had significantly higher levels of periodontal bacteria and inflammation than the other women in the study.

The findings, published in the April 2008 issue of the Journal of Dental Research, underscore how important it is for expectant mothers to maintain good oral health.

"In addition to its potential role in preterm delivery, evidence that gum disease may also contribute to gestational diabetes suggests that women should see a dentist if they plan to get pregnant, and after becoming pregnant," says Dasanayake. "Treating gum disease during pregnancy has been shown to be safe and effective in improving women's oral health and minimizing potential risks."

"In the future," he added, "we can expect to see more research on the link between these two conditions involving other high risk groups, such as Asian and Native American women."

Gestational diabetes is characterized by an inability to transport glucose -- the main source of fuel for the body -- to the cells during pregnancy. The condition usually disappears when the pregnancy ends, but women who have had gestational diabetes are at a greater risk of developing the most common form of diabetes, known as Type 2 diabetes, later in life. Hispanics, Asians, and Native Americans are at the highest risk for developing gestational diabetes. Eighty percent of the women in the NYU study were Hispanic.

Inflammation associated with periodontal disease is believed to play a role in the onset of gestational diabetes, perhaps by interfering with the normal functioning of insulin, the hormone that regulates glucose metabolism.

Bacteria in mouth can cause preterm birth

Cigna offers extended perio care to pregnant women

If expectant mums put on the pounds, so do the kids

You may have heard a few old wives' tales about pregnancy, including “A tooth lost for every child.” While it seems far-fetched, it actually is based loosely in fact. Your teeth and gums are affected by pregnancy, primarily through hormonal changes, just as other tissues in your body. You may not be aware that the health of your gums may also affect the health of your baby.

How does pregnancy affect your teeth and gums?

About 50% of women experience "pregnancy gingivitis". This condition can be uncomfortable and cause swelling, bleeding, redness or tenderness in the gum tissue. A more advanced oral health condition called periodontal disease (a serious gum infection that destroys attachment fibers and supporting bone that hold teeth in the mouth) may affect the health of your baby.

Is periodontal disease linked to preterm low birthweight babies?

Studies have shown a relationship between periodontal disease and preterm, low birthweight babies. In fact, pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small. The likely culprit is a labor-inducing chemical found in oral bacteria called prostaglandin. Very high levels of prostaglandin are found in women with severe cases of periodontal disease.

What if I'm diagnosed with periodontal disease during pregnancy?

If you're diagnosed with periodontal disease, we might recommend a common non-surgical procedure called scaling and root planing. During this procedure, your tooth-root surfaces are cleaned to remove plaque and tartar from deep periodontal pockets and smooth the root to remove bacterial toxins. Research suggests that scaling and root planing may reduce the risk of preterm births in pregnant women with periodontal disease. The added bonus is that the procedure should alleviate many of the uncomfortable symptoms associated with pregnancy gingivitis, such as swelling and tenderness of the gums.

As you make your way through the “to-dos” during pregnancy, remember to check off a visit to your favorite dentist. This will benefit you and your unborn baby.

CLEVELAND, April 6, 2006- The first hard evidence has been uncovered that bacteria in the mouth may find their way to the uterus, causing uterine infections that can lead to preterm birth in pregnant women.

A newly discovered and as yet unnamed species of the bacterium genus Bergeyella was found in the mouth and amniotic fluid of a woman with a uterine infection who gave birth prematurely (24 weeks), reported microbiologist Yiping W. Han, Ph.D., of Case Western Reserve here.

However, the bacterium was not detected in a vaginal swab, as might be expected. The finding confirmed what some scientists have suspected, that intrauterine infections don't always "ascend" from the genital tract but can "descend" from the oral cavity, Dr. Han and colleagues said in the April issue of the Journal of Clinical Microbiology.

The study included 19 pregnant women undergoing transabdominal amniocentesis because of preterm labor or threatened preterm labor. Amniotic fluid, blood samples, vaginal swabs, and oral swabs were collected from each woman and analyzed for bacterial DNA via polymerase chain reaction (PCR) and nucleotide sequencing.

The species of Bergeyella was detected in the mouths of all 14 women tested, but in the amniotic fluid of only one patient.

This woman had been diagnosed with a uterine infection based on an elevated white blood cell count and a low glucose level in the amniotic fluid.

She went into labor, induced because of the infection, and delivered her baby at 24 weeks' gestation. Subsequent analysis of her placenta revealed severe and diffused chorioamnionitis and fetal vasculitis involving the umbilical cord and chorionic plate, which was the presumed cause of her preterm labor.

"Intrauterine infection with Bergeyella has never been reported before. Where could the bacteria come from?" the investigators asked. Because the bacteria were not detected in the vaginal tract, the investigators hypothesized they were transmitted to the uterus from the mouth via the bloodstream.

The bacteria were not detected in the patient's blood, but they had likely been cleared from the blood by the immune system before they could be detected, Dr. Han said.

Although periodontal disease has been implicated in preterm birth, the patient showed no evidence of periodontal disease, the researchers noted.

"The study is an eye-opener," Dr. Han said. "It shows that oral bacteria can get into the uterus."

The study also suggested that more than the usual bacterial suspects may be responsible for uterine infection and resulting preterm birth, Dr. Han added. The usual suspects are known vaginal flora such as Ureaplasma urealyticum or Mycoplasma hominis. But Bergeyella, a little-known, rod-shaped, Gram-negative bacteria associated with dog and cat bite wounds, had not been thought to be an important component of the oral or vaginal flora.

One reason Bergeyella may have been overlooked previously is that it is difficult to grow in culture. As much as 60% to 70% of oral bacteria can not be detected by growing on culture. The current study detected Bergeyella because it used PCR amplification of bacterial DNA rather than traditional culturing techniques, Dr. Han said.

While suggestive, the study's findings do not yet support routine analysis of pregnant women's oral or vaginal flora to identify those who may be at risk for uterine infection, Dr. Han said.

"That is the question we want to ask now," she said. Her research is examining whether particular components or oral or vaginal flora are associated with increased risk for uterine infection or preterm birth.

The mother and baby from the study are healthy and doing well, Dr. Han said.

Primary source: Journal of Clinical Microbiology
Source reference:
Yiping Han et al. Transmission of an uncultivated Bergeyella strain from the oral cavity to amniotic fluid in a case of preterm birth. Journal of Clinical Microbiology 2006; 44:1475-1483.

CIGNA Dental has followed the research that shows women with periodontal (gum) disease may be at increased risk for pre-term babies. That's why we are launching our new CIGNA Dental Oral Health Maternity Program, which enhances benefits for pregnant members with CIGNA medical and fully-insured dental coverage.

We hope this will encourage pregnant members to have an oral health exam and to seek needed treatment for gum disease. Effective 1/1/06 CIGNA Dental will cover periodontal scaling and root planing performed during pregnancy at 100% for eligible members. In addition, for pregnant members not requiring scaling and root planing, we will cover an additional cleaning during pregnancy because we recognize the potential risk of "pregnancy gingivitis." We will also cover treatment for inflamed gums around wisdom teeth at 100% during pregnancy.

If you are pregnant and have CIGNA medical coverage, be sure to enroll in the CIGNA HealthCare Healthy Babies® program. Learn more.

If expectant mums put on the pounds, so do the kids

December 1, 2005

NO WONDER America has a growing weight problem: its children are being condemned to a life of obesity while still in the womb. According to two new studies, overeating by expectant mothers is an important but overlooked factor in the inexorable expansion of the nation's waistlines. More alarming is the conclusion of one of the new studies, from a team at Harvard Medical School, that even women who follow official advice on how much weight they should gain during pregnancy may be priming their children to become obese.

In the US 16 per cent of children are classed as obese - a threefold increase since 1980. Among adults, the obesity rate is 30 per cent. That's a major concern, because obese people suffer from health problems, including heart disease, diabetes and stroke. So far, public health strategists have fought childhood fat by promoting healthy eating and exercise among children themselves.

But the Harvard team, led by Matthew Gillman, and another group led by Andrea Sharma of the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, decided to investigate the effect of weight gain during pregnancy. Last month in Toronto, Canada, they told the third International Congress on Developmental Origins of Health and Disease that the children of women who put on a lot of weight during pregnancy were particularly prone to obesity.

Obstetricians agree that it is important for women to gain some weight - beyond that of the developing fetus - if they are to have a healthy pregnancy. Guidelines issued by the US Institute of Medicine (IOM) in 1990, taking into account that women have different builds, suggest that a "normal" woman should gain between 11.5 and 16 kilograms, including the weight of the fetus. The World Health Organization suggests a similar range of 10 to 12.5 kilograms.

Gillman's PhD student Emily Oken divided her study group of 770 pregnant women from Massachusetts into those who gained "inadequate", "adequate" and "excessive" amounts of weight according to the IOM guidelines. In both of the last two groups, children were on average already overweight by the age of 3. "Only the 'inadequate' group gives a result that is where you want to be," says Gillman.

Sharma, meanwhile, scoured national health records and found a correlation between pregnancy weight gain and obesity among children aged 2 to 4. But her team found that it was mothers who had piled on more pounds than the IOM recommends who were more likely to have obese children - not the "adequate" weight-gainers. "Our data suggest that it's excessive weight gain that is the problem," Sharma says.

It is unclear why the two studies produced different conclusions. Sharma's study was much larger, incorporating some 190,000 families. But because the Harvard group could follow their volunteers in more detail, they may have controlled more effectively for other factors influencing the results. Oken found that the relationship between pregnancy weight gain and childhood obesity remained strong after controlling for factors including race, parental smoking, household income and fetal growth during pregnancy.

The IOM is planning to convene a workshop in spring 2006 to consider new data on the consequences of weight gain during pregnancy, including studies on childhood obesity.

In the meantime, researchers are warning pregnant women against adopting a starvation diet in the hope of having svelte, healthy children. Not only is it important to resolve the discrepancy between the two studies, they say, but women who fail to gain sufficient weight during pregnancy are also at greater risk of problems, including premature births. "It depends on what outcome you look at," says Naomi Stotland, an obstetrician at the University of California, San Francisco.

From issue 2528 of New Scientist magazine, 01 December 2005, page 14