Gum Disease and the Link to Pregnancy Complications

by Jennifer Wider, M.D.

Pregnant women who have gum disease are at a greater risk for developing preeclampsia, or pregnancy-induced hypertension, according to a new study published in the journal Obstetrics and Gynecology. Obstetricians who normally screen women for established preeclampsia risk factors such as chronic high blood pressure, diabetes, kidney disorders, multiple gestation and autoimmune disorders, now need to pay close attention to patients with poor oral health.

Researchers analyzed the deliveries of 763 women and discovered that those with severe periodontal disease during pregnancy were more than twice as likely to develop preeclampsia than women without gum disease. This study contributes to a growing body of evidence that links gum disease to other pregnancy complications including premature birth.

According to Sally Cram, DDS, ADA Consumer Advisor and periodontist in private practice in Washington, DC, periodontal disease is a chronic infection caused by certain types of bacteria. "Pathways present in infections can lead to increased levels of prostaglandins and the production of endotoxins. Since prostaglandins increase normally throughout pregnancy to induce labor and delivery, it seems plausible that increases in these mediators due to infection may hasten the process." In other words, an infection that starts in the mouth may produce chemicals that could cause an early delivery or possibly preeclampsia.

Preeclampsia is a disorder that affects pregnant women who are usually in their late second or third trimesters. It progresses quickly, resulting in high blood pressure, swelling and protein in the urine. Most women experience rapid weight gain, dizziness and vision changes, but some experience fewer symptoms. When left untreated, preeclampsia can turn into eclampsia, an extremely dangerous condition that can cause seizures, stroke and possibly fetal and/or maternal death.

Preeclampsia is one of the foremost causes of preterm birth, or birth before 36 weeks gestation. Women with preeclampsia need to be strictly managed by their physicians. The only known cure is delivery, although medications can prolong the pregnancy and increase the chance of survival for the baby.

Women are prone to gum disease during times of hormonal fluctuation: puberty, pregnancy, and menopause. "This is probably due to increased levels of progesterone and estrogen which cause increased blood flow to the gums," according to Dr. Cram. The gums become swollen, red and sensitive: "which leads to greater susceptibility to foods, plaque and bacteria," explains Cram.

According to Gordon I. Douglass, DDS, President of the American Academy of Periodontology, "New findings suggest that approximately 25 percent of pregnant women demonstrate an increase in periodontal pocketing during pregnancy." These oral changes leave women vulnerable to pregnancy complications, underscoring the need for regular check-ups.

Maintaining good oral health is vital to protect both mother and baby during pregnancy. Pregnant women should schedule an exam with their dentist or periodontist as part of their prenatal care. According to Dr. Douglass: "If a pregnant woman has good periodontal health and has been visiting her dentist every 6 months, she can continue on that schedule. If she notices changes in her gum tissues (bleeding, swelling), she should see her dentist or periodontist immediately. Depending upon the changes that have occurred, the schedule may be shortened to 3-4 months."

The Society for Women's Health Research is the nation's only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Dr. Donnica Moore has been a member of the Society since 1990 and is a past member of its Board of Directors.

Created: 3/21/2003  -  Jennifer Wider, M.D.