The Interaction Effect of Bacterial Vaginosis and Periodontal Disease on the Risk of Preterm Delivery

Abstract

The objective of this article is to determine if coexistence of periodontal disease (PD) and bacterial vaginosis (BV) is synergistic on the risk of spontaneous preterm delivery (sPTD). The study design was secondary analysis of a prospective cohort study. Women were screened 6 to 20 weeks gestation for PD and BV. Groups were defined by presence of BV and stratified on PD. The primary outcome was sPTD <37 weeks gestation. Univariable, stratified, and multivariable analyses were performed to estimate the main and interaction effects of BV and PD on sPTD. Of 1453 women screened, 792 (54.5%) were diagnosed with BV. Neither women with BV in the first trimester nor PD was at higher risk of sPTD (risk ratio [RR] for BV 1.1; 95% confidence interval (CI), 0.8–1.5, and RR for PD 0.9; 95% CI, 0.7–1.3). The interaction between BV and PD did not statistically significantly impact the odds of sPTD. Coexistence of PD and BV did not have a synergistic effect on sPTD.

Keywords

bacterial vaginosis - periodontal disease - preterm delivery

• References

• 1 Goepfert AR, Jeffcoat MK, Andrews WW , et al. Periodontal disease and upper genital tract inflammation in early spontaneous preterm birth. Obstet Gynecol 2004; 104 (4) 777-783
• 2 Hay PE, Lamont RF, Taylor-Robinson D, Morgan DJ, Ison C, Pearson J. Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. BMJ 1994; 308 (6924) 295-298
• 3 Hillier SL, Nugent RP, Eschenbach DA , et al; The Vaginal Infections and Prematurity Study Group.. Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. N Engl J Med 1995; 333 (26) 1737-1742
• 4 Jeffcoat MK, Geurs NC, Reddy MS, Cliver SP, Goldenberg RL, Hauth JC. Periodontal infection and preterm birth: results of a prospective study. J Am Dent Assoc 2001; 132 (7) 875-880
• 5 Offenbacher S, Katz V, Fertik G , et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996; 67 (10, Suppl) 1103-1113
• 6 Persson R, Hitti J, Verhelst R , et al. The vaginal microflora in relation to gingivitis. BMC Infect Dis 2009; 9: 6
• 7 Menard JP, Mazouni C, Salem-Cherif I , et al. High vaginal concentrations of Atopobium vaginae and Gardnerella vaginalis in women undergoing preterm labor. Obstet Gynecol 2010; 115 (1) 134-140
• 8 Romero R, Gomez R, Ghezzi F , et al. A fetal systemic inflammatory response is followed by the spontaneous onset of preterm parturition. Am J Obstet Gynecol 1998; 179 (1) 186-193
• 9 Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med 2000; 342 (20) 1500-1507
• 10 Kornman KS, di Giovine FS. Genetic variations in cytokine expression: a risk factor for severity of adult periodontitis. Ann Periodontol 1998; 3 (1) 327-338
• 11 Verstraelen H, Verhelst R, Nuytinck L , et al. Gene polymorphisms of Toll-like and related recognition receptors in relation to the vaginal carriage of Gardnerella vaginalis and Atopobium vaginae. J Reprod Immunol 2009; 79 (2) 163-173
• 12 Gómez LM, Sammel MD, Appleby DH , et al. Evidence of a gene-environment interaction that predisposes to spontaneous preterm birth: a role for asymptomatic bacterial vaginosis and DNA variants in genes that control the inflammatory response. Am J Obstet Gynecol 2010; 202 (4) 386-, e1–e6
• 13 Macones GA, Parry S, Elkousy M, Clothier B, Ural SH, Strauss III JF. A polymorphism in the promoter region of TNF and bacterial vaginosis: preliminary evidence of gene-environment interaction in the etiology of spontaneous preterm birth. Am J Obstet Gynecol 2004; 190 (6) 1504-1508, discussion 3A
• 14 Macones GA, Parry S, Nelson DB , et al. Treatment of localized periodontal disease in pregnancy does not reduce the occurrence of preterm birth: results from the Periodontal Infections and Prematurity Study (PIPS). Am J Obstet Gynecol 2010; 202 (2) 147-, e1–e8
• 15 Srinivas SK, Sammel MD, Stamilio DM , et al. Periodontal disease and adverse pregnancy outcomes: is there an association?. Am J Obstet Gynecol 2009; 200 (5) 497-, e1–e8
• 16 Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991; 29 (2) 297-301
• 17 Carey JC, Klebanoff MA, Hauth JC , et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000; 342 (8) 534-540
• 18 Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995; 333 (26) 1732-1736
• 19 Kekki M, Kurki T, Pelkonen J, Kurkinen-Räty M, Cacciatore B, Paavonen J. Vaginal clindamycin in preventing preterm birth and peripartal infections in asymptomatic women with bacterial vaginosis: a randomized, controlled trial. Obstet Gynecol 2001; 97 (5 Pt 1) 643-648
• 20 Oittinen J, Kurki T, Kekki M , et al. Periodontal disease and bacterial vaginosis increase the risk for adverse pregnancy outcome. Infect Dis Obstet Gynecol 2005; 13 (4) 213-216