Publikationsserver der Universitätsbibliothek Marburg
Titel:Parodontale Erkrankungen bei Schwangeren und ihr Einfluss auf Frühgeburt und fetale Wachstumsrestriktion - State of the Art: eine Literaturauswertung
Autor:Scheumann, Gwendolyn
Weitere Beteiligte: Kühnert, Maritta (Prof. Dr. med.)
Veröffentlicht:2012
URI:https://archiv.ub.uni-marburg.de/diss/z2012/0872
URN: urn:nbn:de:hebis:04-z2012-08724
DOI: https://doi.org/10.17192/z2012.0872
DDC: Medizin
Titel (trans.):Periodontal disease in pregnant women and its influence on preterm birth and fetal growth restriction - state of the art: a review of the literature
Publikationsdatum:2012-11-01
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Frühgeburt, Preterm birth, Fetal growth restriction, Parodontitis, Frühgeburt, Periodontal disease, Parodontitis, Fetale Wachstumsrestriktion

Zusammenfassung:
Die Reduktion perinataler Morbidität und Mortalität ist ein wichtiges medizinisches Ziel. Als wesentlicher Faktor, der für die perinatale Morbidität und Mortalität verantwortlich gemacht wird, ist die Frühgeburtlichkeit zu nennen. Durch die Unreife der Organsysteme Frühgeborener kann es zu zahlreichen akuten Erkrankungen, wie Atemnotsyndrom, intrazerebralen Blutungen und septischen Krankheitsbildern aufgrund der erhöhten Infektdisposition, kommen. Infolge dessen treten chronische, insbesondere pulmonale und neurologische, Folgeschäden auf, die nicht nur für das Frühgeborene und dessen Familie eine Belastungssituation darstellen, sondern auch vom Gesundheits- und Sozialsystem enorme Leistungen erfordern, die mit hohen Kosten verbunden sind. Schätzungen zufolge waren im Jahr 2006 ca. 12,8 % der Geburten Frühgeburten. Ca. 70 % der Frühgeburten ereignen sich spontan, wovon 45 % auf eine vorzeitige Wehentätigkeit und 25 % auf einen vorzeitigen Blasensprung zurückzuführen sind. Zur Reduktion der Frühgeburtsraten ist es entscheidend, insbesondere die Genese der spontanen Frühgeburten besser zu kennen, um sinnvolle Präventionsmaßnahmen ergreifen zu können. Schätzungen zufolge sind 25 % - 50 % der spontanen Frühgeburten auf eine Infektion zurückzuführen. Seit Offenbacher et al. 1996 ihre Arbeit zum möglichen Zusammenhang einer Parodontitis mit Frühgeburt und niedrigem Geburtsgewicht veröffentlichten, wird ein verstärkter Fokus auf die Untersuchung dieser Theorie gelegt. Offenbacher et al. postulierten, dass eine Parodontitis einen unabhängigen Risikofaktor für die Entbindung untergewichtiger Frühgeborener darstellt. Die pathophysiologischen Überlegungen umfassen verschiedene Wege, wie eine Parodontitis eine Frühgeburt auslösen könnte: entweder kann es durch hämatogene Streuung der oralen pathogenen Keime in die Plazenta oder Amnionflüssigkeit zu einer intrauterinen Infektion kommen, oder die chronische parodontale Entzündung selbst führt zu einer systemischen Infektion, die letztlich über erhöhte Zytokin- und Prostaglandinspiegel eine Frühgeburt auslösen kann. Da die Erkrankung mit Scaling und Root planning gut behandelbar ist, wäre es wichtig, sie als Risikofaktor für eine Frühgeburt zu identifizieren und somit zur Senkung der Frühgeburtsraten beizutragen. Die seit 1996 durchgeführten klinischen Studien variieren sehr in ihren Ergebnissen. So können einige Studien einen positiven Zusammenhag zwischen einer mütterlichen Parodontitis und einer Frühgeburt und einem niedrigen Geburtsgewicht nachweisen, andere wiederum können diese These nicht unterstützen. Bis 2007 kann kein einheitlicher Trend definiert werden. Die in dieser Arbeit betrachteten 37 Veröffentlichungen seit 2008 liefern weiterhin unterschiedliche Ergebnisse. Bei den untersuchten Studien handelt es sich um Beobachtungs- und Interventionsstudien. Zusätzlich wurden die Metaanalysen und Reviews seit 2008 berücksichtigt. Ein großes Problem in der Interpretation der Resultate stellen u.a. die verschiedenen Studiendesigns, die unterschiedlichen Probengrößen, die Populationsheterogenität und das Fehlen einer einheitlichen Parodontitisdefinition dar. Die Studien sind daher nur begrenzt miteinander vergleichbar. Zusammenfassend kann zum aktuellen Zeitpunkt keine definitive Aussage getroffen werden, ob eine Parodontitis einen unabhängigen Risikofaktor für eine Frühgeburt und ein niedriges Geburtsgewicht darstellt oder nicht. Es werden weitere randomisierte kontrollierte Studien, eine einheitliche Parodontitisdefinition, definierte Therapiestrategien und deren Erfolgskontrolle sowie weitere Investitionen in die Grundlagenforschung benötigt. Zum jetzigen Stand der Forschung sollte die Untersuchung des Parodontalstatus in die pränatale Routinevorsorge integriert werden und bei entsprechender Erkrankung auch eine Behandlung stattfinden.

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