Parodontale Erkrankungen bei Schwangeren und ihr Einfluss auf Frühgeburt und fetale Wachstumsrestriktion - State of the Art: eine Literaturauswertung

Preterm birth, defined as a childbirth occurring at less than completed 37 weeks or 259 days of gestation, is a major cause of perinatal mortality and morbidity. Additionally, it has adverse long-term consequences for health as well as economic consequences for the health services and the society. According to latest estimates the annual costs amount to US$ 26 billion in the United States. For different reasons, its rate has been increasing worldwide during the last two decades. The WHO estimated that there were 12.9 Mio. preterm deliveries or 9.6 % of all births in 2005. In Germany, the prevalence with about 9 % is higher than the European standard. In 2006, there was an increase of the worldwide incidence of preterm delivery of 12.8 %. About 70 % of the preterm deliveries occur spontaneously, whereof 45 % follow spontaneous preterm labour and 25 % follow preterm premature rupture of the membranes. A better understanding of the genesis of spontaneous preterm labour is needed to improve access to obstetric and neonatal care to lower the incidence of preterm birth and preterm low birth weight with all its adverse sequelae. Many risk factors like tobacco use, drug use, alcohol consumption, level of prenatal care, parity, genitourinary infections, low socioeconomic status and previous preterm deliveries have already been identified, but in this work, the possible risk factor periodontitis shall be discussed. After Offenbacher et al. demonstrated the results of their study “Periodontal infection as a possible risk factor for preterm low birth weight” in 1996, research on this new risk factor increased. Offenbacher et al. postulated that periodontal disease is an independent risk factor for preterm low birth weight and estimated that 18.2 % of all preterm low birthweight cases may be attributable to periodontal disease. Even though much the topic has been discussed widely, no clear trend of the association between maternal periodontitis and preterm birth and/or low birth weight could be shown and much debate over this topic has been carried out. Studies differ a lot concerning their design, i.e. prospective or retrospective, sample size, population differences or criteria to define periodontal disease. On account of such confounding variables, results may differ and make it difficult to compare the studies. The studies considered in this work since 2008 continue to differ in its findings. In summary, we cannot make a definitive conclusion about the impact of maternal periodontitis and their therapy on an ongoing pregnancy and pregnancy outcomes. Further research is needed on the molecular pathways. We also need a clear definition of periodontitis as well as defined strategies of therapy and their surveillance. At the moment, all we can say is that pregnant women should be screened for periodontal disease as a part of routine prenatal care and should also be treated in case of corresponding disease.