Oral Infection & Pregnancy

In a collaborative study, published in 2009, Case Western Reserve University (Department of Periodontics) and Yale University (Dep. of Obstetrics and Reproductive Science) concluded that intra-amniotic infection and inflammation are major causes of preterm birth. Women who were identified having bacterial DNA more often had elevated levels of inflammatory markers (IL-6) in their amniotic fluid and inflammation of fetal membranes and the umbilical cord. These women delivered neonates with early-onset neonatal sepsis.

Preterm birth remains a significant public health problem. 70% of the infants who die within weeks after being born are those who were born prematurely. Nearly half of those who survive develop long-term neurological problems. There is abundant literature indicating that a significant number of miscarriages are associated with intrauterine microbial infection and inflammation.

By testing the amniotic fluid (amniocentesis) in pregnant women doctors, among other things, are looking for a possible bacterial infection. However, studies have shown that as many as two-thirds of the organisms associated with intra-amniotic infection are uncultivated (cannot be cultured in the lab) or difficult-to-cultivate bacteria.

Taking advantage of the latest cutting-edge DNA-based technologies for the detection and identification of infectious agents, doctors now are able to provide a comprehensive mapping of the bacteria in body fluids, including the amniotic fluid, providing rapid results.

The discovery that bacteria can be identified in the amniotic fluid of women with negative bacterial cultures and high levels of intra-amniotic inflammation is thus of significant clinical relevance.

By using the DNA-based identification method, it was determined that the most prevalent species of bacteria associated with preterm birth were Fusobacterium nucleatum (Fn).
Fn is an opportunistic oral pathogen. Fn bacteria originate in the oral cavity, where they are involved in gum disease (periodontal disease) and create an inflammation.
This finding provided evidence that, in addition to the vaginal species, bacteria from oral sources play a significant role in intra-amniotic infection. It was long suspected but now proven, that after Fn and other oral pathogens enter the bloodstream in the mouth of pregnant women, bacteria “translocate” (move to other sites) to the uterus and, through the umbilical cord, reach the fetus.
In addition, scientists have found that the presence of Fn bacteria in the amniotic fluid was correlated with the increase of IL-6 (an inflammatory marker). Even without the presence of bacteria in the uterus, the general inflammation within the mother’s body involves the inflammation of amniotic membranes, surrounding the fetus, and the walls of the umbilical cord. Therefore, if a pregnant woman has Fn and other oral pathogens in her mouth, even before the bacteria reaches the uterus, the inflammatory reaction of her body already compromises the fetus and the outcome of the pregnancy.
In view of the latest discoveries and obtained knowledge, health scientists and clinicians strongly recommend pregnant women or those who are planning pregnancy, to be thoroughly evaluated for the presence of oral pathogens, treatment of periodontal disease and, if necessary, undergo anti-inflammatory treatment with their physicians, which is vital in preventing preterm birth and its consequences for the neonates.

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