UNIVERSIDADE ESTADUAL PAULISTA

“JÚLIO DE MESQUITA FILHO”

Instituto de Ciência e Tecnologia

Campus de São José dos Campos

ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2023.e3702

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

Impacto da saúde periodontal materna no peso fetal em gestantes iraquianas: um estudo clínico

Ali Raad ABDULAZEEZ

, Ali Bahaa KADHUM

, Bimaa Hameed ALI



1 - University of Mashreq. Baghdad, Iraq.

2 - Iraqi Dental Association. Baghdad, Iraq.

How to cite: Abdulazeez AR, Kadhum AB, Ali BH. Impact of maternal periodontal health on fetus weight in Iraqi pregnant women: a

clinical study. Braz Dent Sci. 2023;26(2):e3702. https://doi.org/10.4322/bds.2023.e3702

ABSTRACT

Objective: the aim of this study was to investigate the relationship between periodontal health condition and the

weight of fetuses in Iraqi pregnant women in order to magnify the importance of periodontal health maintenance

during pregnancy. Material and Methods: fetus weight was determined using ultrasound scanning for 222

pregnant women, accordingly they were divided into two groups: group A: normal fetus weight and group B:

below normal fetal weight. Their periodontal condition was examined by means of Plaque index (PI), Gingival

index (GI), Bleeding on probing (BOP) and Clinical Attachment loss (CAL) using WHO CPITN periodontal probe.

WHO charts of normal fetal weight for each week were considered to determine the normality of fetus weight.

Results: signicant value p=0.00 was obtained when comparing the examined periodontal parameters between

groups A and B, mean of periodontal parameters of PI, GI and BOP were higher in group B (1.1964: 1.4541),

(1.1877: 1.4925), (0.3553: 1.3748) respectively. Q2 and IQR of PI, BOP and GI in group A were (1.190:0.3),

(0.30:0.5), (1.160:0.3) respectively. And (1.460:0.24) (1.50:0.7) (1.460:0.26) in Group B. There were 4 cases of

CAL in group A as opposed to 88 cases in group B, Q2 of CAL in group A=0.00, Q2 in group B=1.00. IQR=0.00

in both groups. Non-signicant value p=0. 503(p>0.05) was seen when comparing the incidence of low fetal

weight between the three trimesters. Conclusion: it is important to maintain a good periodontal condition and

oral Hygiene status in pregnant women for healthier fetal weight and healthier pregnancy with less complications.

KEYWORDS

Oral hygiene; Risk factors; Pregnancy; Fetal weight; Periodontal disease.

RESUMO

Objetivo: o objetivo deste estudo foi investigar a relação entre a condição de saúde periodontal e a peso dos fetos

em gestantes iraquianas para ampliar a importância da manutenção da saúde periodontal durante a gravidez.

Material e Métodos: o peso do feto foi determinado por ultrassonograa 222 As gestantes, consequentemente,

foram divididas em dois grupos: grupo A: peso normal do feto e grupo B: abaixo do peso fetal normal. Sua

condição periodontal foi examinada por meio de índice de placa (IP), gengival índice (GI), Sangramento na

sondagem (BOP) e Perda de Inserção Clínica (CAL) usando a sonda periodontal CPITN da OMS. Os grácos da

OMS de peso fetal normal para cada semana foram considerados para determinar a normalidade do peso feto.

Resultados: obteve-se valor signicativo p=0,00 quando comparados os parâmetros periodontais examinados entre

nos grupos A e B, as médias dos parâmetros periodontais do IP, GI e BOP foram maiores no grupo B (1,1964:

1,4541), (1,1877: 1,4925), (0,3553: 1,3748), respectivamente. Q2 e IQR do PI, BOP e GI no grupo A foram

(1,190:0,3), (0.30:0.5), (1.160:0.3) respectivamente.E (1.460:0.24) (1.50:0.7) (1.460:0.26) no Grupo B. Houve 4

casos de CAL no grupo A em oposição a 88 casos no grupo B, Q2 de CAL no grupo A=0,00, Q2 no grupo B=1,00.

IQR=0,00 em ambos os grupos. Valor não signicativo p=0. 503(p>0,05) foi observado quando comparada a

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

INTRODUCTION

Periodontal health condition can be looked

upon as a mirror for general health, many

correlations and two-way impacts were discovered

between periodontal diseases and a wide variety

of systemic diseases such as: coronary heart

diseases, diabetes mellitus, rheumatism and so

many more [1].

These correlations can be traced back to the

fact that most periodontal pathogens have the

ability to either enter blood stream travelling to

different organs and tissues or its toxins (whether

endotoxins or exotoxins) can damage directly or

indirectly host tissue and cells [2,3].

One of the pictures of how periodontal

condition can impact systemic condition, is

what happens during pregnancy. Despite being

a multifactorial disease, with the dental plaque

accumulation as the major causative factor [3],

it is a well-established fact that pregnancy

promotes periodontal disease. This contradiction

can be explained by the elevation in certain

hormones and inammatory mediators levels

such as IL-6, CRP, TNF-α and progesterone

in blood and gingival sulcular tissue leading

to exaggeration in Immune/inflammatory

responses to dental plaque [4,5], and in the

same time providing extra nutrients for several

periodontal pathogens like

Prevotella intermedia

and

Prevotella nigrescens

[6].

Several researches have backed the idea

of the paramount importance of plaque control

when combined with systemic conditions [7] This

exaggerated inammatory response to periodontal

plaque should be counteracted with magnifying

oral hygiene measures, otherwise the diseased

periodontium will negatively affect both the

mother and the growing fetus in her womb [8].

Raising awareness in this direction (the

health of fetus) may improve the outcome of oral

hygiene and plaque control in pregnant women,

thus many mothers if not all of them prioritize

the health of their child over their own [9].

Estimation of fetus weight has several clinical

signicances, abnormal/low pre-natal weight can

be linked to several neonatal disorders such as:

developmental and neurological disorders and

might also be related to perinatal morbidity [10].

Literature was not empty from debate

around the accuracy of ultrasound measurement

of fetus weight, several researchers mentioned

some inaccuracies of this method when compared

to actual fetus weight at birth and attributed

these discrepancies to several factors such as:

high maternal BMI, late gestation, insufcient

training and experience of examiners and poor

optimization of the ultrasound image [11].

Although alternative clinical methods were

suggested to estimate pre-natal fetus weight with

reasonable outcomes such as Johnson’s formula,

that is useful especially for rural areas where

access to sonography is not quite easy [10].

Other alternatives such as Leopold’s

measurement -which is a bit old technique

described by the German gynecologist Christian

Gerhard Leopold- was also used, still the most

accepted method that obtained better accuracy

with reliability is the ultrasound measurement [12].

In accordance to the subject’s importance,

World Health Organization (WHO) has published

a chart for estimated healthy fetal weight with

variations of outcome in different regions of the

globe, we depended on this chart as a tool to rule

out the normal fetal weight from the abnormal

(whether below or above normal weight)

(Table I) [13].

Periodontal diseases fall into two major

segments: the irreversible form (periodontitis) and

the reversible less serious condition (Gingivitis),

the difference between the two of them is the

term (loss of attachment) [7,14].

Bleeding on probing and change in gingival

color and/or contour can be considered the

incidência de baixo nível fetal peso entre os três trimestres. Conclusão: é importante manter uma boa condição

periodontal e Estado de higiene bucal em gestantes para maior peso fetal e gravidez mais saudável com menos

complicações.

PALAVRAS-CHAVE

Higiene bucal; Fatores de risco; Gravidez; Peso fetal; Doença periodontal.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

clinical signs of Gingivitis, on which feedback

is given to the patient that he or she should put

more effort into the plaque control measures [7].

The periodontitis can be measured clinically

by means of probing pocket depth, clinical

attachment level (CAL) and mobility. These are

the clinical signs that gives us an indication that

periodontal disease has reached the irreversible

stages of periodontitis [15].

The null hypothesis suggests absence of

difference between periodontal parameters in

pregnant women of the two groups: A (normal

fetus weight) and B (low fetal weight), in order

to test the hypothesis, periodontal condition

of pregnant women was examined, indexed

in correlation with fetus weight then studied

statistically.

Aim of this research was to focus more on

the urge to include maternal oral hygiene among

the health/medical parameters that are being

monitored during pregnancy with the same level

of attention. Another null hypothesis was tested

that states that there isn’t a difference between

trimesters regarding normal/abnormal fetus

weight in examined mothers.

Table I - WHO multinational estimated fetus weight chart

Gestational age

Length (US) Cranium

to rump

Weight (US)

Length (cm) Cranium

to rump

Mass (g)

10 weeks 1.22 inch 1.23 ounces 3.1 cm 35 grams

11 weeks 1.61 inch 1.59 ounces 4.1 cm 45 grams

12 weeks 2.13 inches 2.05 ounces 5.4 cm 58 grams

13 weeks 2.64 inches 2.58 ounces 6.7 cm 73 grams

14 weeks 5.79 inches 3.28 ounces 14.7cm 93 grams

15 weeks 6.57 inches 4.13 ounces 16.7 cm 117 grams

16 weeks 7.32 inches 5.15 ounces 18.6 cm 146 grams

17 weeks 8.03 inches 6.38 ounces 20.4 cm 181 grams

18 weeks 8.74 inches 7.87 ounces 22.2 cm 223 grams

19 weeks 9.45 inches 9.63 ounces 24.0 cm 273 grams

20 weeks 10.12 inches 11.68 ounces 25.7 cm 331 grams

21 weeks 10.79 inches 14.07 ounces 27.4 cm 399 grams

22 weeks 11.42 inches 15.17 ounces 29.0 cm 430 grams

23 weeks 12.05 inches 1.10 pounds 30.6 cm 501 grams

24 weeks 12.68 inches 1.32 pounds 32.2 cm 600 grams

25 weeks 13.27 inches 1.46 pounds 33.7 cm 660 grams

26 weeks 13.82 inches 1.68 pounds 35.1 cm 760 grams

27 weeks 14.41 inches 1.93 pounds 36.6 cm 875 grams

28 weeks 14.80 inches 2.22 pounds 37.6 cm 1005 grams

29 weeks 15.47 inches 2.54 pounds 39.3 cm 1153 grams

30 weeks 15.95 inches 2.91 pounds 40.5 cm 1319 grams

31 weeks 16.46 inches 3.31 pounds 41.8 cm 1502 grams

32 weeks 16.93 inches 3.75 pounds 43.0 cm 1702 grams

33 weeks 17.36 inches 4.23 pounds 44.1 cm 1918 grams

34 weeks 17.83 inches 4.73 pounds 45.3 cm 2146 grams

35 weeks 18.23 inches 5.25 pounds 46.3 cm 2383 grams

36 weeks 18.62 inches 5.78 pounds 47.3 cm 2622 grams

37 weeks 19.02 inches 6.30 pounds 48.3 cm 2859 grams

38 weeks 19.41 inches 6.80 pounds 49.3 cm 3083 grams

39 weeks 19.72 inches 7.25 pounds 50.1 cm 3288 grams

40 weeks 20.08 inches 7.63 pounds 51.0 cm 3462 grams

41 weeks 20.39 inches 8.35 pounds 51.8 cm 3787 grams

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

MATERIALS AND METHOD

Principles of Helsinki’s declaration was

carefully followed in this research, a signed letter

of consent was included with the data of every

patient.

Patient’s selection, examination and exclusion

Two hundred twenty two Pregnant

women who attended private Gynecology clinic

participated in this research, complete blood

picture was obtained for all women, testing of

blood pressure and random blood sugar as well

as accumulative blood sugar. After examination

of fetus weight using ultrasonic device model

Fuuda denshi uf-400AX Japan, they were divided

into two groups based on fetus weight:

Group A: Pregnant women with normal

fetus weight

Group B: Pregnant women with abnormal

(below) normal fetus weight (Figure 1).

Exclusion criteria:

1- Women with abnormal blood pressure and/

or blood sugar level.

2- Women with fetal anomalies.

3- Women under legal age for marriage.

4- Women with above average BMI.

Periodontal status (Plaque index, Gingival

index, Bleeding on probing index and Clinical

attachment loss) of each woman from each group

was examined using a CPITN WHO probe and

dental mirror.

Double Blind technique

Each patient had two readings, one by the

dentist who examined the periodontal status

and another by the Gynecologist who estimated

fetus weight. None of them (neither the dentist

nor the gynecologist) knew the readings of the

other. Then the two readings (the periodontal

parameters and the estimated fetus weight)

were unied in statistical analysis stage. This

was performed to rule out bias, especially by

the dentist; if he had known the condition of the

fetus prior to periodontal examination. Names

of patients were covered and only numbers were

used to identify the samples.

Plaque index (PI)

It’s an index designed by Löe et al. [16] to

measure the level of plaque accumulation on teeth

surfaces, it is considered as a measurement of

patient’s commitment with plaque control measures

and an indicator for good/bad oral hygiene [7,16].

It is composed of the following scores:

0: No plaque is evident neither by naked eye

nor by periodontal probe [16];

1: Plaque can be seen on periodontal probe

only [16];

2: Plaque can be seen with naked eye and

doesn’t exceed one third of crown [16];

3: Plaque exceeds one third of crown [16].

Gingival Index (GI)

In order to examine the extent of gingival

inflammation [17], using the CPITN probe, a

gentle it has the following scores:

0: Normal gingival color, contour and absence

of bleeding on probing [17];

1: Abnormal gingival color, contour and

absence of bleeding on probing [17];

2: bleeding on probing that is intermittent [17];

3: sever or continuous bleeding on probing [17].Figure 1 - Patient ﬂow chart.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

Bleeding on probing (BOP)

To rule out presence of bleeding as a sign of

gingivitis more objectively, Bleeding on Probing

was used in which a gentle circular movement of

the WHO periodontal probe’s tip is swept around

the tooth while observing the presence/absence

of bleeding [18]. Scores of this index:

0: No bleeding [18];

1: presence of bleeding [18].

Clinical Attachment Loss (CAL)

To measure the level of attachment loss

clinically, a reference point (cement-enamel

junction) is chosen to represent the “zero”

level; using the WHO calibrated periodontal

probe, 3mm distance apical to this point is

considered clinical attachment loss with exclusion

of attachment loss related to traumatic injuries,

or due to malposition or the attachment loss

distal to the second molar due to extraction of

third molar [19].

Only the presence/absence of Clinical

Attachment Loss was measured, so the patient

who expressed a ≥3mm distance between the

cement-enamel junction and the pocket’s apical

end was recorded positive, otherwise the patient

was considered without clinical attachment loss.

Statistical analysis

Data were tested statistically using IBM SPSS

Statistics. Software version: 26. Null hypothesis

suggested that there is no difference between the

periodontal parameters of the pregnant women in

groups A and B.

Normality test: In-order to test the

distribution of data kromogolov-Smironov test

was used.

Mann-Whitney U test was used to test the

signicance of difference between group A and

group B in periodontal parameters (PI, GI and BOP).

Chi-square test was used regarding the

signicance of difference between the two groups

concerning the clinical attachment loss.

RESULTS

222 samples were divided into two groups,

group A and Group B; group A = mothers of

fetus with normal weight, Group B = mothers

of fetus of below normal weight. Each group had

111 samples.

Normality test

Data were tested for normality, using

kromogolov-Smironov test, the value of

significance was P=0.00, thus we denied the

hypothesis of normal distributed data, indicating

a non-parametric data with abnormal distribution.

(Table II).

Table II - Kolmogorov-Smirnov normality test for distribution of Data

KOLMOGOROV-SMIRNOV

Statistic Diﬀerence Signiﬁcance

PI* 0.090 222 0.000****

BOP** 0.174 222 0.000****

GI*** 0.092 222 0.000****

*PI: Plaque index. **BOP: Bleeding on probing. ***GI: Gingival inde=x

****p < 0.05 are considered signiﬁcant.

Table III - Descriptive statistics of mean of PI, GI, BOP and incidence

of clinical loss of attachment of both groups.

NORMAL

WEIGHT FETUS

UNDERWEIGHT

FETUS

MEAN OF

MOTHER’S PI*

1.1964 1.4541

MEAN OF

MOTHER’S GI**

1.1877 1.4925

MEAN OF

MOTHER’S BOP***

0.3553 1.3748

CLINICAL LOSS

OF ATTACHMENT

INCIDENCE

4 88

*PI: Plaque index. **GI: Gingival index. ***BOP: Bleeding on probing.

Figure 2 - Comparison of PI, GI and BOP between group A: healthy

fetus weight’s mothers and Group B: low fetus weigh’s mothers. *PI:

Plaque index; **GI: Gingival index; ***BOP: Bleeding on probing.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

The mean value of PI in group A (1.1964) was

lower than that of group B (1.4541), Figure 2 and

Table III, p value = 0.00, Table IV. The value of

middle quartile (Q2) of PI in group A =1.190 and

the inter quartile range (IQR) also known as (Q1-

Q3) = 0.3 Figure 3 and Table V. Middle quartile

(Q2) value of group B =1.460 and IRQ=0.24,

Figure 4 and Table VI.

The mean value of GI in group A was (1.1877)

is also lower than mean value of GI of group B

(1.4925), Figure 2 And Table III, p value = 0.00,

Table IV. Middle quartile (Q2) value of group

A = 1.160 and the IQR is (0.3), Figure 5 and Table V.

The middle quartile (Q2) of group B =1.460 and

its IQR is 0.26, Figure 6 and Table VI.

BOP

Mean value of BOP in Group A was (0.3553)

which is less than that in Group B (1.3748),

Figure 2 and Table III, p value = 0.00, Table IV.

Q2 in group A = 0.30 and the IQR is 0.5 Figure 7 and

Table V, while in group B: Q2= 1.50 and the

IQR=0.7, Figure 8 and Table VI.

Table IV - Mann-Whitney U test for the two independent groups

regarding PI, GI and BOP variables

PI* BOP** GI***

MANN-WHITNEY U 2020.000 833.000 1667.000

WILCOXON W 8236.000 7049.000 7883.000

Z -8.687 -11.175 -9.426

ASYMP. SIG. (2-TAILED) 0.000**** 0.000**** 0.000****

*PI: Plaque index. **BOP: Bleeding on probing. ***GI: Gingival index.

****p < 0.05 are considered signiﬁcant.

Table V - Means and quartiles of the periodontal parameters of pregnant women with normal weight fetuses

*PI **BOP ***GI ****CAL

MEAN 1.1964 0.3553 1.1877 0.0360

QUARTILES 25 1.0000 0.0000 1.0000 0.0000

50 1.1900 0.3000 1.1600 0.0000****

75 1.3000 0.5000 1.3000 0.0000****

*PI: Plaque index. **BOP: Bleeding on probing. ***GI: Gingival index. ****CAL: clinical attachment loss. ****p < 0.05 are considered signiﬁcant.

Figure 3 - Quartiles and distribution of Plaque index values of

Group A samples (normal fetus weight).

Figure 4 - Quartiles and distribution of Plaque index values of

Group B samples (below normal fetus weight).

Table VI - Means and quartiles of the periodontal parameters of pregnant women with below normal weight fetuses

*PI **BOP ***GI ****CAL

MEAN 1.4541 1.3748 1.4925 0.7928

QUARTILES 25 1.3600 1.0000 1.3400 1.0000

50 1.4600 1.5000 1.4600 1.0000

75 1.6000 1.7000 1.6000 1.0000

*PI: Plaque index. **BOP: Bleeding on probing. ***GI: Gingival index. ****CAL: clinical attachment loss.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

CAL

In group A only 4 cases were found suffering

from clinical loss of attachment as opposed

to 88 cases in group B, Figure 9 and Table III,

p value = 0.00, Table VII. Q2 of group A

was (0.00) and IQR= 0.00, Figure 10 and

Table V. While Q2=1.00 and IQR= 0 in group B,

Figure 11 and Table VI. (IQR=0 since there are

only two limits Q1=0.00 and Q3=0.00 in group

A, Q1and Q3=1 in group B).

Figure 5 - Quartiles and distribution of Gingival index values of

Group A samples (normal fetus weight).

Figure 6 - Quartiles and distribution of Gingival index values of

Group B samples (below normal fetus weight).

Figure 7 - Quartiles and distribution of Bleeding on probing values

of Group A samples (normal fetus weight).

Figure 8 - Quartiles and distribution of Bleeding on probing values

of Group B samples (below normal fetus weight).

Figure 9 - Comparison of Clinical attachment loss incidence

between Group A: normal fetus weight’s mothers and Group B: low

fetus weigh’s mothers

Figure 10 - Quartiles and distribution of Clinical attachment loss

values of Group A samples (normal fetus weight).

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

Comparison between trimesters

When taking the trimesters in which pregnant

women were during periodontal examination, it

was found that mothers in rst trimester didn’t have

any incidence of abnormal fetus weight, the highest

recorded cases of abnormal weight fetuses was in

the second trimester (71 cases), while the mothers in

third trimester showed the highest number of normal

weight fetuses (47) (Table VIII) and (Figure 12).

These results however have failed to obtain

a signicant difference when tested statistically

P>0.05, thus hypothesis of absence of difference

between trimesters regarding fetus weight was

not denied (Table IX).

DISCUSSION

Periodontal diseases are known to be

caused by several pathogenic bacteria such

as (

Aggregatibacter actinomycetemcomitans

Porphyromonas gingivalis

Prevotella intermedia

...etc.) and manifests itself as inammatory process

that is either confined to the gingiva namely

gingivitis, or extends to the underlying supporting

apparatus to be known as periodontitis [7,20].

These micro-organisms can provoke directly

or indirectly inflammation through several

Table VII - Chi-square test of clinical attachment loss between the two groups

CHI-SQUARE TESTS

Value df

Asymptotic Signiﬁ-

cance (2-sided)

Exact Sig.

(2-sided)

Exact Sig.

(1-sided)

PEARSON CHI-SQUARE 130.973 1 0.000*

CONTINUITY CORRECTIONB 127.873 1 0.000*

LIKELIHOOD RATIO 153.509 1 0.000*

FISHER’S EXACT TEST 0.000* 0.000*

LINEAR-BY-LINEAR ASSOCIATION 130.383 1 0.000*

N OF VALID CASES 222

*p < 0.05 are considered signiﬁcant.

Table VIII - Descriptive statistics of trimesters of the examined

pregnant women

NORMAL

WEIGHT

BELOW

WEIGHT

TOTAL

FIRST

TRIMESTER

19 0 19

SECOND

TRIMESTER

45 71 116

THIRD

TRIMESTER

47 40 87

TOTAL 111 111 222

Table IX - Mann-Whitney U test for the correlation between

trimesters and fetal weight

MANN-WHITNEY U 5874.500

WILCOXON W 12090.500

Z -.670

ASYMP. SIG. (2-TAILED) 0.503

Figure 11 - Quartiles and distribution of Clinical attachment loss

values of Group B samples (below normal fetus weight).

Figure 12 - Distribution of low weight fetuses and normal weight

fetuses on the three main pregnancy trimesters.

Braz Dent Sci 2023 Apr/Jun;26 (2): e3702

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi pr egnant women: a clinical study

Abdulazeez AR et al.

Impact of maternal periodontal health on fetus weight in Iraqi

pregnant women: a clinical study

inammatory mediators [21] such as PGE2 which

was isolated from the gingival crevicular uid

and saliva of pregnant women in their 7

and 8

month of pregnancy [22].

Other biomarkers like 8-OHdG have

the ability to cause dagame to DNA though

disturbance of oxidants/antioxidants balance or

what is known as oxidative stress.

Tumor necrosis factor alpha (TNF-α)

interleukins (IL-6, 1 β) are other inammatory

mediators that are associated with periodontal

diseases and on the same time were linked to

pregnancy problems such as preterm births

(PTB) [23].

Our findings (Figure 2) that was proven

statistically line with these assumptions, in a way

that the worse the periodontal parameters were,

there was a low fetus weight detection.

This was also the case in the meta-analysis

and systemic review that was run by Corbella

et.al in 2016, involving 17035 subjects from

22 different studies. In this review; a signicant

correlation between adverse pregnancy outcomes

and periodontal disease was found [24].

These ndings contradicted an older study

which was conducted in 2012 by Srinivas and

Parry who didn’t nd a signicant relationship

between periodontal diseases and pregnancy [25].

Although there was a raise in the incidence

of low fetus weight among women in their

second trimester (Figure 12) we failed to prove

a statistical difference.

There is a growing body of literature

that supports the concept of maintaining an

inammation -free environment for the fetus to

grow up, this can be achieved through maintaining

a good balance between the pro-inammatory

cytokines and anti-inammatory cytokines [26],

a shift towards inflammatory cytokines like

(IL-6, IL-1, TNF, GM-CSF, G-CSF) was evident

in patients with periodontal disease. Inducing

osteoclasts activity and local tissue destruction

by chemokines like matrix metalloproteinase,

RANKL and VEGF promotes the progression of

disease [27].

The pro-inflammatory trophoblastic

response by the growing embryo, can lead into

restriction of passage of nutrients and oxygen

through placenta to the growing fetus, which will

consequently affect the normal growth process

and might lead to increase in chronic disease risk

in adulthood [28,29].

CONCLUSION

Deterioration of periodontal status in

pregnant women is associated with low fetal

weight as seen in ultrasound scanning. Not only

biolm control measures should be implemented

but also an active periodontal treatment is

recommended.

Author’s Contributions

ARA: Methodology, data analysis, writing

and reviewing, corresponding author. ABK: Data

collection, participation in patients examination,

logistics and access to gynecological clinics.

BHA: Data collection, participation in patients

examination.

Conict of Interest

The authors of this research declare that

there is no conict of interest to disclose.

Funding

This work didn’t receive any funding or

nancial support by any institution(s) and/or

individual(s) rather than the authors themselves.

Regulatory Statement

This research was approved by the medical

ethics committee of University of Mashreq/

College of Dentistry that was given in order

no.218 dated 1/10/2023.

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Ali Raad Abdulazeez

(Corresponding address)

University of Mashreq, Baghdad, Iraq.

Email: dr.aliraad1986@gmail.com

Date submitted: 2022 Nov 19

Accept submission: 2023 Mar 27