Inflammatory Cytokines in Gingival Crevicular Fluid and Placental Tissues in Chronic Periodontitis Patients With Preterm Delivery

Periodontal disease is a commonGram-negative chronic anaerobic infection of the periodontium, with an estimatedworld prevalence of 10% to 15% (Genco RJ, et al. 1992, Petersen PE & Ogawa H. 2005). It Involves both direct tissue damage resulting from plaque bacterial products, and indirect damage via host inflammatory and immune responsesmediated by interactions between numerous cell populations and inflammatory mediators (Yucel-Lindberg T&Båge T.2013).

Periodontal infections have been associated with different systemic diseases; cardiovascular disease, cerebrovascular disease, diabetes mellitus, respiratory infections and others including osteoporosis, cancer, rheumatoid arthritis, erectile dysfunction, Alzheimer's disease, gastrointestinal disease, prostatitis and renal diseases(Gulati M, et al. 2013). Moreover, many investigators have reported an association between periodontal disease and adverse pregnancy outcomes, including preterm birth, low birth weight, foetal growth restriction, preeclampsia and perinatal mortality (Ide M&Papapanou PN.2013).

Preterm birth, defined as a live birth before 37 weeks of gestation, is the leading cause of infant mortality in both developed and developing countries (Saigal S & Doyle LW. 2008), whether following spontaneous preterm labour, premature rupture of membranes, or caesarean section due to foetal distress or maternal medical conditions (Goldenberg RL, et al. 2008).The World Health Organization has recently estimated that annually 12.9 million or 9.6% of all children are born preterm worldwide, despite extensive research and public health efforts(Beck S, et al. 2010).

Major causes for preterm birth are intra-amniotic infections which subsequently cause inflammation, as well as sterile inflammation (Madan I, et al 2010). Moreover, smoking, alcohol consumption, black race, low socio-economic status, low or high maternal body mass index, stress, previous preterm birth, advanced maternal age and short cervix are other associated risk factors (DjelantikA, et al. 2012).

Offenbacher et al in 1996 first hypothesized that gram-negative anaerobic pathogens from periodontium and associated endotoxins and maternal inflammatory mediators could have a possible adverse effect on the developing fetus (Offenbacher S, et al. 1996), whether through translocation of periodontal pathogens to the feto-placental unit or the action of the periodontal reservoir of inflammatory mediators, which elaborated at the remote site of infection and trigger prostaglandins synthesis, resulting in cervical dilation, entry of more microbes into the uterus, and continuation of the "viscous cycle" resulting in premature birth (Gibbas RS, 2001).