Periapical infection may affect birth outcomes via systemic inflammation

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Periodontology

Background:

• Maternal periapical infections are linked to adverse pregnancy outcomes like preterm birth and intrauterine growth restriction.
• The mechanisms behind this association, whether direct bacterial spread or systemic inflammation, require elucidation.

Purpose of the Study:

• To investigate the pathways (direct bacterial spread vs. systemic inflammation) linking maternal periapical infections to adverse pregnancy outcomes.
• To compare birth outcomes in Malawian mothers with and without periapical infections.

Main Methods:

• Compared birth outcomes in mothers with and without periapical infections.
• Assessed placental bacteria (16S rDNA) and inflammation for direct pathway evidence.
• Measured inflammatory markers (C-reactive protein, alpha-1-acid glycoprotein, cortisol) for indirect pathway evidence.

Main Results:

• No association found between periapical infection and placental bacterial DNA or histological inflammation.
• Periapical infection correlated with elevated C-reactive protein, alpha-1-acid glycoprotein, and cortisol levels.
• Inflammatory markers partially mediated the association between periapical infection and pregnancy outcomes.

Conclusions:

• Evidence does not support direct bacterial spread from periapical lesions to the placenta.
• Systemic inflammation plays a partial role in mediating the link between maternal periapical infections and adverse pregnancy outcomes.