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dc.contributor.authorErchick, Daniel J
dc.contributor.authorKhatry, Subarna K
dc.contributor.authorAgrawal, Nitin K
dc.contributor.authorKatz, Joanne
dc.contributor.authorLeClerq, Steven C
dc.contributor.authorRai, Bhola
dc.contributor.authorReynolds, Mark A
dc.contributor.authorMullany, Luke C
dc.date.accessioned2020-09-11T17:39:25Z
dc.date.available2020-09-11T17:39:25Z
dc.date.issued2020-08-20
dc.identifier.urihttp://hdl.handle.net/10713/13689
dc.description.abstractOBJECTIVES: Observational studies have identified associations between periodontitis and adverse pregnancy outcomes, but randomised controlled trials evaluating the efficacy of periodontal therapy have yielded inconsistent results. Few studies have explored relationships between gingival inflammation and these outcomes or been conducted in rural, low-income communities, where confounding risk factors differ from other settings. METHODS: We conducted a community-based, prospective cohort study with the aim of estimating associations between the extent of gingival inflammation in pregnant women and incidence of preterm birth in rural Nepal. Our primary exposure was gingival inflammation, defined as bleeding on probing (BOP) ≥10%, stratified by BOP <30% and BOP ≥30%. A secondary exposure, mild periodontitis, was defined as ≥2 interproximal sites with probing depth (PD) ≥4 mm (different teeth) or one site with PD ≥5 mm. Our primary outcome was preterm birth (<37 weeks gestation). We used Poisson regression to model this relationship, adjusting for potential confounders. RESULTS: Of 1394 participants, 554 (39.7%) had gingival inflammation, 54 (3.9%) mild periodontitis and 197 (14.1%) delivered preterm. In the adjusted regression model, increasing extent of gingival inflammation was associated with a non-significant increase in risk of preterm birth (BOP ≥30% vs no BOP: adjusted relative risk (aRR) 1.37, 95% CI: 0.81 to 2.32). A secondary analysis, stratifying participants by when in pregnancy their oral health status was assessed, showed an association between gingival inflammation and preterm birth among women examined in their first trimester (BOP ≥30% vs no BOP: aRR 2.57, 95% CI: 1.11 to 5.95), but not later in pregnancy (BOP ≥30% vs no BOP: aRR 1.05, 95% CI: 0.52 to 2.11). CONCLUSIONS: Gingival inflammation in women examined early in pregnancy and poor oral hygiene behaviours were risk factors for preterm birth. Future studies should evaluate community-based oral health interventions that specifically target gingival inflammation, delivered early in or before pregnancy, on preterm birth. TRIAL REGISTRATION NUMBER: Nepal Oil Massage Study, NCT01177111. © Author(s) (or their employer(s)) 2020.en_US
dc.description.urihttps://doi.org/10.1136/bmjopen-2019-036515en_US
dc.language.isoen_USen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofBMJ Openen_US
dc.subjectcommunity child healthen_US
dc.subjectepidemiologyen_US
dc.subjectobstetricsen_US
dc.subjectoral medicineen_US
dc.subjectperinatologyen_US
dc.subjectpublic healthen_US
dc.titleRisk of preterm birth associated with maternal gingival inflammation and oral hygiene behaviours in rural Nepal: a community-based, prospective cohort studyen_US
dc.typeArticleen_US
dc.identifier.doi10.1136/bmjopen-2019-036515
dc.identifier.pmid32819989
dc.source.volume10
dc.source.issue8
dc.source.beginpagee036515
dc.source.endpage
dc.source.countryUnited States
dc.source.countryEngland


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