Oral health during pregnancy in rural Nepal: a community-based cohort study of practices, periodontal status, and pregnancy outcomes

Annually, almost three million babies die prior to 28 days of life; the number one cause of these deaths both in high- and low-income settings is complications arising from preterm birth. Therapeutic options for managing preterm birth are generally unavailable for 98% of the almost 15 million preterm babies born each year, and the evidence base for preventative interventions is lacking. One area that has been substantially neglected in developing countries is the role that poor oral health may play raising the likelihood of early spontaneous delivery. There is epidemiologic and microbiologic evidence for an association between maternal periodontal disease and preterm birth, however, causal mechanisms are not fully understood, and results from randomized trials intervening on mothers with periodontal therapies to reduce prematurity have been mixed. In 2014, we initiated a community-based project to examine this question in a high burden setting with low levels of confounding risk factors. Sarlahi District in southern Nepal fit this description, with high rates of neonatal mortality (28 / 1,000 live births), preterm birth (17%), low birth weight (30%), poor oral health, and low rates of smoking, alcohol use, and chronic diseases. The overall objective of our study was to assess the epidemiologic relationship between periodontal disease and preterm birth and investigate causal mechanisms on the pathway from oral infection to early spontaneous delivery. Our specific aims included the following: 1. Assess the incidence of preterm birth among women with / without periodontitis 2. Examine relationships between causal mechanisms, specifically clinical signs of periodontitis, subgingival biofilm composition, and levels of inflammatory mediators in gingival crevicular fluid and serum 3. Conduct a small pilot trial to estimate the association between adherence to a 0.12% chlorhexidine (non-alcohol) daily mouthrinse and subgingival biofilm composition and levels of inflammatory mediators in gingival crevicular fluid and serum 4. Describe the knowledge, attitudes, and practices related to oral hygiene among women and health professionals in the community (2018-02)