Periodontal status of postpartum women in relation to preterm birth and low birth weight at Kenyatta national hospital
Wanjiru, Wangari Veronica
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Background: Periodontal diseases in Kenya are highly prevalent. Gingivitis has been reported to affect up to 90% while chronic periodontitis affects 1-10% of the population. Preterm birth and low birth weight (PLBW) are leading causes of perinatal complications worldwide and contribute upto 70% of perinatal mortality. About 50% of the causes of preterm birth are idiopathic and a large proportion of PLBWS are of unknown aetiology (70%), therefore identification of the risk factors is paramount. While some studies have associated periodontitis with preterm birth and low birth weight pregnancy outcomes, others have found contradictory results. There is no available literature in Kenya on the association of preterm birth and low birth weight among post partum women with periodontal disease. Premature birth, low birth weight and periodontal diseases continue to be fundamental health problems despite efforts to control for all known risk factors. Aim: The aim of this study was to investigate the periodontal status of post partum women and its relationship with preterm birth and low birth weight pregnancy outcomes. Study design: This was a descriptive cross-sectional study which was carried out among post partum women at the labour ward in Kenyatta National Hospital. Methods: Two hundred and forty six participants were recruited into the study. A validated semi-structured, interviewer-administered questionnaire was used collect sociodemographic data, past medical history; self reported gingival symptoms as well as the oral health practices of the study group. Information of the weight of the infant at birth was retrieved from the medical records. The gestational age which was calculated from the last menstrual period and via ultrasound where available was retrieved from the medical records. Oral hygiene status and periodontal status were recorded on the clinical examination form (Appendix IV). The Silness and Löe 1964 plaque index and the Löe and Silness 1963 gingival index were used to assess the oral hygiene status and gingival inflammation respectively. Periodontitis was assessed using periodontal probing depth (PPD), recession and clinical attachment loss (CAL). Data analysis and presentation: Statistical Package for Social Sciences (SPSS) version 20.0 for Windows was used for data analysis. Chi-square, Fishers tests, Independent t-tests and ANOVA tests were used for analysis. Pearson Correlation was also done to find the relationship between variables. Data was presented in the form of frequency diagrams, tables and pie charts. Results: Two hundred and forty six study participants were examined. Majority (43%) of the participants were aged between 26-30 years with an age range of 18-42 years. The mean gestation age was 37 months with a range of 20-42 months. The average birth weight was 3015g with a range of 500-4690grams. Slightly more than half of the participants (57.3%) brushed their teeth once daily. There was 100% prevalence of gingivitis and no mother suffered from gingival overgrowth. The prevalence of severe periodontitis was 3.7 %( 9), 27.2 %( 67) or moderate periodontitis and 69.1 %( 170) for mild periodontitis. The average probing depth was 2.8mm (S.D±0.37) and the average CAL was 2.34mm (S.D±0.42). The prevalence of preterm birth was 19.9% (49) and low birth weight was 12.6 % (31) while prevalence of preterm birth was 19.9% (49) and low birth weight was 12.6 % (31) while prevalence of combined PLBW was 6.5% (16). There was a positive correlation between the negative correlation between the mean gingival score and gestation age(r=-0.029, p=0.647) and birth weight(r=-0.100, p=0.118). There was no statistically significant relationship between periodontitis and preterm birth and low birth weight. (X2= 2.72, df=2, p=0.250; X2= 1.45, df = 2, p= 0.483). None of thee mothers that had preterm birth or low birth weight infant suffered from severe periodontitis. Conclusion: There was no association between periodontal disease and preterm birth and low birth weight. Recommendations: Large prospective cohort studies are required in this area to investigate any associations between periodontitis and preterm and low birth weight and identify other risk factors.