Preconception periodontitis and adverse pregnancy outcomes in a prospective cohort of pregnancy planners

高血压疾病的患病率(例如妊娠期高血压、先兆子痫和子痫)和 代谢性疾病(如妊娠期糖尿病)很高，对产妇 发病率和死亡率。此外，这些情况是早产和低出生体重的主要危险因素。 因此，这也极大地增加了新生儿发病率和死亡率。鉴于不断增长的利率 以及与之相关的有害健康后果、预防和早期 检测对于改善孕产妇和新生儿结局至关重要。妊娠前全身炎症 被认为是这些条件和结果发展的促成因素，但潜在的 原因大多不得而知。了解和解决全身炎症的来源 妊娠期可能会阻碍妊娠期高血压和代谢紊乱的发展， 以及减少早产和低出生体重儿的发生率。牙周炎是最多的 美国成年人中常见的慢性炎症性疾病，影响到38%的30岁及以上女性。 牙周炎与妊娠相关疾病和结局之间的关系已在 近几十年来。然而，这项工作的结果好坏参半，因为对 妊娠期牙周炎，缺乏关于重要混杂因素的数据，以及难以获得足够的 数据，以提供有意义的、准确的结果。通过使用从怀孕中获得的预期数据 在线研究(Presto)，这是一项对近17,000名北方人进行的基于互联网的先入为主的队列研究 美国计划怀孕的妇女，这项提案旨在： 1.评估早孕牙周炎与高血压和代谢紊乱的关系 妊娠、早产和低出生体重结局。 2.通过进行概率定量偏差分析和 结合逆概率加权来探索可供选择的解释的合理性 观察结果(例如，未测量的混杂、暴露错误分类偏差和选择偏差)。 完成建议的目标将加强我们对牙周炎可能在 孕产妇和新生儿发病率和死亡率，并可能为以下机制研究提供基础 阐明这些联系背后的炎症途径。最终，这项工作可能会导致治疗 采取干预措施，减少这些严重生殖健康疾病造成的人口负担 结果。

The prevalence of hypertensive disorders (e.g. gestational hypertension, pre-eclampsia, and eclampsia) and metabolic disorders (e.g. Gestational Diabetes Mellitus) is high and significantly contribute to maternal morbidity and mortality. Further, these conditions are primary risk factors for preterm birth and low-birthweight outcomes, and thus also contribute dramatically to neonatal morbidity and mortality. Given the increasing rates of these disorders in recent years, and the associated detrimental health outcomes, prevention and early detection are critical for improving maternal and neonatal outcomes. Systemic inflammation prior to pregnancy is regarded as a contributing factor in the development of these conditions and outcomes, yet the underlying causes are mostly unknown. Understanding and addressing sources of systemic inflammation in the preconception period may hinder the development of hypertensive and metabolic disorders during pregnancy, as well as reduce the incidence of preterm birth and low birthweight outcomes. Periodontitis is the most common chronic inflammatory condition among U.S adults, affecting 38% of women aged 30 years and older. The associations between periodontitis and pregnancy-related conditions and outcomes have been studied in recent decades. However, results of this work have been mixed, owing to the restricted measurement of periodontitis during pregnancy, the lack of data on important confounders, and difficulty in obtaining enough data to provide meaningful, precise results. Through the use of prospective data obtained from PREgnancy STudy Online (PRESTO), an ongoing internet-based preconception cohort study of nearly 17,000 North American women planning a pregnancy, this proposal aims to: 1. Estimate the associations between preconception periodontitis and hypertensive and metabolic disorders in pregnancy, preterm birth, and low birthweight outcomes. 2. Evaluate the validity of the associations through the conduct of probabilistic quantitative bias analyses and the incorporation of inverse probability weighting to explore the plausibility of alternative explanations for the observed results (e.g., unmeasured confounding, exposure misclassification bias, and selection bias). Completion of the proposed aims will enhance our understanding of the role that periodontitis may play in maternal and neonatal morbidity and mortality and may provide a foundation for mechanistic studies that elucidate inflammatory pathways underlying these associations. Eventually, this work could lead to therapeutic interventions to reduce the population-level burden of these serious reproductive health conditions and outcomes.