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

高血压疾病（如妊娠期高血压、先兆子痫和子痫）的患病率， 代谢紊乱（如糖尿病）是高，并显着有助于孕产妇 发病率和死亡率。此外，这些条件是早产和低出生体重的主要危险因素 结果，因此也大大有助于新生儿发病率和死亡率。考虑到越来越多的 近年来，这些疾病的发生，以及相关的有害健康结果，预防和早期 检测对于改善孕产妇和新生儿的结果至关重要。妊娠前全身炎症 被认为是这些条件和结果发展的一个促成因素，但基本的 原因大多未知。了解和解决全身性炎症的来源， 孕前可能会阻碍怀孕期间高血压和代谢紊乱的发展， 以及降低早产和低出生体重的发生率。牙周炎是最 美国成年人中常见的慢性炎症，影响38%的30岁及以上的女性。 牙周炎与妊娠相关疾病和结局之间的关系已经在 近几十年然而，这项工作的结果喜忧参半，原因是对 妊娠期牙周炎，缺乏重要混杂因素的数据，难以获得足够的 数据，以提供有意义的，精确的结果。通过使用从妊娠期获得的前瞻性数据， STudy Online（PRESTO）是一项正在进行的基于互联网的前概念队列研究，涉及近17，000名北 计划怀孕的美国妇女，这项建议旨在： 1.估计孕前牙周炎与高血压和代谢紊乱之间的关系 妊娠、早产和低出生体重结局。 2.通过概率定量偏差分析评估关联的有效性， 采用逆概率加权法，探讨对 观察到的结果（例如，未测量的混杂、暴露误分类偏倚和选择偏倚）。 完成所提出的目标将提高我们对牙周炎可能发挥的作用的理解， 产妇和新生儿的发病率和死亡率，并可能为机制研究提供基础， 阐明这些关联背后的炎症途径。最终，这项工作可能会导致治疗 采取干预措施，减轻这些严重生殖健康状况给人口造成的负担， 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.