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ABSTRACT
In this observational and prospective study, we investigated if microbiological and serological markers of periodontitis associated with conception in 256 non-pregnant women (Mage = 29.2 years; range 19-42 years). Clinical oral and gynecological examinations were performed, major periodontal pathogens in the saliva were detected, and serum and saliva antibodies against major periodontal pathogens were analyzed. The follow-up period for becoming pregnant was 12 months. Porphyromonas gingivalis was significantly (p = 0.032) more frequently detected in the saliva among those who did not become pregnant (8.3%) than among those who became pregnant (2.1%). The median levels of salivary P. gingivalis immunoglobulin A (IgA; p = 0.006) and IgG (p = 0.007) antibodies were higher among those who did not become pregnant compared to those who became pregnant. Hazard ratios (HR) for not becoming pregnant were HR = 3.75 (95% confidence interval [CI] 1.01-13.9; p = 0.048) if the subject was polymerase chain reaction-positive for P. gingivalis with high salivary antibodies against it, and HR = 1.62 (95% CI 1.03-2.54; p = 0.035) if she had high levels of serum P. gingivalis IgA and signs of periodontal infection. P. gingivalis associated with no success in getting pregnant.
ARTICLE HISTORY
Received 18 January 2017
Accepted 7 May 2017
KEYWORDS
Periodontal-systemic disease interactions; microbiology; oral hygiene; periodontal diseases; periodontitis; women's health
Introduction
Periodontal diseases are prevalent worldwide. Severe chronic periodontitis is the sixth most common medical condition according to the Global Burden of Disease Study [1]. Periodontal infection has been linked to several medical conditions such as cardiovascular diseases, diabetes, respiratory infections, and adverse pregnancy outcomes, including premature birth and low birth weight [2,3]. This systemic connection may be mediated by bacterial lipopolysaccharide (LPS), resulting in endotoxemia and a subsequent low-grade pro-inflammatory state [4]. Gram-negative bacteria, such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, that are enriched in the biofilm of periodontal infection may contribute to endotoxemia [5,6] and therefore contribute to systemic inflammation. These species may also give rise to molecular mimicry, that is, cross-activation of autoreactive immune cells by pathogen-associated epitopes, which have harmful implications [7,8].
Several causes, such as ovulation disorders, ovarian insufficiency, Fallopian tube pathology, endometriosis, and uterine or cervical abnormalities, may affect fertility in women. Infection and inflammation play a role in infertility...