Periodontal disease: a potential modifiable risk factor limiting conception
Hum. Reprod. (2012) 27 (5): 1332-1342. doi: 10.1093/humrep/des034 First published online: February 22, 2012
BACKGROUND Periodontal disease (PD) is a common chronic infectious and inflammatory disease of the gums and its supporting tissues, associated with several adverse health outcomes including significant obstetric consequences. PD is treatable with good oral hygiene and dental care, and consequently is a modifiable variable that may lead to improvements in adult health. To date, there are no published studies describing the influence of PD on a woman's time to conceive (TTC).
METHODS This study formed part of the Smile study, which was a multi-centre randomized controlled trial of treatment for PD in mid-pregnancy. PD was defined as the presence of pockets ≥4-mm deep at ≥12 probing sites in fully erupted teeth. At the time of recruitment, women were asked about their TTC and whether they had required fertility treatment.
RESULTS Of 3737 pregnant women recruited to the study, information was available from 3416 spontaneous conceptions, including 1014 cases with PD (29.7%). Planned pregnancies accounted for 1956 of the 3416 pregnancies available for study. For 146 women, the TTC was >12 months and PD was more prevalent in this group (34.9% versus 25.7%, P = 0.015). The mean TTC in women with PD was 7.1 months [confidence interval (CI): 5.7–8.6] compared with 5.0 months (CI: 4.4–5.5, P = 0.019) in those without PD. PD was present in 23.8% of Caucasian women and 41.4% of non-Caucasian women. Compared with Caucasian women without PD, non-Caucasian women with PD had an increased likelihood of TTC >12 months [13.9% versus 6.2%, odds ratio (OR): 2.88 (CI: 1.62–5.12), P < 0.001], but there was no difference for Caucasians with PD (8.6% versus 6.2%, OR: 1.15, CI: 0.74–1.79, P = 0.534). Other simultaneous predictors of TTC >1 year included age, BMI >25 and smoking.
CONCLUSIONS In the non-Caucasian population, PD was associated with an increased TTC, but whether this is related to PD, or some other factor also present within this population, should be further investigated.