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A doença periodontal na gravidez como fator de risco de parto prematuro: revisão narrativa
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| Projeto de pós-graduação_39492 | 4.14 MB | Adobe PDF |
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Introdução: A doença periodontal (DP) é uma inflamação crónica multifatorial da cavidade oral, podendo ter implicações sistémicas. Na gravidez, alterações hormonais e imunológicas tornam os tecidos periodontais mais suscetíveis à inflamação, levando à hipótese de que a periodontite possa contribuir para problemas como parto prematuro (PP) ou baixo peso à nascença. Este estudo tem como objetivo analisar a evidência científica disponível sobre a associação entre a DP na gravidez e o risco de PP, explorando os mecanismos biológicos e a sua relevância clínica.
Metodologia: Esta revisão narrativa baseou-se em artigos científicos obtidos nas bases de dados PubMed, ScienceDirect e B On, publicados entre 2014 e 2024. Incluíram-se estudos observacionais, de coorte, ensaios clínicos randomizados e revisões que abordassem a relação entre a DP e o PP. As palavras-chave utilizadas foram “periodontal disease”, “periodontitis”, “pregnancy”, “preterm birth” e “preterm delivery”. Após triagem e exclusão de duplicados e artigos não relacionados, incluíram-se 59 na análise final.
Resultados: A análise dos estudos indicou uma associação positiva entre a DP materna e o risco de PP e baixo peso neonatal. Dois mecanismos principais foram identificados: (1) via direta, com disseminação hematogénica de microrganismos periodontopatogénicos (ex: Porphyromonas gingivalis; Fusobacterium nucleatum) para os tecidos placentários; (2) via indireta, mediada por citocinas pró-inflamatórias (IL-1β, IL-6, TNF-α) e prostaglandina E₂, que podem induzir rutura prematura das membranas e contrações uterinas precoces. Apesar disso, a eficácia do tratamento periodontal na gestação para prevenção de PP continua controversa dado que os ensaios clínicos demonstram não haver impacto positivo consistente nos resultados obstétricos.
Conclusão: A evidência científica sugere que a DP pode ser um potencial fator de risco para o PP, embora não constitua o único determinante. A deteção e tratamento precoce das DP, bem como a integração de cuidados de saúde oral nos programas de acompanhamento pré-natal, podem contribuir para a redução de complicações gestacionais e para a promoção da saúde materno-fetal.
Introduction: Periodontal disease (PD) is a chronic multifactorial inflammation of the oral cavity that can have systemic implications. During pregnancy, hormonal and immunological changes make periodontal tissues more susceptible to inflammation, leading to the hypothesis that periodontitis may contribute to problems such as preterm birth (PTB) or low birth weight. This study aims to analyze the available scientific evidence on the association between PD in pregnancy and the risk of PC, exploring the biological mechanisms and their clinical relevance. Methodology: This narrative review was based on scientific articles obtained from the PubMed, ScienceDirect, and B-On databases, published between 2014 and 2024. Observational studies, cohort studies, randomized clinical trials, and reviews addressing the relationship between PD and PP were included. The keywords used were “periodontal disease,” “periodontitis,” “pregnancy,” “preterm birth,” and “preterm delivery.” After screening and exclusion of duplicates and unrelated articles, 59 were included in the final analysis. Results: The analysis of the studies indicated a positive association between maternal PD and the risk of PP and low birth weight. Two main mechanisms have been identified: (1) direct route, with hematogenous spread of periodontopathogenic microorganisms (e.g., Porphyromonas gingivalis; Fusobacterium nucleatum) to placental tissues; (2) indirect route, mediated by proinflammatory cytokines (IL-1β, IL-6, TNF-α) and prostaglandin E₂, which can induce premature rupture of membranes and early uterine contractions. Despite this, the effectiveness of periodontal treatment during pregnancy for the prevention of PP remains controversial, as clinical trials show no consistent positive impact on obstetric outcomes. Conclusion: Scientific evidence suggests that PD may be a potential risk factor for PP, although it is not the only determinant. Early detection and treatment of PD, as well as the integration of oral health care into prenatal care programs, can contribute to reducing gestational complications and promoting maternal-fetal health.
Introduction: Periodontal disease (PD) is a chronic multifactorial inflammation of the oral cavity that can have systemic implications. During pregnancy, hormonal and immunological changes make periodontal tissues more susceptible to inflammation, leading to the hypothesis that periodontitis may contribute to problems such as preterm birth (PTB) or low birth weight. This study aims to analyze the available scientific evidence on the association between PD in pregnancy and the risk of PC, exploring the biological mechanisms and their clinical relevance. Methodology: This narrative review was based on scientific articles obtained from the PubMed, ScienceDirect, and B-On databases, published between 2014 and 2024. Observational studies, cohort studies, randomized clinical trials, and reviews addressing the relationship between PD and PP were included. The keywords used were “periodontal disease,” “periodontitis,” “pregnancy,” “preterm birth,” and “preterm delivery.” After screening and exclusion of duplicates and unrelated articles, 59 were included in the final analysis. Results: The analysis of the studies indicated a positive association between maternal PD and the risk of PP and low birth weight. Two main mechanisms have been identified: (1) direct route, with hematogenous spread of periodontopathogenic microorganisms (e.g., Porphyromonas gingivalis; Fusobacterium nucleatum) to placental tissues; (2) indirect route, mediated by proinflammatory cytokines (IL-1β, IL-6, TNF-α) and prostaglandin E₂, which can induce premature rupture of membranes and early uterine contractions. Despite this, the effectiveness of periodontal treatment during pregnancy for the prevention of PP remains controversial, as clinical trials show no consistent positive impact on obstetric outcomes. Conclusion: Scientific evidence suggests that PD may be a potential risk factor for PP, although it is not the only determinant. Early detection and treatment of PD, as well as the integration of oral health care into prenatal care programs, can contribute to reducing gestational complications and promoting maternal-fetal health.
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Periodontite materna Doença periodontal Gravidez Parto prematuro Inflamação Periodontal disease Pregnancy Preterm birth Inflammation Maternal periodontitis