Annually, almost three million babies die prior to 28 days of life, and preterm birth complications is the leading cause of neonatal death. Therapeutic options for managing preterm birth are generally unavailable for 98% of the almost 15 million preterm babies born each year, and the evidence base for preventative interventions is lacking. One area of research that has been substantially neglected in developing countries is the role that poor oral health in pregnant women may play in raising the likelihood of prematurity. There is epidemiologic and microbiologic evidence for this association; however, no strong consensus has emerged on the causal pathways underlying this relationship and randomized controlled trials have failed to consistently find that intervening with periodontal treatment during pregnancy reduces risk for adverse pregnancy outcomes. We suggest that the maternal periodontal disease and preterm birth association might be assessed most clearly in a setting of high prevalence and severity of periodontitis and low levels of confounding risk factors. Sarlahi, a rural community in southwest Nepal, exhibits such characteristics, and is the site of a longstanding community-based public health research site operated by the Nepal Nutrition Intervention Project Sarlahi (NNIPS) since 1988. This study proposes to evaluate the periodontal disease and preterm birth association (Aim 1), alongside relationships with inflammatory mediators and periodontal pathogens (Aim 2), through a prospective cohort study of pregnant women in Sarlahi. Results from this study may help lay the groundwork for future intervention trials to reduce prematurity through improved oral health of mothers.  

Global Health Project Grant Advisor/Mentor: Luke Mullany, PhD