Association between excessive maternal weight, periodontitis during the third trimester of pregnancy, and infants' health at birth.
- 作者列表："Foratori-Junior GA","Jesuino BG","Caracho RA","Orenha ES","Groppo FC","Sales-Peres SHC
INTRODUCTION:Excessive weight is associated with periodontitis because of inflammatory mediators secreted by the adipose tissue. Periodontal impairments can occur during pregnancy due to association between high hormonal levels and inadequate oral hygiene. Moreover, periodontitis and excessive weight during pregnancy can negatively affect an infant's weight at birth. OBJECTIVE:This observational, cross-sectional study aimed to evaluate the association between pre-pregnancy overweight/obesity, periodontitis during the third trimester of pregnancy, and the infants' birth weight. METHODOLOGY:The sample set was divided into 2 groups according to the preconception body mass index: obesity/overweight (G1=50) and normal weight (G2=50). Educational level, monthly household income, and systemic impairments during pregnancy were assessed. Pocket probing depth (PPD) and clinical attachment level (CAL) were obtained to analyze periodontitis. The children's birth weight was classified as low (<2.5 kg), insufficient (2.5-2.999 kg), normal (3-3.999 kg), or excessive (≥4 kg). Bivariate analysis (Mann-Whitney U test, t-test, chi-squared test) and logistic regression (stepwise backward likelihood ratio) were performed (p<0.05). RESULTS:G1 showed lower socioeconomic levels and higher prevalence of arterial hypertension and gestational diabetes mellitus during pregnancy than G2 (p=0.002). G1 showed higher means of PPD and CAL (p=0.041 and p=0.039, respectively) and therefore a higher prevalence of periodontitis than G2 (p=0.0003). G1 showed lower infants' birth weight than G2 (p=0.0004). Excessive maternal weight and educational levels were independent variables associated with periodontitis during the third trimester of pregnancy (X2=23.21; p<0.0001). Maternal overweight/obesity was also associated with low/insufficient birth weight (X2=7.01; p=0.008). CONCLUSION:The present findings suggest an association between excessive pre-pregnancy weight, maternal periodontitis, and low/insufficient birth weight.
介绍: 由于脂肪组织分泌的炎症介质，过多的体重与牙周炎有关。由于高激素水平和口腔卫生不足之间的关联，怀孕期间可能会发生牙周损伤。此外，牙周炎和怀孕期间体重过重会对婴儿出生时的体重产生负面影响。 目的: 这项观察性、横断面研究旨在评估孕前超重/肥胖、妊娠晚期牙周炎与婴儿出生体重之间的关系。 方法: 根据孕前体重指数将样本集分为 2 组: 肥胖/超重 (G1 = 50) 和正常体重 (G2 = 50)。评估教育水平、家庭月收入和孕期全身损害。获得口袋探诊深度 (PPD) 和临床附着水平 (CAL) 以分析牙周炎。儿童出生体重分为低 (<2.5千克) 、不足 (2.5-2.999千克) 、正常 (3-3.999千克) 或过多 (≥ 4千克)。进行双变量分析 (Mann-Whitney U 检验、 t 检验、卡方检验) 和 logistic 回归 (逐步向后似然比) (p<0.05)。 结果: 与 G2 相比，G1 组社会经济水平较低，妊娠期动脉高血压和妊娠期糖尿病的患病率较高 (p = 0.002)。G1 显示 PPD 和 CAL 均值较高 (分别为 p = 0.041 和 p = 0.039)，因此牙周炎患病率高于 G2 (p = 0.0003)。G1 显示婴儿出生体重低于 G2 (p = 0.0004)。母亲体重和教育水平过高是与妊娠晚期牙周炎相关的自变量 (X2= 23.21; p<0.0001)。母亲超重/肥胖也与低/出生体重不足相关 (X2= 7.01; p = 0.008)。 结论: 目前的研究结果表明孕前体重过多、母亲牙周炎和低/出生体重不足之间存在关联。
METHODS:BACKGROUND:Ultrasound has been demonstrated to accurately diagnose rectal deep endometriosis (DE) and pouch of Douglas (POD) obliteration. The role of ultrasound in the assessment of patients who have undergone surgery for rectal DE and POD obliteration has not been evaluated. AIM:To describe the transvaginal ultrasound (TVS) findings of patients who have undergone rectal surgery for DE. MATERIALS AND METHODS:An observational cross-sectional study at a tertiary care centre in Sydney, Australia between January and April 2017. Patients previously treated for rectal DE (low anterior resection vs rectal shaving/disc excision) were recruited and asked to complete a questionnaire on their current symptoms. On TVS, POD state and rectal DE were assessed. Correlating recurrence of POD obliteration and/or rectal DE to surgery type and symptoms was done. RESULTS:Fifty-six patients were contacted; 22/56 (39.3%) attended for the study visit. Average interval of surgery to study visit was 52.8 ± 24.6 months. Surgery type breakdown was as follows: low anterior resection (56%) and rectal shaving/disc excision (44%). The prevalence of POD obliteration was 16/22 (72.7%) intraoperatively and 8/22 (36.4%) at study visit, as per the sliding sign. Nine patients (39.1%) had evidence on TVS of recurrent rectal DE. Recurrence of POD obliteration and rectal DE was not associated with surgery type or symptomatology. CONCLUSION:Despite surgery for rectal DE, many patients have a negative sliding sign on TVS, representing POD obliteration, and rectal DE. Our numbers are too small to correlate with the surgery type or their current symptoms.
METHODS::Minimally invasive surgery for complex endometriosis requires preoperative planning that intimately connects the gynecologic surgeon to the radiologist. Understanding the surgeon's perspective to endometriosis treatment facilitates a productive relationship that ultimately benefits the patient. We examine minimally invasive surgery for endometriosis and the key radiologic information which enable the surgeon to successfully negotiate patient counseling, preoperative planning, and an interdisciplinary approach to surgery.
METHODS:STUDY OBJECTIVE:Prior research collectively shows that endometriosis is inversely related to women's adiposity. The aim of this study was to assess whether this inverse relationship holds true by disease severity and typology. DESIGN:Cross sectional study among women with no prior diagnosis of endometriosis. SETTING:Fourteen clinical centers in Salt Lake City, Utah and San Francisco, California. PATIENTS:Four hundred and ninety five women, ages 18-44 years, were enrolled in the operative cohort of the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. INTERVENTIONS:Gynecologic laparoscopy/laparotomy, regardless of clinical indication. MEASUREMENTS AND MAIN RESULTS:Participants underwent anthropometric assessments, body composition, and body fat distribution ratios before surgery. Surgeons completed a standardized operative report immediately after surgery to capture revised ASRM staging (I to IV) and typology of disease (superficial [SE], ovarian endometrioma [OE], and deep infiltrating endometriosis [DIE]). Linear mixed models, taking into account within-clinical-center correlation were used to generate least square means (95% confidence intervals) to assess differences in adiposity measures by endometriosis stage (no endometriosis, I-IV) and typology (no endometriosis, SE, DIE, OE, OE + DIE) adjusting for age, race/ethnicity, and parity. While the majority of confidence intervals were wide and overlapping, three general impressions emerged: 1) women with versus without incident endometriosis had the lowest anthropometric/body composition indicators; 2) women with stage I or IV had lower indicators compared to women with stage II or III; and 3) women with OE and/or DIE tended to have the lowest indicators, while women with SE had the highest indicators. CONCLUSION:Our research highlights that the relationship between women's adiposity and endometriosis severity and typology may be more complicated than prior research indicates.