About the Lecture:

Title: "Unexpected Beginnings: The Value of Pregnancy Microbiome Care & Oral Health."

Saturday, September 12, at 1:00 PM on the Main Stage

 
In this keynote address, we will review the incredibly diverse world of microbiome science through the lens of pregnancy. By initially providing an overview of the unique characteristics of the microbiome during pregnancy and the postpartum period, we will set the stage for appreciating how interventions aimed at microbial health during pregnancy are of potential lifelong benefit.
 
Of interest to the AAOSH audience, during pregnancy, periodontal disease is associated with a 2- to 3-fold increased risk for a preterm birth (PTB) or low birthweight (LBW) delivery. This relationship may be explained by the inflammatory response associated with periodontal disease, or through hematogenous spread of oral commensal or dysbiotic microbiota. In humans, 1 mm3 of dental plaque contains approximately 100 million aerobic and anaerobic bacteria, including opportunistic pathogens (pathobionts) implicated in periodontal disease, transient bacteremia, and intra-amniotic inflammation leading to PTB or fetal growth restriction. Animal studies have demonstrated that inoculation of oral pathobionts results in transplacental transmission and inflammatory PTB.
 
Aligning with these studies and other clinical trials, we recently demonstrated in a large cluster randomized trial that xylitol chewing gum was effective at preventing preterm and low birthweight deliveries in Malawi. In this open-label, multicenter, matched-pair cluster-randomized, controlled trial, pre-pregnant and early pregnant participants who received tailored antenatal health messages and xylitol-containing chewing gum had a significant reduction in the co-primary study outcomes of preterm and low birthweight deliveries. Specifically, we observed a 24% reduction in the incidence of <37 week preterm delivery and a 30% reduction in very low birthweight neonates compared to participants at active control sites with the same antenatal health messages. After rigorously controlling for potential bias given the number of clusters, the significance in the measures of association between xylitol initiation and reduction of preterm births at 34 to 36 6/7 weeks withstood correction with a RR of 0.73 (95% CI 0.53-0.99; p=0.048), and all point estimates for both our primary outcomes remained consistent, albeit with limitations in confidence. Importantly, this risk reduction resulted in significantly fewer neonatal demises (0.2% [8/4305] vs. 0.4% [22/5260]; RR 0.41, 95%CI 0.19-0.89) and composite of non-live birth or neonatal demise (paired RR 0.56 95% CI 0.33-0.95, p=0.032). Among the approximate 10% of study participants compliant with two dental visits 10 weeks apart, only the xylitol group demonstrated a significant improvement in clinical metrics of gingival inflammation (bleeding on probing). These results add to the existing literature demonstrating that non-surgical periodontal therapies (e.g., dental scaling and root planing) may improve perinatal and obstetric outcomes.

• To describe the importance of the microbiome across the lifespan
• To identify how the microbiome, including the oral microbiome, is wonderfully unique and adaptive during pregnancy and postpartum
• To present focused data and a concise history of the importance of oral health in pregnancy and preterm birth
• To analyze the outcomes of the PPaX trial, demonstrating the benefits of oral xylitol in chewing gum on the prevention of preterm birth
• To share future opportunities for research and advancement in oral health and pregnancy outcomes

• Focus on enabling and advancing oral health in pregnancy and postnatal care
• Consider how you can optimize oral health in pregnancy
• Consider prebiotic approaches to optimizing oral health in pregnancy and postnatal care