DR. MACONES said he has no disclosures relevant to this article. E-mail him at
Infection's Relationship to Prematurity
The United States spends almost 18% of its gross domestic product on health care, yet its infant mortality rate is higher than that in most other developed countries. The latest available data show the United States ranking 29th in the world in infant mortality.
One may ask why the United States continues to have this asynchrony between its investments and such an adverse health outcome. One way to assess this is to examine the factors that contribute most significantly to infant mortality: prematurity and birth defects. Prematurity remains a vexing problem in the United States – one for which the mechanism and the treatment remain, at best, elusive.
Infection or inflammation is considered to play a dominant role in the pathogenesis of prematurity. Data to support this role have been generated from a number of controlled, uncontrolled, and even laboratory studies. Most recently, additional studies have shown that inflammation or infection occurring within body cavities, including the vagina (bacterial vaginosis) or the oral cavity (periodontal disease) are associated with increased rates of prematurity.
The conundrum that we find ourselves in at this point is that there does not appear to be an effective means of altering the status of infection or inflammation in order to have a direct impact on prematurity rates. The studies so far have been controversial, leaving obstetricians very confused as to how they can best intervene and improve the perinatal outcome.
It is because of this very difficult situation that we believe it is important to have a Master Class that examines the relationship between infection – most significantly, periodontal infection – and the outcome of prematurity, and the options that can be exercised at this time with regard to oral health, prenatal care, and management pending definitive answers.
We have invited Dr. George A. Macones, an expert in maternal-fetal medicine who has extensively studied the prediction and prevention of prematurity, to serve as our guest author. Dr. Macones is the Mitchell and Elaine Yanow Professor and chair of the department of obstetrics and gynecology at Washington University, St. Louis. In this column, Dr. Macones details the value of counseling our patients about good oral health.