Levels of inflammatory mediators associated with periodontitis in preeclampsia

Abstract

Background: Periodontitis is a chronic inflammatory disease triggered by bacterial infection, which can lead to the destruction of the tooth-supporting tissues, including the gingiva, periodontal ligament, and alveolar bone. If untreated, it can result in tooth mobility, impaired chewing function, and eventual tooth loss. Beyond the oral cavity, periodontitis can act as a persistent source of infection and inflammation, contributing to systemic inflammation that may increase the risk of pregnancy complications. Preeclampsia (PE) is a complex multisystem disorder affecting both maternal and foetal health. It continues to be a major contributor to maternal and perinatal illness and death. particularly in low- and middle-income countries. Growing evidence suggests a possible link between maternal periodontitis and the development of PE, likely mediated through inflammatory pathways. However, most existing studies have been conducted in high-income settings. In South Africa, where both periodontitis and PE are prevalent, there is an urgent need for local, context-specific research to better understand this relationship and inform preventive healthcare strategies. Aim: To determine whether there is an association between periodontitis, the release of pro-inflammatory cytokines, and PE among pregnant women in the Western Cape, South Africa. Objectives: To compare the periodontal status and levels of specific inflammatory mediators between preeclamptic and normotensive pregnant women, and to examine the relationship between these inflammatory markers and periodontal status in relation to PE. Additionally, the study sought to assess whether periodontitis is linked to a higher risk of PE. Methods: This case-control study included 294 pregnant women: 141 with a confirmed PE diagnosis at enrolment (cases) and 153 normotensive pregnant women (controls) admitted to the Gynaecology and Obstetrics departments of tertiary hospitals in the Western Cape, South Africa. All participants were evaluated by a qualified dental clinician, who performed the clinical periodontal examination. Periodontitis was defined as the presence of two or more sites with a PPD > 4 mm, CAL > 3 mm, and positive BOP. Serum levels of Prostaglandin E2 (PGE2) and E2-E4 (PGE2-E4), Interleukin 1-β (IL-1), IL-6, IL-8, and Tumour Necrosis Factor-α (TNF-α) were determined using 2.5 ml of blood collected from each participant in a PAX gene Blood RNA Tube. RNA extraction and gene expression using SYBR Green quantitative polymerase chain reaction (qPCR) on the Quant Studio 12K Flex Real-Time PCR System.