Pregnant women understandably may be thinking about what color to paint their baby's room or what to name their baby, but medical researchers and dental hygienists say they also should be thinking about their teeth.

	Martha Rial/Post Gazette
	Dr. Gabriella Gosman is expecting twin girls in August. She is an obstetrician/gynecologist at Magee Womens Hospital, where, in partnership with the University of Pittsburgh School of Dental Medicine, a new program will target dental care for low-income women.

The hormonal changes of pregnancy make them particularly susceptible to the gum inflammation known as gingivitis and to more serious oral diseases.

And research suggests a link may exist between periodontal disease and low birthweights and premature labor, as well as infections that potentially can be fatal for both mother and baby.

"If you think about the effects on an unborn child, it's scary," said Pam Dodge, director of ambulatory services at Magee Womens Hospital, home to the region's largest obstetrical service.

Gum disease and poor oral health affect about 9 out of every 10 of the hospital's obstetrical patients, she estimated. In some cases, doctors have made emergency referrals of pregnant women to hygienists.

Most other types of prenatal check-ups are mandatory, but dental appointments seem to fall through the cracks.

It's a particular concern among low-income women, Dodge said, and that has prompted the hospital and the University of Pittsburgh School of Dental Medicine to begin a new program providing dental care for these women.

"A little intervention is really going to decrease any likelihood of disease," said Dr. Gordon Douglass, a spokesman for the American Academy of Periodontology Researchers.

For instance, he said expectant mothers can raise their blood pressure significantly by not taking regular care of their teeth.

Douglass said bacteria in the mouth that is not killed by either regular brushing and flossing can fester and spread through the body, causing high blood pressure. High blood pressure during pregnancy is detrimental to not only the mother's health, but to the child's as well.

"Pregnancy gingivitis" also can be exacerbated by poor brushing and gum care. If left unattended, hormonal plaque, produced by the rise in hormone levels during pregnancy, can turn into the first stages of periodontal disease. Gingivitis thus can lead to periodontitis, a severe form of gingivitis affecting teeth roots and underlying bone, and in turn cause bacterial infections that can spread through the body.

Many researchers also say that poor dental health also can trigger the release of hormone-like substances known as prostaglandins, which can lead to premature labor.

Debate remains within the dental and medical communities about whether poor oral health actually causes premature delivery and low birthweight. But studies thus far has shown a strong association between the two.

Steven Offenbacher, a periodontist at the University of North Carolina at Chapel Hill School of Dentistry, performed one of the country's largest studies on gum disease and low birthweights. His team of researchers monitored the effects of poor dental hygiene in 891 pregnant women.

The babies of mothers with gum disease, the researchers found, were smaller and more premature, even when considering the contribution of maternal risk factors such as smoking, vaginal infections and other factors known to contribute to pregnancy complications.

Offenbacher also found that poor dental care in pregnant women increased the risk for pre-eclampsia, a complication of pregnancy that results in high blood pressure and affects about 5 to 8 percent of pregnant women. Pre-eclampsia and other hypertensive disorders of pregnancy are a leading cause of both maternal and infant death.

Despite this association between oral health and preterm labor/low birth weight, researchers have yet to prove that poor oral health is the direct cause of pregnancy problems.

"The question is whether this is real or simply confined to the U.S. population," said Ananda P. Dasanayake, who is studying the effects of gum disease on small groups of pregnant women at Bellevue Hospital in New York City.

Dasanayake, a professor in the Department of Epidemiology and Health Promotion at the New York University College of Dentistry, said other countries seem to have lower incidences of gum disease. He suspects that tobacco and alcohol use by expectant mothers in the United States -- lifestyle factors often not assessed in similar studies -- might account for some of the preterm births.

But even if the precise link between poor oral health and pregnancy complications is not yet known, Douglass said many studies have shown that "simple scaling and root planing," a hygienist procedure, can eliminate the increased risk of pregnancy problems.

Unfortunately, some women actually avoid dental visits during pregnancy under the misconception that dental X-rays will harm their babies, Dasanayake said. X-rays should be avoided during the third trimester, he noted, but that should not restrict pregnant women from sitting in a dentist chair anytime before the third trimester, or just getting a cleaning thereafter.

"A lot of the misconceptions stem from this being a new area," he observed. "There has been an overshadowing of the mounting evidence that gum disease can lead to delivering a pre-term baby."