Periodontal status in early-onset preeclamptic women versus late preeclamptic women and normals, directly postpartum

Recent studies suggest a significant association between maternal periodontal
disease and preeclampsia. The etiology of preeclampsia however is still not
clear. A recent thought is that mild infection of the bloodvessels during
normal pregnancy results in activation of the endothelium, mild activation of
the coagulation cascade and a mild reduction in fibrinolysis. It has been
hypothesized that preeclampsia is an exaggerated immune response in the
bloodvessels with more pronounced endothelial damage and an induced activation
of the coagulation cascade. Several riskfactors play a role in the pathogenesis
of this syndrome. The presence of a chronic infection during pregnancy is
thought to be an important riskfactor for preeclampsia. Periodontal disease is
a chronic infection of the supporting tissues of the teeth, which can be
present subclinically for years. We hypothesise that the presence of
periodontal disease during pregnancy might play a role in the pathogenesis of
preeclampsia.

Two forms of preeclampsia can be distinguished: early-onset preeclampsia
(occurring <34 weeks of pregnancy) and late-onset preeclampsia (occurring >34
weeks of pregnancy). Although placental dysfunction plays a central role in the
development of both forms of this syndrome, boths forms differ in pathogenesis.
Early-onset preeclampsia is associated with low birth weight en starts with
(genetically predisposed) abnormal placentation, leading to reduced placental
perfusion and a hypoxic placenta. This abnormal placentation and fetal growth
restriction is not seen in late-onset preeclampsia. Late-onset preeclampsia
seems to be an abnormal maternal response. Late-onset preeclampsia is thought
to be the result of a maternal haemodynamic failure to comply with the
additional demands of the feto-placental unit. The endothelial damage that
causes the clinical syndrome of preeclampsia resembles the endothelial
abnormalities as seen in atherosclerosis. Especially women with a history of
early-onset preeclampsia seem to be at higher risk for cardiovascular diseases
in later life. A history of early-onset preeclampsia might thus be a predictor
for the development of cardiovascular diseases in later life.

To determine and compare the periodontal status between the different groups of
women. Periodontal examinations will be performed within one week after
delivery. If periodontal disease is diagnosed within the selected groups, it is
plausible to assume periodontal disease was present during pregnancy.

Clinical case-control study, in which the periodontal condition, genetic
profile and microbiological composition of the subgingival plaque of the
different groups will be determined.
One extra blood sample, drawn from the antecubital vein of patients during
routine vein puncture, will be taken at the moment of hospitalization.

The periodontal screening, microbial test and genetic screening will take about
1 hour. The used periodontal screenings will not be painful, but can sometimes
be experienced as inconvenient.
One extra blood sample, drawn from the antecubital vein of patients during
routine vein puncture, will be taken.