Periodontopathogenic microbiota, infectious mechanisms and preterm birth: analysis with structural equations (cohort—BRISA)

  • Elisa Miranda CostaEmail author
  • Camilla Silva de Araujo Figueiredo
  • Rafiza Félix Marão Martins
  • Cecília Claudia Costa Ribeiro
  • Claudia Maria Coelho Alves
  • Maria Lúcia Talarico Sesso
  • Ruchele Dias Nogueira
  • Maria da Conceição Saraiva
  • Marco Antônio Barbieri
  • Heloisa Bettiol
  • Antônio Augusto Moura da Silva
  • Erika Bárbara Abreu Fonseca Thomaz
Maternal-Fetal Medicine



The association between periodontopathogenic microbiota and preterm birth (PTB) has been overly studied. However, the biological mechanisms involved are little known. The objective is to evaluate the effect of periodontopathogenic bacteria burden (PBB), periodontal disease and other infections during pregnancy on preterm birth (PTB), through Structural Equation Modeling.


This was a case–control study nested in a prospective cohort called BRISA, including 330 pregnant women, 110 cases and 220 controls. This study included the following variables: cytokines interleukin-10 (IL-10) and transforming growth factor beta (TGF-β), periodontal disease, PBB, age, socioeconomic status (SES), systemic infections and PTB. The correlations between variables were analyzed using Standardized Coefficient (SC).


Greater PBB interfered positively with the occurrence of periodontal disease (SC: 0.027; p: 0.011), but these were not associated with the cytokines studied, nor with PTB. The lower serum levels of IL-10 (SC − 0.330; p 0.022) and TGF-β (SC − 0.612; p  < 0.001), and the presence of other systemic infections during pregnancy (SC 0.159; 0.049) explained the higher occurrence of PTB.


It is possible that only the more severe periodontal disease and other systemic infections are capable of altering the cascade of cytokines regulating the inflammatory process and have an effect on the occurrence of PTB.


Infection Periodontal diseases Anaerobic bacteria Premature birth Epidemiological studies 



Thanks to all the pregnant women who participated in the study.

Author contributions

EBAFT, CCCR, AAMS, HB, and MCS designed the study. EMC, CMSAF, RFMM, and CMCA reviewed the literature. EMC and EBAFT performed the statical analyses. EMC, MLTS, RFMM, and RDS performed the laboratorian analyses. EMC, RFMM, and CSAF wrote the draft. EBAFT, EMC, and RFMM critically revised the manuscript. All the authors approved the final version.


This work was supported by the Maranhão Research and Scientific and Technological Development Foundation (FAPEMA); National Council of Scientific and Technological Development (CNPq); Program of Support to Cores of Excellence (PRONEX); and Foundation of Support to Research of the State of São Paulo (FAPESP).

Compliance with ethical standards

Conflict of interest

There is no conflict of interest in this paper.

Ethical standards

The study was approved by the Research Ethics of the University Hospital of the Federal University of Maranhão under the no 223/2009, protocol: 4771 / 2008–30. All participants have signed the free and informed consent form.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Elisa Miranda Costa
    • 1
    Email author
  • Camilla Silva de Araujo Figueiredo
    • 2
  • Rafiza Félix Marão Martins
    • 1
  • Cecília Claudia Costa Ribeiro
    • 1
    • 2
  • Claudia Maria Coelho Alves
    • 1
    • 2
  • Maria Lúcia Talarico Sesso
    • 3
  • Ruchele Dias Nogueira
    • 4
  • Maria da Conceição Saraiva
    • 5
  • Marco Antônio Barbieri
    • 6
  • Heloisa Bettiol
    • 6
  • Antônio Augusto Moura da Silva
    • 1
  • Erika Bárbara Abreu Fonseca Thomaz
    • 1
    • 2
  1. 1.Department of Public HealthFederal University of MaranhãoSão LuísBrazil
  2. 2.Department of Dentistry IIFederal University of MaranhãoSão LuísBrazil
  3. 3.Department of Pediatrics, Medical School of Ribeirão PretoUniversity of São PauloRibeirão PretoBrazil
  4. 4.Department of DentistryUniversity of UberabaUberabaBrazil
  5. 5.Department of Pediatrics and Social Dentistry, Ribeirão Preto School of DentistryUniversity of São PauloRibeirão Preto, São PauloBrazil
  6. 6.Department of Puericulture and PediatricsGraduate Program in Child and Adolescent Health, São Paulo UniversityRibeirão Preto, São PauloBrazil

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