Vol 95, No 2 (2024)
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Published online: 2023-08-09

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Streptococcus mutans in the oral cavity as a risk factor for threatened miscarriage

Hanna I. Klimek1, Hanna Moczulska2, Piotr Sieroszewski1
Pubmed: 37599575
Ginekol Pol 2024;95(2):123-125.

Abstract

Objectives: The aim of this study was to investigate the bacterial colonization of the oral and vaginal ecosystem in pregnant women during the first trimester of pregnancy. Material and methods: We analyzed 162 pregnant women, (99 women with threatened abortion and 63 women with healthy pregnancies). We collected oral and vaginal swabs, using PCR analysis to assess the presence of various bacteria (S. mutans, E. faecalis, E. coli, Lactobacillus acidophilus, Prevotella intermedia, Gardnerella vaginalis, S. agalactiae). Results: Results showed that the presence of Streptococcus mutans in the oral cavity was significantly more common in women with threatened abortion compared to those with healthy pregnancies (p = 0.046). The presence of Lactobacillus acidophilus in the vagina was significantly more common in women with healthy pregnancies (p = 0.041). Conclusions: Our study suggests that the presence of Streptococcus mutans in the oral cavity may be a risk factor for threatened abortion.

ORIGINAL PAPER / OBSTETRICS

Ginekologia Polska

2024, vol. 95, no. 2, 123–125

Copyright © 2024 PTGiP

ISSN 0017–0011, e-ISSN 2543–6767

DOI 10.5603/gpl.94849

Streptococcus mutans in the oral cavity as a risk factor for threatened miscarriage

Hanna I. Klimek1Hanna Moczulska2Piotr Sieroszewski1
1Department of Fetal Medicine and Gynecology, Medical University of Lodz, Poland
2Department of Clinical Genetics, Medical University of Lodz, Poland

Corresponding author:

Hanna I. Klimek

Medical University of Lodz, al. Tadeusza Kosciuszki 4, 90–419 Lodz, Poland

e-mail: hanna.i.klimek@gmail.com

Received: 26.03.2023 Accepted: 19.04.2023 Early publication date: 9.08.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

ABSTRACT

Objectives: The aim of this study was to investigate the bacterial colonization of the oral and vaginal ecosystem in pregnant women during the first trimester of pregnancy.

Material and methods: We analyzed 162 pregnant women, (99 women with threatened abortion and 63 women with healthy pregnancies). We collected oral and vaginal swabs, using PCR analysis to assess the presence of various bacteria (S. mutans, E. faecalis, E. coli, Lactobacillus acidophilus, Prevotella intermedia, Gardnerella vaginalis, S. agalactiae).

Results: Results showed that the presence of Streptococcus mutans in the oral cavity was significantly more common in women with threatened abortion compared to those with healthy pregnancies (p = 0.046). The presence of Lactobacillus acidophilus in the vagina was significantly more common in women with healthy pregnancies (p = 0.041).

Conclusions: Our study suggests that the presence of Streptococcus mutans in the oral cavity may be a risk factor for threatened abortion.

Keywords: miscarriage; periodontal disease; pregnancy; Streptococcus mutans

Ginekologia Polska 2024; 95, 2: 123125

INTRODUCTION

The presence of Streptococcus mutans in the oral cavity of a pregnant woman may be a risk factor for miscarriage. We observed that Streptococcus mutans is significantly more widespread in the oral cavity of women with threatened abortion than in those undergoing a healthy pregnancy.

Objectives

The aim of this study was to investigate the bacterial colonization of the oral and vaginal ecosystem in pregnant women during the first trimester of pregnancy.

MATERIAL AND METHODS

We analyse the oral and vaginal bacterial flora of pregnant women in the Polish population during the first trimester of pregnancy. A total of 162 Caucasian women in their first trimester of pregnancy were qualified for the study. The study group was formed of 99 women in their first trimester of pregnancy, i.e., before the 15th week of pregnancy, with a potential miscarriage (bleeding, abdominal pains); they were referred from the Department of Fetal Medicine and Gynecology, Medical University of Lodz. In addition, a comparison group was formed of sixty-three pregnant women under the care of an Outpatient Clinic, who were experiencing a normal first-trimester pregnancy. For the examination, vaginal and oral swabs were collected. Using PCR analysis, the presence of the following bacteria was assessed: Streptococcus mutans, Enterococcus faecalis, Escherichia coli, Lactobacillus acidophilus, Prevotella intermedia, Gardnerella vaginalis, Streptococcus agalactiae. Table 1 shows the distribution of patients and test results.

Table 1. Distribution of patients and test results

Oral cavity

Examined group n = 99

Comparison group n = 63

p value

Lactobacillus acidophilus

39 (0.398)

25 (0.391)

0.926

Gardnerella vaginalis

11 (0.112)

5 (0.078)

0.480

Escherichia coli

3 (0.031)

0 (0.000)

0.160

Enterococcus faecalis

0 (0.000)

1 (0.016)

0.214

Streptococcus mutans

53 (0.535)

24 (0.375)

0.046

Streptococcus agalactiae

10 (0.101)

7 (0.111)

0.839

Prevotella intermedia

6 (0.061)

4 (0.063)

0.974

Vagina

Examined group n = 99

Comparison group n = 63

p value

Lactobacillus acidophilus

61 (0.629)

50 (0.781)

0.041

Gardnerella vaginalis

26 (0.265)

19 (0.297)

0.663

Eschericha coli

4 (0.412)

3 (0.469)

0.865

Enterococcus faecalis

13 (0.131)

13 (0.203)

0.224

Streptococcus mutans

0 (0.000)

1 (0.016)

0.215

Streptocuccus agalactiae

8 (0.081)

7 (0.109)

0.541

Prevotella intermedia

0 (0.000)

0 (0.000)

RESULTS

Cases with threatened miscarriage and the control group presented a similar mean duration of pregnancy at the time of inclusion in the study: 9.4 weeks (p = 0.86). The examined groups were also comparable in terms of age and education. Pregnant women with symptoms of threatened miscarriage tended to have a higher BMI (24.9 vs 23.8 kg/m2 p = 0.03). The patients with symptoms of threatened miscarriage were more likely to have experienced previous miscarriages and a greater number of pregnancies and were more likely to have used progesterone derivatives to a greater degree. We found that the presence of Lactobacillus acidophilus in the vagina was observed significantly more frequently in the group of healthy pregnancies (p = 0.041) (Fig. 1). In our study significantly higher incidence of Streptococcus mutans was found in the oral cavity in the group of patients with a risk of miscarriage (p = 0.046) (Fig. 2). However, the analysed population was comparable in terms of the number of multiple births, manner of completion of previous pregnancies, consumption of legal stimulants such as coffee and tobacco, and identified sources of infection.

Figure 1. Distribution of patients and test results — vagina
Figure 2. Distribution of patients and test results — oral cavity

DISCUSSION

In all healthy women, including pregnant women, the dominant bacterial strains in the vaginal ecosystem are those of the Lactobacillus species and they play a key role in protection against infections of the female genital tract. In our studies, we also found a significant dominance of Lactobacillus acidophilus in the vagina of healthy pregnant women. It has already been observed in previous studies by other researchers. Jiao et al. [1] demonstrated that Lactobacillus and Gardnerella were significantly decreased in recurrent miscarriage patients compared to healthy control group. Studies made so far generally investigated the relationship between periodontal disease and adverse pregnancy outcomes such as preterm deliveries [2–4].

The presence of Streptococcus mutans in oral cavity has not been described as a risk factor for miscarriage so far. Our research showed however that significantly higher incidence of S.mutans was found in the oral cavity patients with a risk of miscarriage. The oral health condition of a pregnant woman can have a significant impact on the entire course of her pregnancy. Our work focused on the study of the presence of bacterial strains in the vagina and in the oral cavity of pregnant women. Other papers on the topic have focused on different aspects, such as the relationship between S. mutans and periodontal disease or the relationship between S. mutans and inflammation of the vagina. Only a few researchers have compared the ecosystems of the oral cavity and vagina among pregnant women. An assessment of various caries risk factors in pregnant and non-pregnant women indicated that pregnant women are more prone to dental caries [5]. Streptococcus mutans, Lactobacillus acidophilus, and Prevotella intermedia are primarily responsible for the development of dental caries [6]. It has also been found that pregnant women with complications during pregnancy were more likely to suffer from severe gingivitis and require more frequent dental treatment than those with a physiological pregnancy [7, 8].

CONCLUSIONS

Our work focuses on a specific population of Eastern European pregnant women at risk of miscarriage and was conducted on a relatively large group, which increases the power of inference. Some other similar work has focused on smaller groups or even individual cases.

To conclude, the occurrence of Streptococcus mutans in the oral cavity may be a risk factor for threatened miscarriage, it is advisable to further study the association of this bacterial strain with the aetiology of miscarriages.

Article information and declarations
Conflict of interest

The authors of the paper have no financial interests or other affiliations with companies or products that could influence the research results or interpretation of the data. The authors have not received any financial or other contributions from companies or organizations that could influence the work.

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