62° SRI ABSTRACT NUMBER: 651283 REFERENCES (1) Kabiru et al 2004 (2) Cetin 2000 et al, Barker 1998 (3) Madan et al 2009, Wolf et al 2001 (4) Suvan et al 2011 (5) Madan et al 2009 Supported by Fondazione Giorgio Pardi and MIUR Grant20102CHST5 METHODS 73 obese (OB, BMI ≥30 kg/m 2 ) and 20 normal weight (NW, BMI 18-25 kg/m 2 ) singleton pregnant women were prospectively enrolled at their first prenatal visit, as part of an ongoing longitudinal study. Exclusion criteria: maternal infections (HIV, HCV); maternal drug abuse; abnormal placental insertion; fetal malformations and chromosomal abnormalities; complete edentulism. At recruitment, the following informations were recorded: - medical history and obstetrical history - data about the current pregnancy, such as gestational age, maternal weight, pre-pregnancy BMI, smoking habits (table I). Nutritional and lifestyle advices were provided to OB patients related to advisable weight gain and oral care. CRP levels were measured every trimester by blood testing. At delivery, gestational weight gain (GWG), gestational age, type of delivery, neonatal and placental weights were recorded (table I). Dental and periodontal status was assessed by complete oral clinical examination in 19 OB and 13 NW during the third trimester (28-38 weeks). Informations about oral risk factors, oral health status, oral hygiene habits, oral subjective symptoms and signs were collected via a custom developed questionnaire. Women were visited in the facilities of the obgyn clinical department under standardized conditions with a portable led headlamp system, disposable mouth mirrors (Brillant, Hager&Werken, Duisburg-D), sterile color coded plastic periodontal probes with millimetre markings (Hawe Perio- Probe, Hawe-Neos Dental, Bioggio-CH). The full mouth dental and periodontal examination was performed by two trained and calibrated dental examiners according to the WHO guidelines. Several measures of dental and periodontal health were collected: number of teeth, the caries Decayed Missing and Filled Teeth Index (DMFT), the dental plaque index, gingival bleeding after probing, gingival pocket depth and gingival recession. For each tooth 4 sites were probed (buccal, lingual, mesial and distal). For the purpose of this analysis the oral health data collected were calculated following the WHO indications as DMFT Index, bleeding on probing index (BOP), pocket probing depth (PPD), proportion of sites with PPD and tooth attachment loss equal or over than 4mm. The periodontal disease involvement was categorized as positive if at least one site with PPD ≥ 4mm was present. Missing teeth, partially erupted teeth, prostheses and wisdom teeth were excluded from the periodontal charting. RESULTS 23/73 OB (32%) vs 2/20 NW (10%) had gestational diabetes. CRP levels during the 3 trimesters indicated mild or severe inflammatory status in OB (I trim: 16.5±10.9; II trim: 12.5±6.9; III trim:11.1±9.4 mg/dL). GWG was significantly lower in OB (7.6±7.1 kg) vs NW (14.5±4.7kg) women (p<0.001), according to the provided nutritional advice. Gestational age, birthweight and placental diameters were not significantly different in OB vs NW. Placental weight was significantly different (p<0.005) with OB women having heavier placentas. Requested about oral symptoms, obese mothers complained gingival bleeding (78.9%), gingival swelling (36.8%), tooth mobility (15.8%), tooth pain (36.8%) and oral halitosis (42.1%). The mean number of teeth was 26.6 in OB and 27.7 in NW women; DMFT index was 5.74 vs. 4.85 (see Table 2 for complete oral evaluation data). The mean PPD was 2.8 mm in OB and 2.4 in NW women; the BOP index was 55.7 in OB vs. 47.1 in NW (p<0.1); the PL index was 58.2 in OB and 36.1 in NW (p<0.5). None of the women presented high scores of dental disease indexes but defining at least one periodontal site with a probing depth ≥ 4 mm as a positive PD score, 52.6% of OB had PD, while only 15.4% of NW pregnant patients had PD (OR 6.1, p< 0.05). CONCLUSIONS Obesity is an aggravating inflammatory condition of pregnancy. Obese women may have more compromised oral conditions whereby PD may also represent one distant source of low-grade systemic inflammation with the potential to increase adverse pregnancy outcomes through the direct and indirect effects of oral pathogens. In our small study population, CRP high levels in obese pregnants are a marker of maternal systemic inflammation. Obese women reported more oral symptoms and more gingival bleeding; they showed more dental plaque, deeper periodontal pockets and higher PD score that may reflect different lifestyles and the heavier systemic inflammation of obesity. Society for Reproductive Investigation 62 nd Annual Meeting San Francisco, CA, USA ORAL EVALUATION AND INFLAMMATION IN OBESE PREGNANT WOMEN Silvio ABATI, Veronica CLIVIO, Chiara MANDÓ, Manuela CARDELLICCHIO, Martina MAZZOCCO, Alessandra LISSONI, Paolo CASTELLARIN, Laura STROHMENGER and Irene CETIN Unit of Oral Diseases, Dept. of Health Sciences, H San Paolo and Unit of Ob-Gyn, Dept. of Biomedical and Clinical Sciences, H Sacco University of Milano, Italy INTRODUCTION Overweight and obesity are a rapidly growing health-related problem in the world. Obese people have abnormal or excessive fat accumulation that may impair their health as major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases, other life-threatening diseases. Maternal pregestational obesity has been associated with gestational diabetes, hypertension, PE and delivery complications (1). It is also associated with several fetal and neonatal complications including premature birth and it is related to the development of metabolic syndrome in adulthood (2). Obesity induces a chronic, low-grade inflammation with elevated levels of circulating inflammatory markers such as C-reactive protein (CRP) (3). Thus, maternal obesity may lead to fetal inflammatory response via placenta inflammation, compromising placental function and altering fetal growth and development. Periodontitis (PD) is a chronic inflammatory disease caused by bacterial infection of the supporting tissues around the teeth and can result in the deepening of normal gingival sulci with formation of soft tissue pockets, loss of connective tissue and bone support, loosening of teeth, gingival bleeding, pain, and impaired mastication. PD is one of the most common chronic diseases in the world, and it is also one of the main causes necessitating extraction of teeth. The altered inflammatory and immune state found in obesity could lead to increased periodontal tissue destruction. PD is associated with increased risk for preterm birth and low birth weight, and is often recurring in obesity, due to the common inflammation pathways. Recent clinical and epidemiological evidence suggests that obesity is a risk factor for periodontitis, with gingival inflammatory responses and altered periodontal microbial compositions (4). As both PD and pregnancy induce inflammation and immunological changes, the interplay between pregnancy, obesity and PD can be particularly harmful for both mother and fetus (5). The aim of this study is to evaluate the oral and periodontal status in a cohort of obese pregnant women in comparison to normal weight pregnancies and to correlate the collected data, focusing on the role of PD as a distant source of low- grade systemic inflammation in the mother and on the possible indirect effects on the placenta and the fetus. Table II – oral evaluation data Table I – maternal and fetal data the pathogenesis of PD clinical picture of OB pregnant patient with PD