Gum health may be one of the last things on people’s minds when they are actively trying to become pregnant, but there’s a well-known association between periodontitis during pregnancy and adverse birth outcomes. Now, Julia Bond SPH 24 is trying to learn more about whether that association extends to gum health before pregnancy.
In 2022, Bond received a Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship (F31 grant) from the National Institute of Dental and Craniofacial Research to examine the association between preconception periodontitis and reproductive health outcomes. Now, halfway through the grant, Bond said it has been a wonderful experience participating in high quality oral health research using self-reported observational data.
“I think the point of an F31 is that you combine a training plan with research to get a broad training experience,” Bond said. “My experience, thus far, is that I’ve really been able to learn a whole lot about not just my aims, but also the other training components that we put in the plan.”
The F31 grant provides Bond with two and a half years of funding for research that examines preconception periodontitis in relation to spontaneous abortion (miscarriage) and predictors of preconception oral health status. Some of the research findings from the ongoing investigation on spontaneous abortion were recently published in the American Journal of Epidemiology, indicating a positive association between a preconception history of tooth mobility and risk of spontaneous abortion, but little association for a preconception history of periodontitis diagnosis or treatment.
Bond is also investigating the potential to conduct a target trial (or imitation of a randomized trial using observational data) to evaluate the effect of treatment of preconception periodontitis on time to pregnancy.
She has been using observational data from the web-based study of couples’ fertility in North America, the Boston University Pregnancy Study Online (PRESTO). As of October 24, 17,775 primary participants and 4,090 of their partners have enrolled in PRESTO.
The benefit of the PRESTO data, according to Bond, is that people are enrolled before they become pregnant and are then followed through conception to pregnancy outcome. This means that the cohort includes preconception baseline data, said Bond.
“This is a cool opportunity to have a cohort with a ton of different predictors that maybe haven’t been looked at in relation to oral healthcare engagement and figure out if we can make profiles of people who are not going to the dentist and if we can draw any new conclusions about what may or may not be keeping people out of the dental office,” Bond said.
Bond’s mentor is Dr. Brenda Heaton SPH 05 SPH 12, GSDM adjunct associate professor of health policy & health services research and Boston University School of Public Health adjunct associate professor of epidemiology. The pair has also worked together researching periodontal mortality, further solidifying previous findings that men with periodontal disease were at a greater risk of dying earlier.
As a Boston University School of Public Health epidemiology doctoral student, Bond said she became interested in researching reproductive health after she got pregnant, but she did not envision pursuing any overlapping dental research. After she started working with Heaton in 2019, though, she saw the benefits of examining the relationship between oral health and overall health. According to Bond, Heaton has been the perfect mentor to help guide her research.
“She’s the best,” Bond said. “I really think none of this really would’ve happened without Dr. Heaton’s support. She was the one who really encouraged me to look into this.”
Dr. Lauren Wise, Boston University School of Public Health professor of epidemiology and PRESTO principal investigator, said the goal of PRESTO is to identify modifiable determinants of successful reproduction and healthy pregnancy. According to Wise, there has been a growing amount of research on the relationship between oral health and adverse reproductive and perinatal outcomes, such as chronic periodontal inflammation potentially causing early uterine contractions.
As an additional outcome of Bond’s work, Heaton, in partnership with Wise, received new funding in September 2023 from the National Institute of Dental and Craniofacial Research to further investigate the role of preconception oral health on adverse pregnancy outcomes, including gestational hypertension and diabetes, eclampsia, and pre-term and/or low birthweight outcomes.
“I am delighted that Julia Bond and Dr. Brenda Heaton were successful in receiving this F31 grant that leverages data from the PRESTO cohort to answer critical questions about dental health and reproductive outcomes,” Wise said. “I believe that their work is paradigm-shifting in generating novel and critically important scientific data for advancing clinical care and improving population health.”
The current work builds on a previous paper published by Bond in Human Reproduction, which found that people with a history of periodontitis, as measured by three different self-reported measures, took longer to become pregnant compared to people without that history. This original study prompted the investigation into other reproductive outcomes associated with preconception periodontitis and thus the development of the F31.
“That was exciting,” Bond said. “That was the beginning of a road into, ‘Are we seeing a connection between periodontitis and reproductive health outcomes if the periodontitis is happening before conception?’”
According to Bond, there is much that is still unknown about reproductive health outcomes, but it’s vital to explore the possible connections between oral health and outcomes such as infertility or spontaneous abortion. Understanding more about the links between oral health and these outcomes might generate knowledge that can inform biological models (experimental systems that recreate aspects of human tissue function or disease), she said.
Bond said she hopes her work will help highlight that the preconception period is an important window for individuals trying to become pregnant, and they need to be cognizant of both their oral and overall health.
“People are thinking about their health … they may be more engaged with their healthcare providers, they may be making behavioral changes,” she said. “If there is something to [the connection between preconception periodontitis and birth outcomes], it could be a really beneficial time period.”
