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Purpose: The purpose of this study was to assess the knowledge, opinions and practice behaviors of nurse practitioners (NP) and certified nurse midwives (CNM) regarding periodontal disease and adverse pregnancy outcomes. Methods: A 45 item survey was developed, approved, pretested, revised and mailed to 404 North Carolina NPs and CNMs who provide prenatal care. Data was entered into an excel database and transferred to SPSS for Windows for complete analysis. Linear regression modeling was used to determine statistical significance. Results: A total of 219 NPs and CNMs responded to the mailed survey, achieving a response rate of 54%. NPs and CNMs reported having limited knowledge regarding oral health. The majority felt they should collaborate with oral health care professionals to screen patients for periodontal disease. Most agreed they needed more information about periodontal disease and adverse pregnancy outcomes. Conclusion: NPs and CNMs who frequently examine women could serve an important role in screening for oral health problems and making appropriate dental health referrals. Increased basic and continuing education could prepare these professionals for collaborative care with oral health care professionals. This study suggests that collaboration between NPs and CNMs with dental professionals could lead to improved oral health care for pregnant patients. Keywords: Periodontal disease, Preterm birth, adverse pregnancy outcomes, oral health knowledge, interprofessional collaboration, nurse practitioners, certified nurse midwives This study supports the NDHRA priority area, Health Promotion/Disease Prevention: Validate and test assessment instruments/strategies/mechanisms that increase health promotion and disease prevention among diverse populations., Introduction Several governmental, dental and medical agendas have been published that state the importance of oral health and overall well being. The first Surgeon General's Report on Oral Health in [...]

Yes. The benefits--and cost savings--are clear. In the absence of labor or ruptured membranes, cesarean delivery is done for a number of indications, including breech presentation, placenta previa, and prior [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.11.059 Byline: Kim A. Boggess (a)(b), James D. Beck (b), Amy P. Murtha (c), Kevin Moss (b), Steven Offenbacher (b) Abstract: The objective of the study was to determine whether periodontal disease is associated with delivery of a small-for-gestational-age infant. Author Affiliation: (a) Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine (b) Center for Oral and Systemic Diseases, University of North Carolina, Chapel Hill, NC (c) Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC Article History: Received 29 June 2005; Revised 29 November 2005; Accepted 30 November 2005 Article Note: (footnote) Supported by National Institutes of Health Grants K08 HD043284 and R01 DE12453 and the University of North Carolina General Clinical Research Center Grant RR00046. Reprints not available from the authors.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.02.026 Byline: Kim A. Boggess (a), Kevin Moss (b), Amy Murtha (c), Steven Offenbacher (b), James D. Beck (b) Abstract: The purpose of this study was to determine the risks for fetal exposure to oral pathogens and the relationship between vaginal bleeding and fetal exposure in preterm birth risk. Author Affiliation: (a) Department of Obstetrics and Gynecology (b) Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC (c) Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC Article History: Received 9 December 2005; Revised 5 February 2006; Accepted 15 February 2006 Article Note: (footnote) Supported by National Institutes of Health grants K08 HD043284, R01 DE12453 and the University of North Carolina General Clinical Research Center grant RR00046. Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, January 30-February 4, 2006, Miami, Florida. Reprints will not be available from the authors.

Study is presented to determine the risks for fetal exposure to oral pathogens and the relationship between vaginal bleeding and fetal exposure in preterm birth risk. Vaginal bleeding is associated with fetal exposure to oral pathogens, however, whether the bleeding is the cause of or result of fetal exposure to oral pathogens remains to be determined.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.03.062 Byline: Kim A. Boggess (a), Jennifer L. Bailit (b)(c), Mendel E. Singer (c)(d)(e), Valerie M. Parisi (a), Brian M. Mercer (b) Abstract: The purpose of this study was to compare strategies of corticosteroid administration for the prevention of neonatal morbidity and death. Author Affiliation: (a) Departments of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (b) Metrohealth Medical Center (c) Center for Health Care Research and Policy (d) Department of Epidemiology and Biostatistics (e) Case Western Reserve University; Center for Quality Improvement Research, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH Article History: Received 9 November 2004; Revised 25 March 2005; Accepted 26 March 2005 Article Note: (footnote) Supported by National Institute of Child and Human Development, National Institutes of Health grant nos. 1K08 HD 043284 (K.A.B.) and K12 HD98004 (J.L.B.). Reprints not available from the authors.

A study was conducted with an aim to compare strategies of corticosteroid administration for the prevention of neonatal morbidity and death. A universal strategy of corticosteroid administration confers potential benefit for the prevention neonatal morbidity or death over the existing strategy, but requires that a large number of women be treated.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.05.039 Byline: Kim A. Boggess (a)(c), Wayne A. Price (b), John S. Preisser (d), Kenneth J. Moise (a), Steven Offenbacher (c) Abstract: The purpose of this study was to describe maternal insulin-like growth factor, interleukin-1[beta], and fetal size in a rabbit model of Porphyromonas gingivalis exposure. Author Affiliation: (a) Departments of Obstetrics and Gynecology (b) Pediatrics, University of North Carolina at Chapel Hill School of Medicine (c) Center for Oral and Systemic Diseases, University of North Carolina School of Dentistry (d) Department of Biostatistics, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC Article History: Received 1 March 2005; Revised 2 May 2005; Accepted 9 May 2005 Article Note: (footnote) Supported by NIH K08 HD043284 (K.A.B.) and NIH R01 HL 55581 (W.A.P.) and the General Clinical Research Center of the University of North Carolina (RR00046). Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, Reno, Nevada, February 7-12, 2005.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.05.050 Byline: Kim A. Boggess (a)(c), Kevin Moss (b)(c), Phoebus Madianos (c), Amy P. Murtha (d), James Beck (b)(c), Steven Offenbacher (b)(c) Abstract: The purpose of this study was to determine the relationship between fetal inflammatory and immune responses to oral pathogens and risk for preterm birth. Author Affiliation: (a) Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (b) Department of Dental Ecology, and Center for Oral and Systemic Diseases (c) University of North Carolina School of Dentistry (d) Department of Obstetrics and Gynecology, Duke University Medical Center, Chapel Hill, NC Article History: Received 25 February 2005; Revised 9 May 2005; Accepted 10 May 2005 Article Note: (footnote) Supported by K08 HD043284 (K. A. B.), R01 DE12453 (S. O.), and the University of North Carolina General Clinical Research Center grant RR00046. Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2005.01.068 Byline: Kim A. Boggess (a)(b), Thomas N. Trevett (a), Phoebus N. Madianos (b), Lorna Rabe (c), Sharon L. Hillier (c), James Beck (b), Steven Offenbacher (b) Abstract: The purpose of this study was to determine whether microbial DNA hybridization is a useful method to study bacterial vaginosis in asymptomatic pregnant women. Author Affiliation: (a) Department of Obstetrics and Gynecology, and Center for Oral and Systemic Diseases (b) University of North Carolina at Chapel Hill, Chapel Hill, NC (c) Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Women's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA Article History: Received 26 October 2004; Revised 12 January 2005; Accepted 26 January 2005 Article Note: (footnote) Supported by NIDCR grants R01-DE-12453, P60-DE-13079, and RR 00046. Presented at the Annual Meeting of the Infectious Diseases Society for Obstetrics and Gynecology. Reprints not available from the authors.

Study is conducted to determine whether microbial DNA hybridization is a useful method to study bacterial vaginosis in asymptomatic pregnant women. Result shows that DNA hybridization may be a useful method to study shifts in vaginal flora during pregnancy.

Each year over 400,000 infants are born prematurely as a result of preterm labor, preeclampsia, and other adverse events. In fact preterm birth (less than 37 weeks' gestation) is the [...]

Preeclampsia may occur in part because the woman's immune system does not suppress part of the T cell receptor, which normally happens during pregnancy. Preeclampsia is a serious complication of pregnancy.

Extracellular superoxide dismutase is located in the placenta, but it appears to remain inside cells until about 17 weeks' gestation. This enzyme breaks down superoxide, preventing it from inactivating nitric oxide.

Byline: Kim A. Boggess, D.Heather Watts, Ann C. Hobson, Rhoda L. Ashley, Zane A. Brown, Lawrence Corey Keywords: genital herpes simplex virus; polymerase chain reaction; immunoglobulin A Abstract: OBJECTIVES: Our goal was to define the frequency of asymptomatic herpes simplex virus type 2 shedding by culture and polymerase chain reaction and to correlate our findings with cervical anti-herpes simplex virus type 2 immunoglobulin A production. STUDY DESIGN: Women who were seropositive for herpes simplex virus type 2 collected daily genital tract samples during the third trimester for culture and deoxyribonucleic acid quantitation by polymerase chain reaction. Cervical secretions were collected weekly for anti-herpes simplex virus type 2 immunoglobulin A. Asymptomatic shedding by culture versus polymerase chain reaction and anti-herpes simplex virus type 2 immunoglobulin A detection with and without genital shedding were compared by means of McNemar's I.sup.2 test. RESULTS: Asymptomatic shedding was more frequent by polymerase chain reaction than by culture (13.8% vs 2.3%, p < 0.0001). When cervical anti-herpes simplex virus type 2 immunoglobulin A was present, patients were more likely to have negative results by polymerase chain reaction than positive results (66.7% vs 26.7%, p = 0.001). Anti-herpes simplex virus type 2 immunoglobulin A was detected beyond 37 weeks in only one subject. CONCLUSIONS: Polymerase chain reaction was more sensitive than culture for detecting asymptomatic genital herpes simplex virus. The role of immunoglobulin A in clearing genital herpes simplex virus remains to be determined. (Am J Obstet Gynecol 1997;176:443-51.) Author Affiliation: Seattle, Washington Article History: Received 30 July 1996; Revised 12 September 1996; Accepted 15 October 1996 Article Note: (footnote) [star] From the Departments of Obstetrics and Gynecologya and Laboratory Medicine,b University of Washington Medical Center., [star][star] Supported by National Institute of Allergy and Infectious Diseases training grant AI-01740-17 and Program Project grant AI-30731-04., a Reprint requests: Kim A. Boggess MD, Department of Obstetrics and Gynecology, Duke University Medical Center, Box 3967, Durham, NC 27710., aa 6/1/78619

The polymerase chain reaction test may be more accurate than culture in detecting asymptomatic herpes simplex virus type 2 shedding from the genital tract. Researchers collected daily genital tract samples from nine pregnant women during the third trimester who were infected with herpes simplex virus type 2 and analyzed samples for asymptomatic herpes simplex virus shedding. Polymerase chain reaction detected more asymptomatic herpes simplex virus shedding in both women without genital herpes and in symptomatic women. Women without genital herpes may transmit the virus to their infants. Immunoglobulin A appeared to fight herpes simplex virus.

Careful prenatal management of pregnant women with restrictive lung disease may result in good outcomes for both mother and fetus. Restrictive lung disease may involve lung fibrosis, connective tissue disease, or be drug induced. Researchers cared for nine pregnant women with lung inflammation and diminished respiratory function. Five patients with immune diseases were treated with prednisone during pregnancy. Supplemental oxygen was provided for women whose lungs could not adequately eliminate carbon monoxide. Lung function should be tested at the beginning of pregnancy in patients with restrictive lung disease. Epidural anesthesia during labor and delivery may be useful in decreasing the need for oxygen. Drugs, pets, and other allergens should be removed from the patient during pregnancy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2010.04.048 Byline: Arthur M. Baker (a), Sina Haeri (a), Richard L. Klein (b), Kim Boggess (a) Keywords: oxidative stress; paraoxonase 1; preterm birth Abstract: The objective of the study was to determine whether an association exists between low paraoxonase 1 activity and dyslipidemia at midgestation and preterm birth. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (b) Division of Endocrinology, Metabolism, and Medical Genetics, Department of Medicine, Medical University of South Carolina, and Research Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC Article History: Received 8 February 2010; Revised 13 April 2010; Accepted 29 April 2010 Article Note: (footnote) This study was supported in part by grants from the University of North Carolina Medical Alumni Endowment Fund (to A.M.B.), the North Carolina Translational and Clinical Sciences Institute (to A.M.B.), and a Department of Veterans Affairs MERIT award (to R.L.K.)., Cite this article as: Baker AM, Haeri S, Klein RL, et al. Association of midgestation paraoxonase 1 activity and pregnancies complicated by preterm birth. Am J Obstet Gynecol 2010;203:246.e1-4.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.06.017 Byline: Sina Haeri (a), Marla Shauer (b), Monica Dale (b), Jennie Leslie (b), Arthur M. Baker (a), Stephanie Saddlemire (b), Kim Boggess (a) Keywords: highly active antiretroviral therapy; human immunodeficiency virus; low birthweight; pregnancy; preterm birth Abstract: Our aim was to examine perinatal outcomes in women who are infected with human immunodeficiency virus (HIV) and who receive highly active antiretroviral therapy compared with the general population. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (b) Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC Article History: Received 5 February 2009; Revised 28 April 2009; Accepted 5 June 2009 Article Note: (footnote) Supported by the MedStar Research Institute and a Washington Hospital Center Graduate Medical Education Research Grant., Cite this article as: Haeri S, Shauer M, Dale M, et al. Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy. Am J Obstet Gynecol 2009;201:315.e1-5.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2009.05.037 Byline: Arthur M. Baker (a), Richard L. Klein (b), Kevin L. Moss (c), Sina Haeri (a), Kim Boggess (a) Keywords: preeclampsia; pregnancy; serum lipids Abstract: We sought to determine whether serum lipids at midgestation differ between normotensive women and women developing mild and severe preeclampsia. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (b) Division of Endocrinology, Metabolism, and Medical Genetics, Department of Medicine, Medical University of South Carolina, and Research Service, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC (c) School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC Article History: Received 5 February 2009; Revised 21 April 2009; Accepted 20 May 2009 Article Note: (footnote) Cite this article as: Baker AM, Klein RL, Moss KL, et al. Maternal serum dyslipidemia occurs early in pregnancy in women with mild but not severe preeclampsia. Am J Obstet Gynecol 2009;201:293.e1-4. , This study was supported by a Grant from the University of North Carolina Medical Alumni Endowment Fund (A.M.B.) and funding from a Department of Veterans Affairs MERIT award (R.L.K.).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2008.04.017 Byline: Amy H. Picklesimer (a), Heather L. Jared (b), Kevin Moss (b), Steven Offenbacher (c), James D. Beck (b), Kim A. Boggess (d) Keywords: allostatic load; C-reactive protein; CRP; human pregnancy; inflammation; racial disparity Abstract: The purpose of this study was to characterize serum C-reactive protein (CRP) levels in a diverse population of healthy pregnant women with the use of a high sensitivity assay. Author Affiliation: (a) Department of Obstetrics and Gynecology, Greenville Hospital System University Medical Center, Greenville, SC (b) Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC (c) Department of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC (d) Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC Article History: Received 23 October 2007; Accepted 8 April 2008 Article Note: (footnote) Cite this article as: Picklesimer AH, Jared HL, Moss K, Offenbacher S, Beck JD, Boggess KA. Racial differences in C-reactive protein levels during normal pregnancy. Am J Obstet Gynecol 2008;199:523.e1-523.e6. , Reprints not available from the authors., This study was supported by grants K12 HD01441, K08 HD043284, R01 HD26652, and DE-R01-12453.

Periodontal diseases affect the majority of the population either as gingivitis or periodontitis. Recently there have been many studies that link or seek to find a relationship between periodontal disease and other systemic diseases including, cardiovascular disease, diabetes, stroke, and adverse pregnancy outcomes. For adverse pregnancy outcomes, the literature is inconclusive and the magnitude of the relationship between these 2 has not been fully decided. The goal of this paper is to review the literature regarding periodontal diseases and adverse pregnancy outcomes, and provide oral health care providers with resources to educate their patients. Alternatively, this paper will also discuss what is occurring to help increase the availability of care for pregnant women and what oral health care providers can do to help improve these issues. Keywords: gingivitis, periodontitis, preterm labor, preterm birth, low birth weight, Introduction Periodontal diseases are a group of conditions that cause inflammation and destruction to the supporting structures of the teeth. These chronic oral infections are characterized by the presence of [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.12.002 Byline: Michael Ruma (a), Kim Boggess (a), Kevin Moss (b), Heather Jared (b), Amy Murtha (d), James Beck (b), Steven Offenbacher (c) Keywords: C-reactive protein; inflammation; periodontal disease; preeclampsia; pregnancy Abstract: Maternal periodontal disease, a chronic oral infectious and inflammatory disorder, is associated with an increased risk for preeclampsia. Our objective was to determine the relationship between maternal periodontal disease, maternal systemic inflammation, and the development of preeclampsia. Author Affiliation: (a) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC (b) Department of Dental Ecology, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC (c) Department of Periodontology, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC (d) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC. Article History: Received 19 January 2007; Revised 3 December 2007; Accepted 6 December 2007 Article Note: (footnote) Cite this article as: Ruma M, Boggess K, Moss K, et al. Maternal periodontal disease, systemic inflammation, and risk for preeclampsia. Am J Obstet Gynecol 2008;198:389.e1-389.e5. , Supported by NIDCR grant R01-DE012453, NCRR RR00046, and NICHD K08HD043284, RO1HD26652, and K12HD01441.

Introduction. Investigators have reported that periodontal disease may be a risk factor for pregnancy complications including preterm delivery (PTD) and low birth weight (LBW). This study assessed obstetricians&apos; knowledge and practice behaviors concerning periodontal disease and its role in adverse pregnancy outcomes. Methods. One hundred ninety four practicing obstetricians in a 5 county area in central North Carolina were surveyed. Of the 138 eligible physicians, 55 responded yielding a 40% response rate. Results. Most answered correctly when asked about the description of gingivitis (95%). A lower number of respondents were correct when asked about the description of periodontitis (67%). When asked about what causes periodontal disease or what is associated with periodontal disease, most answered correctly with bacteria (94%), although many answered tooth decay (73%), aging (69%), and excess dietary sugar (51%). Most were correct in responding that periodontitis was more serious than gingivitis (80%). Twenty-two percent looked into patients&apos; mouths at initial prenatal examination, 9% periodically, and 48% only when a problem was mentioned by the patient. Forty-nine percent rarely or never recommended a dental examination. Most (84%) considered periodontal disease to be as important a risk factor to adverse pregnancy events as those currently known in obstetrics practice. Conclusions. Data from this study demonstrate that there is knowledge of periodontal disease and its potential role as a pregnancy risk factor but suggest limited incorporation of dental care into clinical medical practice. Keywords: Dental Hygiene, Physician&apos;s Knowledge, Oral Health, Low Birth Weight, Preterm Labor, Physician&apos;s Practice Behaviors, Pregnancy; Periodontitis, Introduction Preterm birth, low birth weight infants, and infant mortality are major health concerns in the United States and are considered leading perinatal problems in the developed world. (1) A [...]

Funding for this project was provided by the ADHA Institute for Oral Health. Purpose. Recent evidence has shown that periodontal disease may be a risk factor for preterm low birth weight (PTLBW). This study assessed obstetricians&apos; knowledge and practice behaviors concerning periodontal disease and its possible effect on preterm low birth weight. Methods and Materials. One hundred ninety-four practicing obstetricians in afire-county area in central North Carolina were surveyed. Second and third mailings were sent to non-respondents. Descriptive statistics, chi square, and Fisher&apos;s exact tests were calculated using SAS software (Cary, NC). Fifty-five obstetricians in the population were ineligible because they had retired, were no longer practicing obstetrics, or were no longer in the study area. Results. Of the remaining 139 eligible obstetricians, 55 responded, yielding a 40% response rate. When asked about the cause of gingivitis (95%) and periodontitis (67%) most answered correctly. When asked about risk factors for periodontal disease, most correctly indicated bacteria (94%), tooth decay (73%), aging (69%), and excess dietary sugar (51%). When asked if they looked into patients mouths, 22% did so at the initial visit, 9% did so periodically, and 48% did so only when a problem was mentioned by the patient. When asked if they recommended dental examinations, 49% responded rarely or never. When asked about risk factors that may contribute to PTLBW, 99% responded maternal smoking, 94% responded preeclampsia, 84% indicated periodontal disease, and 79% indicated bacterial vaginosis., Christina B. Robinson, RDH, MS, is a student researcher at the University of North Carolina; Susan Lieff, PhD, is an assistant professor at the University of North Carolina. Rebecca Wilder, [...]