J Korean Med Sci.  2020 Apr;35(14):e105. 10.3346/jkms.2020.35.e105.

Determinants of Spontaneous Preterm Labor and Birth Including Gastroesophageal Reflux Disease and Periodontitis

• Lee KS
• Song IS
• Kim ES
• Ahn KH

• KMID: 2509615
• DOI: http://doi.org/10.3346/jkms.2020.35.e105

Abstract

Background
Periodontitis is reported to be associated with preterm birth (spontaneous preterm labor and birth). Gastroesophageal reflux disease (GERD) is common during pregnancy and is expected to be related to periodontitis. However, little research has been done on the association among preterm birth, GERD and periodontitis. This study uses popular machine learning methods for analyzing preterm birth, GERD and periodontitis.
Methods
Data came from Anam Hospital in Seoul, Korea, with 731 obstetric patients during January 5, 1995 - August 28, 2018. Six machine learning methods were applied and compared for the prediction of preterm birth. Variable importance, the effect of a variable on model performance, was used for identifying major determinants of preterm birth.
Results
In terms of accuracy, the random forest (0.8681) was similar with logistic regression (0.8736). Based on variable importance from the random forest, major determinants of preterm birth are delivery and pregestational body mass indexes (BMI) (0.1426 and 0.1215), age (0.1211), parity (0.0868), predelivery systolic and diastolic blood pressure (0.0809 and 0.0763), twin (0.0476), education (0.0332) as well as infant sex (0.0331), prior preterm birth (0.0290), progesterone medication history (0.0279), upper gastrointestinal tract symptom (0.0274), GERD (0.0242), Helicobacter pylori (0.0151), region (0.0139), calcium-channel-blocker medication history (0.0135) and gestational diabetes mellitus (0.0130). Periodontitis ranked 22nd (0.0084).
Conclusion
GERD is more important than periodontitis for predicting and preventing preterm birth. For preventing preterm birth, preventive measures for hypertension, GERD and diabetes mellitus would be needed alongside the promotion of effective BMI management and appropriate progesterone and calcium-channel-blocker medications.

Keyword

Premature Birth; Gastroesophageal Reflux; Periodontitis

Figure

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  Fig. 1 Variable importance from the random forest: top 01–top 20.BMI = body mass index, BP = blood pressure, GERD = gastroesophageal reflux disease.

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  Fig. 2 Variable importance from the random forest: top 21–top 36.

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  Fig. 3 Receiver-operating-characteristic curves.AUC = area under the receiver-operating-characteristic curve.

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