The biochemistry of saliva throughout pregnancy

Rio, Rute; Azevedo, Álvaro; Simões-Silva, Liliana; Marinho, Jorge; Silva, Mário Jorge; Sampaio-Maia, Benedita

doi:10.5935/MedicalExpress.2015.05.06

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ORIGINAL RESEARCH • MedicalExpress (São Paulo, online) 2 (5) • Oct 2015 • https://doi.org/10.5935/MedicalExpress.2015.05.06 copy

The biochemistry of saliva throughout pregnancy

O EFEITO DA GRAVIDEZ SOBRE A BIOQUÍMICA SALIVAR

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND & OBJECTIVE:

Sialometric and sialochemical analyses during pregnancy are not consistent, and frequently contradictory in terms of salivary flow rate, pH, and concentration of calcium, phosphorous, sodium, potassium, chloride, glucose and α-amylase. We, therefore, measured the evolution of these parameters throughout pregnancy.

METHOD:

A cross-sectional study compared sialometric and sialochemical analyses of 30 pregnant women vs. 30 age-matched non-pregnant women, and a longitudinal study evaluated the pregnant women in the first and third trimester of pregnancy.

RESULTS:

Pregnant women presented acidic non-stimulated saliva, but neutral stimulated saliva pH, and no relevant changes in salivary flow rate. Scialochemical analysis showed decreased calcium levels, increased phosphate levels, and a progressive decrease in glucose levels throughout pregnancy.

CONCLUSION:

Pregnancy significantly changes the oral biochemical milieu, creating a favorable environment for the development of oral pathology, in particular, dental caries.

KEYWORDS:
Saliva; pregnancy; pH; calcium; phosphorous; glucose

	Effect^Ref
Salivary flow
NSS	= Rockenbach,¹³13 Rockenbach MI, Marinho SA, Veeck EB, Lindemann L, Shinkai RS. Salivary flow rate, pH, and concentrations of calcium, phosphate, and sIgA in Brazilian pregnant and non-pregnant women. Head & Face Med. 2006;2:44. Ozturk⁶6 Öztürk LK, Akyüz S, Garan A, Yarat A. Salivary and Dental - Oral Hygiene Parameters in 3rd Trimester of Pregnancy and Early Lactation: The Effect of Education. Marmara Dent J 2013;1:1-8.
NSS	↑Naveen¹²12 Naveen S, Asha M, Shubha ML, Bajoria AA, Jose AA. Salivary Flow Rate, pH and Buffering Capacity in Pregnant and Non Pregnant Women - A Comparative Study. JMED Res. 2014;2014: Article ID 506946.
SS	= Saluja,¹⁹19 Saluja P, Shetty V, Dave A, Arora M, Hans V, Madan A. Comparative Evaluation of the Effect of Menstruation, Pregnancy and Menopause on Salivary Flow Rate, pH and Gustatory Function. J Clin Diagn Res. 2014;8(10):ZC81-5. Laine²⁰20 Laine M, Pienihakkinen K. Salivary buffer effect in relation to late pregnancy and postpartum. Acta Odontol Scand, 2000;58(1):8-10.
SS	↑Naveen¹²12 Naveen S, Asha M, Shubha ML, Bajoria AA, Jose AA. Salivary Flow Rate, pH and Buffering Capacity in Pregnant and Non Pregnant Women - A Comparative Study. JMED Res. 2014;2014: Article ID 506946.
PH
NSS	↓ Naveen,¹²12 Naveen S, Asha M, Shubha ML, Bajoria AA, Jose AA. Salivary Flow Rate, pH and Buffering Capacity in Pregnant and Non Pregnant Women - A Comparative Study. JMED Res. 2014;2014: Article ID 506946. Rockenbach,¹³13 Rockenbach MI, Marinho SA, Veeck EB, Lindemann L, Shinkai RS. Salivary flow rate, pH, and concentrations of calcium, phosphate, and sIgA in Brazilian pregnant and non-pregnant women. Head & Face Med. 2006;2:44.
NSS	Ozturk,⁶6 Öztürk LK, Akyüz S, Garan A, Yarat A. Salivary and Dental - Oral Hygiene Parameters in 3rd Trimester of Pregnancy and Early Lactation: The Effect of Education. Marmara Dent J 2013;1:1-8. Jain²¹21 Jain K, Kaur H. Prevalence of oral lesions and measurement of salivary pH in the different trimesters of pregnancy. Singapore Med J. 2015;56(1):53-7.
SS	= Saluja¹⁹19 Saluja P, Shetty V, Dave A, Arora M, Hans V, Madan A. Comparative Evaluation of the Effect of Menstruation, Pregnancy and Menopause on Salivary Flow Rate, pH and Gustatory Function. J Clin Diagn Res. 2014;8(10):ZC81-5.
SS	Salvolini¹⁵15 Salvolini E, Di Giorgio R, Curatola A, Mazzanti L, Fratto G. Biochemical modifications of human whole saliva induced by pregnancy. Br J Obstet gynaecology 1998;105(6):656-60.*
Calcium	= Rockenbach,¹³13 Rockenbach MI, Marinho SA, Veeck EB, Lindemann L, Shinkai RS. Salivary flow rate, pH, and concentrations of calcium, phosphate, and sIgA in Brazilian pregnant and non-pregnant women. Head & Face Med. 2006;2:44. Guidozzi,²²22 Guidozzi F, Maclennan M, Graham KM, Jooste CP. Salivary calcium, magnesium, phosphate, chloride, sodium and potassium in pregnancy and labour. S Afr Med J. 1992;81(3):152-4.
Calcium	Salvolini 1998¹⁵15 Salvolini E, Di Giorgio R, Curatola A, Mazzanti L, Fratto G. Biochemical modifications of human whole saliva induced by pregnancy. Br J Obstet gynaecology 1998;105(6):656-60.
Phosphate	↑ Ozturk⁶6 Öztürk LK, Akyüz S, Garan A, Yarat A. Salivary and Dental - Oral Hygiene Parameters in 3rd Trimester of Pregnancy and Early Lactation: The Effect of Education. Marmara Dent J 2013;1:1-8.
	↓ Ozturk,⁶6 Öztürk LK, Akyüz S, Garan A, Yarat A. Salivary and Dental - Oral Hygiene Parameters in 3rd Trimester of Pregnancy and Early Lactation: The Effect of Education. Marmara Dent J 2013;1:1-8. Bakhshi,²³23 Bakhshi M, Sabet MS, Hashemi ES, Bakhtiari S, Tofangchiha M, Marhabi SA, Alirezaei S. Evaluation of biochemical changes in unstimulated salivary, calcium, phosphorous and total protein during pregnancy. Afr J Biotechnol. 2012;11(8):2078-83.
	Salvolini¹⁵15 Salvolini E, Di Giorgio R, Curatola A, Mazzanti L, Fratto G. Biochemical modifications of human whole saliva induced by pregnancy. Br J Obstet gynaecology 1998;105(6):656-60.***
	= Rockenbach,¹³13 Rockenbach MI, Marinho SA, Veeck EB, Lindemann L, Shinkai RS. Salivary flow rate, pH, and concentrations of calcium, phosphate, and sIgA in Brazilian pregnant and non-pregnant women. Head & Face Med. 2006;2:44. Guidozzi,²²22 Guidozzi F, Maclennan M, Graham KM, Jooste CP. Salivary calcium, magnesium, phosphate, chloride, sodium and potassium in pregnancy and labour. S Afr Med J. 1992;81(3):152-4.
	Salvolini 1998¹⁵15 Salvolini E, Di Giorgio R, Curatola A, Mazzanti L, Fratto G. Biochemical modifications of human whole saliva induced by pregnancy. Br J Obstet gynaecology 1998;105(6):656-60.****
Sodium	= Guidozzi²²22 Guidozzi F, Maclennan M, Graham KM, Jooste CP. Salivary calcium, magnesium, phosphate, chloride, sodium and potassium in pregnancy and labour. S Afr Med J. 1992;81(3):152-4.
Potassium	↓ Guidozzi²²22 Guidozzi F, Maclennan M, Graham KM, Jooste CP. Salivary calcium, magnesium, phosphate, chloride, sodium and potassium in pregnancy and labour. S Afr Med J. 1992;81(3):152-4.
Chloride	= Guidozzi²²22 Guidozzi F, Maclennan M, Graham KM, Jooste CP. Salivary calcium, magnesium, phosphate, chloride, sodium and potassium in pregnancy and labour. S Afr Med J. 1992;81(3):152-4.
α-Amylase	↑ Abrao,²⁴24 Abrao AL, Leal SC, Falcao DP. Salivary and serum cortisol levels, salivary alpha-amylase and unstimulated whole saliva flow rate in pregnant and non-pregnant. Rev Bras Ginecol Obstetr. 2014;36(2):72-8. Salvolini¹⁵15 Salvolini E, Di Giorgio R, Curatola A, Mazzanti L, Fratto G. Biochemical modifications of human whole saliva induced by pregnancy. Br J Obstet gynaecology 1998;105(6):656-60.
Glucose	-

	Non-pregnant	Pregnant	p values
Age, years	32.64 ± 4.48	32.26 ± 4.15	0.752
Education			0.386
Basic	4.0% (1)	0.0% (0)
Secondary	40.0% (10)	29.6% (8)
University	56.0% (14)	70.4% (19)

	Non-pregnant	Pregnant		P-values
		1^st T	3^rd T	NP vs. P1^st T	NP vs.P3^rd T	P1^st vs. P3^rd T
Salivary flow, mL/min
NSS	1.75 ± 0.44	1.86 ± 0.49	1.89 ± 0.40	0.409	0.247	0.662
SS	2.64 ± 0.31	2.55 ± 0.37	2.71 ± 0.44	0.361	0.484	0.019
PH
NSS	7.03 ± 0.26	6.69 ± 0.35	6.73 ± 0.28	< 0.001	< 0.001	0.370
SS	7.34 ± 0.29	7.33 ± 0.36	7.24 ± 0.26	0.924	0.186	0.053
Calcium, mmol/L	0.51 ± 0.28	0.32 ± 0.28	0.34 ± 0.16	0.022	0.013	0.765
Phosphate, mmol/L	4.45 ± 1.93	6.50 ± 3.67	5.84 ± 3.45	0.040	0.081	0.809
Sodium, mmol/L	11.68 ± 11.80	4.04 ± 4.66	12.17 ± 10.75	0.006	0.894	0.058
Potassium, mmol/L	20.12 ± 3.39	23.75 ± 6.89	22.22 ± 6.54	0.073	0.191	0.661
Chloride, mmol/L	35.96 ± 15.29	41.23 ± 18.09	29.90 ± 19.20	0.346	0.277	0.323
α-Amylase, U/L	117.82 ± 148.85	212.83 ± 416.92	236.96 ± 404.65	0.292	0.172	0.709
Glucose, mg/dL	3.29 ± 4.38	1.65 ± 2.39	0.57 ± 0.46	0.107	0.005	0.023

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