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Meta-Analysis
. 2010 Dec 29:341:c7017.
doi: 10.1136/bmj.c7017.

Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis

Nikolaos P Polyzos  1 , Ilias P Polyzos, Apostolos Zavos, Antonis Valachis, Davide Mauri, Evangelos G Papanikolaou, Spyridon Tzioras, Daniel Weber, Ioannis E Messinis
Affiliations
Meta-Analysis

Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis

Nikolaos P Polyzos et al. BMJ. .

Abstract

Objective: To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate.

Design: Systematic review and meta-analysis of randomised controlled trials.

Data sources: Cochrane Central Trials Registry, ISI Web of Science, Medline, and reference lists of relevant studies to July 2010; hand searches in key journals.

Study selection: Randomised controlled trials including pregnant women with documented periodontal disease randomised to either treatment with scaling and root planing or no treatment.

Data extraction: Data were extracted by two independent investigators, and a consensus was reached with the involvement a third. Methodological quality of the studies was assessed with the Cochrane's risk of bias tool, and trials were considered either high or low quality. The primary outcome was preterm birth (<37 weeks). Secondary outcomes were low birthweight infants (<2500 g), spontaneous abortions/stillbirths, and overall adverse pregnancy outcome (preterm birth <37 weeks and spontaneous abortions/stillbirths).

Results: 11 trials (with 6558 women) were included. Five trials were considered to be of high methodological quality (low risk of bias), whereas the rest were low quality (high or unclear risk of bias). Results among low and high quality trials were consistently diverse; low quality trials supported a beneficial effect of treatment, and high quality trials provided clear evidence that no such effect exists. Among high quality studies, treatment had no significant effect on the overall rate of preterm birth (odds ratio 1.15, 95% confidence interval 0.95 to 1.40; P=0.15). Furthermore, treatment did not reduce the rate of low birthweight infants (odds ratio 1.07, 0.85 to 1.36; P=0.55), spontaneous abortions/stillbirths (0.79, 0.51 to 1.22; P=0.28), or overall adverse pregnancy outcome (preterm births <37 weeks and spontaneous abortions/stillbirths) (1.09, 0.91 to 1.30; P=0.34).

Conclusion: Treatment of periodontal disease with scaling and root planing cannot be considered to be an efficient way of reducing the incidence of preterm birth. Women may be advised to have periodical dental examinations during pregnancy to test their dental status and may have treatment for periodontal disease. However, they should be told that such treatment during pregnancy is unlikely to reduce the risk of preterm birth or low birthweight infants.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of selection of trials
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Fig 2 Risk of bias among included trials
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Fig 3 Meta-analysis plot for preterm birth <37 weeks of gestation. M-H=Mantel-Haenszel model
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Fig 4 Meta-analysis plot for low birthweight infants (<2500 g). M-H=Mantel-Haenszel model
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Fig 5 Meta-analysis plot for spontaneous abortions/stillbirths. M-H=Mantel-Haenszel model
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Fig 6 Meta-analysis plot for overall adverse pregnancy outcome (preterm birth <37 weeks of gestation and spontaneous abortions/stillbirths). M-H=Mantel-Haenszel model
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Fig 7 Meta-analysis plots for other secondary outcomes: spontaneous preterm birth <37 weeks of gestation (top); preterm birth <35 weeks of gestation (middle); very low birthweight infants (<1500 g) (bottom). M-H=Mantel-Haenszel model
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Fig 8 Contour enhanced funnel plot for estimation of publication bias
See this image and copyright information in PMC

Comment in

References

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