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Meta-Analysis
. 2017 Jun 12;6(6):CD005297.
doi: 10.1002/14651858.CD005297.pub3.

Treating periodontal disease for preventing adverse birth outcomes in pregnant women

Zipporah Iheozor-Ejiofor  1 , Philippa Middleton, Marco Esposito, Anne-Marie Glenny
Affiliations
Meta-Analysis

Treating periodontal disease for preventing adverse birth outcomes in pregnant women

Zipporah Iheozor-Ejiofor et al. Cochrane Database Syst Rev. .

Abstract

Background: Periodontal disease has been linked with a number of conditions, such as cardiovascular disease, stroke, diabetes and adverse pregnancy outcomes, all likely through systemic inflammatory pathways. It is common in women of reproductive age and gum conditions tend to worsen during pregnancy. Some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes. There is need for a comprehensive Cochrane review of randomised trials to assess the effect of periodontal treatment on perinatal and maternal health.

Objectives: To assess the effects of treating periodontal disease in pregnant women in order to prevent or reduce perinatal and maternal morbidity and mortality.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), Cochrane Pregnancy and Childbirth's Trials Register (to 7 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 9) in the Cochrane Library, MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 6 October 2016). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials on 6 October 2016. We placed no restrictions on the language or date of publication when searching the electronic databases.

Selection criteria: We included all randomised controlled trials (RCTs) investigating the effects of periodontal treatment in preventing or reducing perinatal and maternal morbidity and mortality. We excluded studies where obstetric outcomes were not reported.

Data collection and analysis: Two review authors independently screened titles and abstracts and extracted data using a prepiloted data extraction form. Missing data were obtained by contacting authors and risk of bias was assessed using Cochrane's 'Risk of bias' tool. Where appropriate, results of comparable trials were pooled and expressed as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) . The random-effects model was used for pooling except where there was an insufficient number of studies. We assessed the quality of the evidence using GRADE.

Main results: There were 15 RCTs (n = 7161 participants) meeting our inclusion criteria. All the included studies were at high risk of bias mostly due to lack of blinding and imbalance in baseline characteristics of participants. The studies recruited pregnant women from prenatal care facilities who had periodontitis (14 studies) or gingivitis (1 study).The two main comparisons were: periodontal treatment versus no treatment during pregnancy and periodontal treatment versus alternative periodontal treatment. The head-to-head comparison between periodontal treatments assessed a more intensive treatment versus a less intensive one.Eleven studies compared periodontal treatment with no treatment during pregnancy. The meta-analysis shows no clear difference in preterm birth < 37 weeks (RR 0.87, 95% CI 0.70 to 1.10; 5671 participants; 11 studies; low-quality evidence) between periodontal treatment and no treatment. There is low-quality evidence that periodontal treatment may reduce low birth weight < 2500 g (9.70% with periodontal treatment versus 12.60% without treatment; RR 0.67, 95% CI 0.48 to 0.95; 3470 participants; 7 studies).It is unclear whether periodontal treatment leads to a difference in preterm birth < 35 weeks (RR 1.19, 95% CI 0.81 to 1.76; 2557 participants; 2 studies; ) and < 32 weeks (RR 1.35, 95% CI 0.78 to 2.32; 2755 participants; 3 studies), low birth weight < 1500 g (RR 0.80, 95% CI 0.38 to 1.70; 2550 participants; 2 studies), perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth) (RR 0.85, 95% CI 0.51 to 1.43; 5320 participants; 7 studies; very low-quality evidence), and pre-eclampsia (RR 1.10, 95% CI 0.74 to 1.62; 2946 participants; 3 studies; very low-quality evidence). There is no evidence of a difference in small for gestational age (RR 0.97, 95% CI 0.81 to 1.16; 3610 participants; 3 studies; low-quality evidence) when periodontal treatment is compared with no treatment.Four studies compared periodontal treatment with alternative periodontal treatment. Data pooling was not possible due to clinical heterogeneity. The outcomes reported were preterm birth < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality (very low-quality evidence). It is unclear whether there is a difference in < 37 weeks, preterm birth < 35 weeks, birth weight < 2500 g, birth weight < 1500 g and perinatal mortality when different periodontal treatments are compared because the quality of evidence is very low.Maternal mortality and adverse effects of the intervention did not occur in any of the studies that reported on either of the outcomes.

Authors' conclusions: It is not clear if periodontal treatment during pregnancy has an impact on preterm birth (low-quality evidence). There is low-quality evidence that periodontal treatment may reduce low birth weight (< 2500 g), however, our confidence in the effect estimate is limited. There is insufficient evidence to determine which periodontal treatment is better in preventing adverse obstetric outcomes. Future research should aim to report periodontal outcomes alongside obstetric outcomes.

PubMed Disclaimer

Conflict of interest statement

Zipporah Iheozor‐Ejiofor: no interests to declare. Zipporah is an Editor with Cochrane Oral Health. Philippa Middleton: no interests to declare. Marco Esposito: no interests to declare. Marco is an Editor with Cochrane Oral Health. Anne‐Marie Glenny: no interests to declare. Anne‐Marie is Deputy Co‐ordinating Editor of Cochrane Oral Health.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of Comparison 1 Periodontal treatment versus no treatment, Outcome 1.1 Gestational age (preterm birth).
1.1
1.1. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 1 Gestational age (preterm birth).
1.2
1.2. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 2 Birth weight (low birth weight).
1.3
1.3. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 3 Small for gestational age.
1.4
1.4. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 4 Perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth).
1.5
1.5. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 5 Pre‐eclampsia.
1.6
1.6. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 6 Probing depth.
1.7
1.7. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 7 Bleeding on probing.
1.8
1.8. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 8 Plaque index.
1.9
1.9. Analysis
Comparison 1 Periodontal treatment versus no treatment, Outcome 9 Clinical attachment level.
2.1
2.1. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 1 Gestational age (preterm birth < 37 weeks).
2.2
2.2. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 2 Gestational age (preterm birth < 35 weeks).
2.3
2.3. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 3 Birth weight (low birth weight).
2.4
2.4. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 4 Perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth).
2.5
2.5. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 5 Probing depth.
2.6
2.6. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 6 Clinical attachment level.
2.7
2.7. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 7 Bleeding on probing.
2.8
2.8. Analysis
Comparison 2 Periodontal treatment versus alternative periodontal treatment, Outcome 8 Gingival index.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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