Treating periodontal disease for preventing adverse birth outcomes in pregnant women.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 28605006 · doi:10.1002/14651858.CD005297.pub3
What was done
This Cochrane systematic review searched multiple databases through October 2016 for randomized controlled trials (RCTs) evaluating the effect of periodontal treatment in pregnant women on maternal and perinatal outcomes. Data were extracted independently, pooled using random-effects meta-analyses where appropriate to calculate risk ratios (RR) with 95% confidence intervals (CI), and assessed using Cochrane risk of bias and GRADE methodology.
What was found
Fifteen RCTs (n = 7,161) were included. Comparing periodontal treatment versus no treatment during pregnancy (11 RCTs): - Preterm birth < 37 weeks: no clear difference (RR 0.87, 95% CI 0.70 to 1.10; 11 studies, n = 5,671; low-quality evidence). - Low birth weight < 2500 g: significant reduction with treatment (9.70% vs 12.60%; RR 0.67, 95% CI 0.48 to 0.95; 7 studies, n = 3,470; low-quality evidence). - Other outcomes showed no clear difference or wide confidence intervals: preterm birth < 35 weeks (RR 1.19, 95% CI 0.81 to 1.76; 2 studies, n = 2,557), preterm birth < 32 weeks (RR 1.35, 95% CI 0.78 to 2.32; 3 studies, n = 2,755), low birth weight < 1500 g (RR 0.80, 95% CI 0.38 to 1.70; 2 studies, n = 2,550), perinatal mortality (RR 0.85, 95% CI 0.51 to 1.43; 7 studies, n = 5,320; very low-quality evidence), pre-eclampsia (RR 1.10, 95% CI 0.74 to 1.62; 3 studies, n = 2,946; very low-quality evidence), and small for gestational age (RR 0.97, 95% CI 0.81 to 1.16; 3 studies, n = 3,610; low-quality evidence). Four trials comparing different periodontal treatment intensities could not be pooled due to clinical heterogeneity. No maternal deaths or intervention adverse effects were reported.
Why it matters
Treating maternal periodontal disease does not clearly prevent preterm birth, although it may reduce low birth weight; evidence is currently insufficient to determine if one periodontal protocol is superior to another for improving birth outcomes.
Limits
All 15 included studies were judged to be at high risk of bias, largely driven by lack of blinding and baseline participant imbalances. Overall evidence certainty was graded low to very low across all evaluated outcomes, and trials comparing different periodontal therapies could not be meta-analyzed due to clinical heterogeneity.
Cited by
- partial Periodontal pathogens found in gum pockets can cause heart attacks, brain damage, stroke risk, and preterm birth in pregnancy.
- contradicts Periodontal pathogens in the mouth can cause heart attacks, brain damage, increased risk for stroke, and preterm birth in pregnancy.