An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and adverse pregnancy outcomes: A position paper from the Canadian Dental Hygienists Association.
Level 1 - systematic review of randomized trials
Umbrella review synthesizing systematic reviews and meta-analyses of randomized controlled trials
What was done
An umbrella review evaluated whether non-surgical periodontal therapy (NSPT) reduces adverse pregnancy outcomes compared to no NSPT among systemically healthy adults with periodontal disease. The authors searched multiple databases (PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Library, Clinical Trials Registry) for English-language systematic reviews and meta-analyses of randomized controlled trials published between 2007 and 2019. Methodological quality was evaluated using the PRISMA checklist, and causality was assessed using the Bradford Hill criteria.
What was found
From 37 identified records, 9 systematic reviews met inclusion criteria. None of the 9 reviews demonstrated that NSPT lowered the risk of adverse pregnancy outcomes. No numerical effect sizes (such as relative risks or odds ratios) were reported in the abstract. Application of the Bradford Hill criteria failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes.
Why it matters
While observational studies show an association between periodontal disease and adverse pregnancy outcomes, treating periodontal disease during pregnancy does not improve these outcomes, indicating that the observed link is non-causal.
Limits
The abstract does not report specific outcome metrics, definitions of adverse pregnancy outcomes, or effect sizes from the included reviews. Selection was restricted to English-language reviews published between 2007 and 2019. The evaluation relied on PRISMA (a reporting guideline) rather than a dedicated risk-of-bias assessment tool for systematic reviews like AMSTAR 2.
Cited by
- context Gum disease and oral inflammation cross the placental barrier and cause complications such as preterm birth and low birth weight.