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Periodontal disease as a risk factor for adverse pregnancy outcomes. A systematic review
Frank A Scannapieco1, Renee B Bush, Susanna Paju
1Department of Oral Biology, School of Dental Medicine, University at Buffalo, State University of New York, Buffalo, New York, USA. fas1@buffalo.edu
Insights
Periodontal disease may increase the risk of preterm birth and low birth weight (PT/LBW). Further research is needed, but early findings suggest periodontal treatment may improve pregnancy outcomes.
Area of Science:
- Obstetrics and Gynecology
- Periodontology
- Public Health
Background:
- Infections, including periodontal disease, are increasingly linked to adverse pregnancy outcomes like prematurity and low birth weight.
- Bacterial vaginosis is a known risk factor for PT/LBW, but the role of periodontal disease requires further investigation.
- This systematic review explores the potential association between periodontal disease and PT/LBW.
Purpose of the Study:
- To determine if preventing or controlling periodontal disease impacts adverse pregnancy outcomes.
- To assess the relationship between periodontal disease and PT/LBW.
Main Methods:
- Searched MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and Cochrane Oral Controlled Trials Register through October 2002.
- Included RCTs, case-control, and cohort studies of mothers with or without periodontal disease.
- Excluded studies not involving humans; meta-analysis was not feasible due to heterogeneity.
Main Results:
- 12 studies met inclusion criteria; findings were heterogeneous.
- Some studies suggested periodontal disease is a risk factor for PT/LBW, but few assessed intervention impacts.
- Several epidemiologic studies did not support this association.
Conclusions:
- Periodontal disease may be a risk factor for PT/LBW.
- More longitudinal, epidemiologic, and interventional studies are necessary to confirm causality.
- Preliminary evidence indicates periodontal intervention might reduce adverse pregnancy outcomes.
Background:
Recent studies have implicated a variety of infections, including periodontal diseases, as risk factors for adverse pregnancy outcomes such as prematurity and low birth weight.
Rationale:
A number of studies have shown that bacterial vaginosis is related to preterm and/or low birth weight (PT/LBW), which continues to be a significant cause of infant morbidity and mortality. It is also possible that other infectious processes, including periodontal diseases, contribute to PT/LBW. This systematic review examines the literature to determine the possible relationship between PT/LBW and periodontal diseases.
Focused Question:
Does prevention/control of periodontal disease as compared to controls have an impact on the initiation/progression of adverse pregnancy outcomes?
Search Protocol:
MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Oral Controlled Trials Register were searched to identify published studies that related variables associated with PT/LBW and periodontal disease. Searches were performed for articles published through October 2002.
Inclusion Criteria:
Randomized controlled clinical trials (RCTs), case-control, and cohort studies were included. Study populations included mothers, with or without periodontal disease, who gave birth to preterm and/or mature infants. The interventions considered included all forms of periodontal therapy.
Exclusion Criteria:
Only studies on humans were included.
Data Collection And Analysis:
Due to study heterogeneity, meta-analysis was not possible.
Main Results:
1. Of the over 660 studies identified, 12 (6 case-control, 3 cross-sectional and longitudinal, and 3 intervention) met inclusion and exclusion criteria and were included in the analysis. 2. While several studies implicated periodontal disease as a risk factor for PT/LBW, few assessed the impact of the prevention and treatment of periodontal disease on outcomes. 3. Several epidemiologic studies did not support periodontal disease as a risk factor for PT/LBW.
Reviewers' Conclusions:
1. Periodontal disease may be a risk factor for PT/LBW. 2. Additional longitudinal, epidemiologic, and interventional studies are needed to validate this association and to determine whether it is causal. 3. It is not yet clear whether periodontal diseases play a causal role in adverse pregnancy outcomes. 4. Preliminary evidence to date suggests that periodontal intervention may reduce adverse pregnancy outcomes.
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