Periodontal treatment for the prevention of adverse birth outcomes

Data sourcesCochrane Oral Health and Pregnancy and Childbirth's Trial Registries, Cochrane Register of Controlled Trials, Cochrane Library, Medline Ovid, Embase Ovid and LILACS BIREME, clinicaltrials.com and the WHO Clinical Trials Registry Platform were searched for published and ongoing trials until October of 2016.Study selectionRandomised controlled trials (RCTs) investigating the effects of periodontal treatment in reducing or preventing perinatal and maternal morbidity and mortality with no exclusions of language or date of publication. Primary perinatal outcomes included: gestational age at birth, birth weight, small for gestational age and perinatal mortality, while the primary maternal outcomes included mortality, pre-eclampsia and treatment adverse effects.Data extraction and synthesisTwo authors independently screened for inclusion and extracted data. Risk of bias was assessed using the Cochrane 'risk of bias' tool.Dichotomous results were expressed as risk ratios (RR) with a 95% confidence interval (CI), and continuous data were expressed as mean differences (MD) with 95% confidence interval. Random-effects model was used for combining results.The quality of the evidence was assessed using GRADE.ResultsFifteen studies with a total of 7,161 participants met the inclusion criteria.Eleven studies (n = 5671) compared periodontal treatment with no treatment. For the outcome preterm birth before <37 weeks a calculated RR of 0.87, 95% CI 0.70-1.10 shows no clear difference. From seven studies (n = 3470) there is evidence that periodontal treatment may reduce birth weight <2500g (RR 0.77, 95% CI 0.48-0.95).There is unclear evidence on the effect of periodontal treatment on preterm birth <35 weeks, <32 weeks, perinatal mortality and pre-eclampsia.Three studies with 3,610 participants showed no evidence of difference in the outcome small for gestational age: RR 0.97, 95% CI 0.81-1.16.ConclusionsThere is no clear evidence that periodontal treatment during pregnancy has an effect on preterm birth. There is some evidence that it may reduce incidence of low birth weight.There is insufficient evidence to define what type of periodontal treatment is superior in preventing any adverse pregnancy outcome.