Periodontal disease is one of the commonest diseases in the world with reports of the prevalence of gingivitis globally varying between 50-90% and more than 10% of the world’s adults estimated to be affected by severe periodontitis.  Other studies have reported periodontal disease rates in pregnancy ranging between 11-100%. A number of observational studies and reviews have suggested an association between periodontal disease and pre-terms birth and other adverse pregnancy outcomes.

The aim of this review was to assess the association between periodontitis and preterm birth in women of childbearing age.

Methods

Searches were conducted in the Medline/PubMed, Embase, Science Direct, SciELO, Redalyc, and Clinicaltrials.gov databases. Case-control studies and prospective cohort studies evaluating the association between maternal periodontitis and preterm birth that were published in English or Spanish and used odds ratios and multiple logistic regression models were considered.

Two reviewers independently selected studies and abstracted data. All included studies had to score 5 or higher on the Newcastle-Ottawa scale.  Odds ratios (OR) and confidence intervals (CI) were extracted and meta-analysis carried out.

Results

• 31 studies were included with 20 contributing to the meta-analysis.
• Of the 20 studies (involving 10,215 patients) included in the meta-analysis 16 were case-controlled and 4 were prospective cohorts.
• 12 of the 20 studies reported a positive association, 8 did not.
• A random effects meta-analysis showed a significant positive association OR = 2.01 (95%CI; 1.71 – 2.36).
• The 20 studies used 13 definitions for diagnosis of periodontitis.
• The most frequently assessed covariable or risk factors in the 20 studies were tobacco use, history of preterm birth, maternal age, multiparous pregnancy and parity with 38 different factors assessed overall.

Conclusions

The authors concluded: –

this meta-analysis showed a positive association between preterm birth and maternal periodontitis. To reduce the incidence of preterm birth, health and education centres should prioritize this risk factor, implementing actions that favour prevention in all women of childbearing age. Further research is needed to assess the effectiveness of promptly diagnosing and treating periodontitis in pregnant mothers.

Comments

While this review has been well conducted it is just the latest in a number of reviews on this topic and in an earlier blog (Dental Elf – 17^thOct 2017) we looked at an overview of 23 previous reviews in this area. 17 of these earlier reviews have looked at this topic with an overall  RR =1.6 (1.3 to 2.0).

Furthermore there has been a recent Cochrane review (Dental Elf – 19^thJun 2017) that looked at whether periodontal treatment had a beneficial impact on adverse pregnancy outcomes. The Cochrane reviewers concluded:-

 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.

Are with earlier reviews there is concern regarding the quality of the available studies and the variations in the definitions of periodontal disease used in the studies. A clear common outcomes set for periodontal disease and better conduct and reporting of studies is needed to improve the quality of the evidence.

Links

Primary Paper

Manrique-Corredor EJ, Orozco-Beltran D, Lopez-Pineda A, Quesada JA, Gil-Guillen VF, Carratala-Munuera C. Maternal periodontitis and preterm birth:Systematic review and meta-analysis. Community Dent Oral Epidemiol. 2019 Feb 27. doi: 10.1111/cdoe.12450. [Epub ahead of print] PubMed PMID: 30812054.

Other references

Dental Elf – 19^thJun 2017

Periodontal treatment during pregnancy-no evidence of impact on preterm birth

Dental Elf – 17^thOct 2017

Periodontal disease and pregnancy outcomes