ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Presence of Periodontal Disease in Pregnant Women Increases the Risk of Developing Preeclampsia
Clinical Question Is periodontitis a risk factor for development of preeclampsia during pregnancy?
Clinical Bottom Line Research has shown that periodontal disease contributes to the development of preeclampsia during pregnancy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23990948Sgolastra/2013384 studies Meta-Analysis
Key resultsThis meta-analysis concluded that a relationship between pregnant women with periodontal disease (PD) and development of preeclampsia (PE) does indeed exist. Originally, 384 studies were reviewed; however, only 15 studies qualified for inclusion in this meta-analysis. Exclusion criteria included: 1) patients with systemic disease 2) no report of adjustment for confounding factors and 3) duplicate studies. Sample sizes ranged from 54 to 1206 participants between each study. The odds ratio for all case-control studies was 2.17 with a 95% confidence interval of (1.29-3.63). The results from case-control studies appeared to contain more data validating a relationship between PD and PE, particularly when PD is defined as deep probing depths and clinical attachment loss. The odds ratio for these findings was 2.50.
#2) 23631578Ide/201310 studiesSystematic review
Key results5 case-control studies were examined in this systemic review to evaluate the association of maternal periodontitis and preeclampsia. In general, PD was defined as the presence of 4 or more teeth with probing depths equal to or exceeding 4mm. These same sites must also have 3mm or greater clinical attach loss. The systemic review collected data from a total 4224 participants when combining all 5 case-control studies. The case group contained 1535 women and the control group contained 2689. The odds ratio for the entire data was 1.61 with a 95%confidence interval of (1.36-1.92). Overall, data from all 5 studies showed a positive association between maternal PD and preeclampsia.
#3) 16460242Contreras/2006373 pregnant women Case Control Study
Key resultsOf the 373 participants, 243 (63.4%) women with healthy gingiva/gingivitis did not develop preeclampsia during pregnancy, compared to 130 (36.3%) women who did—having a statistical significance of P < 0.001. Women with preeclampsia had a greater occurrence of periodontitis than women without the disease. 63.8% of the case group had chronic periodontitis (83 out of 130). Only 36.6% of the control group was diagnosed with periodontitis (89 out of 243). The p-valve for this relationship was also P < 0.001. The relationship between periodontitis and preeclampsia had an odds ratio of 3.0, and increased to 3.32 in women with moderate/severe periodontitis. Pathogens, such as P. gingivalis, T. forsythensis, and E. corrodens, which are suspected to induce complications in pregnancy, had a 61.5%, 28.5%, and 49.2% occurrence rate, respectively, in the case group. The odds ratio for the presence of these pathogens and development of preeclampsia were 1.77 and 1.80 respectively.
Evidence Search periodontitis, periodontal disease, preeclampsia, pregnancy, adverse birth outcomes
Comments on
The Evidence
Current research on the relationship between periodontal disease and preeclampsia is convincing; and, a conclusion regarding their association can be affirmed based on available evidence, which includes meta-analysis, systemic reviews, and case-control studies.
Applicability As oral healthcare providers, it’s our job to educate expecting mothers about the importance of receiving dental care before and during pregnancy, in particular periodontal treatment. Continuation of dental treatment will decrease the risk of developing conditions, such as preeclampsia, that can compromise the health of both mother and baby.
Specialty/Discipline (Public Health) (Pediatric Dentistry) (Periodontics)
Keywords periodontitis, periodontal disease, preeclampsia, pregnancy
ID# 2704
Date of submission: 03/08/2014spacer
E-mail Artesha.Porter@ucdenver.edu
Author Artesha Porter
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Deise Oliveira, DDS
Faculty mentor/Co-author e-mail Deise.Oliveira@ucdenver.edu
Basic Science Rationale
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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