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Title Pregnant Women Who Have Periodontal Disease Are at an Increased Risk for Pre-Term Birth and/or a Low Birth Weight Child
Clinical Question Are pregnant women who have periodontal disease at a higher risk for having pre-term birth or low birth weight children compared to pregnant women who do not have periodontal disease?
Clinical Bottom Line Pregnant women who have periodontal disease are at an increased risk for having a pre-term birth (PB) and/or low birth weight (LBW) child. This association is supported by several systematic reviews looking at pregnant women with periodontal disease and the occurrence of PB and LWB. Educating women of childbearing years and preventing periodontal disease could help reduce the amount of women experiencing adverse pregnancy outcomes due to periodontal disease.
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) 30370334Daalderop/201823 systematic reviews (120 individual studies were included)Systematic review of non-randomized trials
Key resultsThis is an extensive review comprised of 23 systematic reviews (SR) looking at periodontal disease (PD) and adverse pregnancy outcomes. 17 of the SRs found an association between PD and PB. Seven of those SR conducted a meta-analysis showing a significant risk for PD and PB with an odds ratio (OR)/relative risk (RR) ranging from 1.6 to 3.9. Sixteen SRs reported an association between PD and LBW. Six of the 16 conducted a meta-analysis demonstrating a significant risk for pregnant women with PD and LBW with OR/RR ranging from 1.3-4.0.
#2) 21707694Chambrone/201112,173 subjects in 11 prospective cohort studies includedSystematic review of non-randomized trials
Key resultsOut of the original 1,680 articles found, 11 articles were included. The methodological quality of the studies was assessed and 9 of the studies received high methodological quality while 2 studies received medium methodological quality. Nine of the 11 studies showed an association between PD and PB and LBW. A meta-analysis was performed, and pregnant women with PD had a RR of 1.70 (95% CI 1.03, 2.81) for PB, a RR of 2.11 (95% CI: 1.05, 4.23) for LBW and a combined RR for PB and LBW of 3.57 (95% CI: 1.87, 6.84). It was also found that pregnant women with more severe periodontal disease were associated with a higher risk ratio of PB and LBW.
#3) 17306654Vergnes/20077,150 subjects in 17 articles were includedMeta-Analysis
Key results17 articles were included in the meta-analysis. Results demonstrated that pregnant women with PD were at an increased risk for PB and/or LBW with a cumulative OR of 2.83(95% CI: 1.95-4.10 P< 0.0001) from all studies. PD and PB had an OR of 2.27 (95% CI: 1.06-4.85, P<.05) while PD and LBW had an OR of 4.03 (95% CI: 2.05-7.93, P<.05).
Evidence Search MeSH Terms: periodontics; periodontal diseases; periodontitis; pregnancy outcome. MeSH Terms: infant, low birth weight; periodontitis; periodontics; periodontal diseases MeSH Terms: periodontitis; periodontics; premature birth; periodontal diseases MeSH Terms: premature birth; periodontal diseases; pregnancy
Comments on
The Evidence
Validity: The SRs all demonstrated strict inclusion/exclusion criteria. The Daalderop article used the revised PRIMSA-P guidelines to report on the SRs and two reviewers used the AMSTAR checklist to assess the risk of bias. In the Chambrone article quality of the studies were measured by combining the Newcastle-Ottawa scale and other relevant domains of methodological quality such as sample size calculation and appropriateness of analytical statistics. The Vergnes article followed the MOOSE guidelines when selecting articles; two independent readers reported on the quality of the studies using a scoring system created by Margetts el al. (Margetts B.M., Thompson R.L, Key T, Duffy S, Nelson M, Bingham S, Wiseman M, 1995)
Applicability The latest evidence suggests that there is a clear association between women who have periodontal disease (PD) and experience adverse pregnancy outcomes such as preterm birth (PB) and low birth weight (LBW). Periodontal pathogens and their byproducts cause inflammation leading to an increase in inflammatory markers such as IL-6, IL-8, PGE2 amongst others that enter the circulatory system gaining entrance into the placenta and into the fetal circulation and amniotic fluid which can be harmful during pregnancy and can lead to PB and LBW. Educating women of childbearing years and preventing PD could help reduce the risk of women having a PB or LBW. Through collaboration between gynecologists and dentists, patients can be equipped with the proper information needed to promote an optimal pregnancy and reduce the number of possible adverse pregnancy outcomes.
Specialty/Discipline (Public Health) (General Dentistry) (Periodontics)
Keywords Pregnancy, Periodontitis, Adverse Pregnancy Outcomes, Pre-term Birth, Low Birth Weight
ID# 3410
Date of submission: 11/26/2019spacer
E-mail landm1@livemail.uthscsa.edu
Author Marcela Land
Co-author(s) Hyungjoo Kim
Co-author(s) e-mail true.kim.dds@gmail.com
Faculty mentor/Co-author Angela M Synatzske, DDS, MS
Faculty mentor/Co-author e-mail angela.m.synatzske.mil@mail.mil
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