Review
Effect of periodontal disease treatment during pregnancy on preterm birth incidence: a metaanalysis of randomized trials

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We conducted a metaanalysis of randomized controlled trials to determine whether periodontal disease treatment with scaling and/or root planing during pregnancy may reduce preterm birth (PTB) or low birthweight (LBW) infant incidence. Treatment resulted in significantly lower PTB (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.35-0.86; P = .008) and borderline significantly lower LBW (OR, 0.48; 95% CI, 0.23-1.00; P = .049), whereas no difference was found for spontaneous abortion/stillbirth (OR, 0.73; 95% CI, 0.41-1.31; P = .292). Subgroup analysis suggested significant effect of treatment in the absence of history of PTB or LBW (OR, 0.48; 95% CI, 0.29-0.77; P = .003) and less severe periodontal disease as defined by probing depth (OR, 0.49; 95% CI, 0.28-0.87; P = .014) or bleeding on probing site (OR, 0.37; 95% CI, 0.14-0.95; P = .04). If ongoing large and well-designed randomized trials support our results, we might need to reassess current practice or at least be cautious prior to rejecting treatment of periodontal disease with scaling and/or root planing during pregnancy.

Section snippets

Background and objective

Preterm birth (PTB) rate affects almost 12-13% of pregnancies in the United States and 5-9% in Europe and developed countries.1 PTB is the number 1 cause of neonatal morbidity and mortality and causes 75% of neonatal deaths that are not a result of congenital anomalies. Although most preterm babies survive, they are at increased risk of neurodevelopmental, respiratory, and gastrointestinal complications.2

Approximately 70% of cases of PTB are spontaneous and no specific cause can be identified.3

Identification of randomized studies

Two independent investigators (D. M. and S. T.) searched the Cochrane Central Trials Registry, Web of Science, and Medline without year and language restriction. The last search was updated in January 2008. Results were compared and a consensus was reached with the involvement of a third investigator (I. P. P.). We used the following searching algorithm: (periodontal disease or periodontitis or gingivitis) and (preterm labor or PTB or premature rupture of membranes or PROM or LBW). In addition,

Eligible trials characteristics

The electronic searches yielded 429 items; 246 from Medline, 173 from Web of Science, and 10 from Cochrane Central. Of those, 18 reports were scrutinized in full text. Eleven reports were considered ineligible. Seven randomized trials were recorded. There were 2663 patients: 1491 had been randomized to receive periodontal treatment and 1172 to no treatment (Figure 1).

Table 1 shows the key characteristics of the included trials.

Design and quality characteristics

Three trials reported an adequate randomization mode,9, 13, 14

Comment

Our metaanalysis provides evidence in favor of the treatment of periodontal disease during pregnancy. Despite moderate between-study heterogeneity we observed for 2 of the primary outcomes, treatment with scaling and root planing reduces the rate of PTB and may reduce the rate of LBW infants. Mechanisms by which surgical treatment of periodontal disease might reduce PTB risk remain unknown. It is likely that the benefit of treatment of periodontal disease is related to the decline of oral

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