Adverse Pregnancy Outcomes and Maternal Periodontal Disease: An Overview on Meta-Analytic and Methodological Quality

Abstract

This umbrella review aims to appraise the methodological quality and strength of evidence on the association between maternal periodontitis and adverse pregnancy outcomes (APOs). PubMed, CENTRAL, Web-of-Science, LILACS, and Clinical Trials were searched until February 2023, without date or language restrictions. Two authors independently screened studies, extracted data, performed the risk-of-bias analysis, and estimated the meta-analytic strengths and validity and the fail-safe number (FSN). A total of 43 SRs were identified, of which 34 conducted meta-analyses. Of the 28 APOs, periodontitis had a strong association with preterm birth (PTB), low birth weight (LBW), and gestational diabetes mellitus (GDM), PTB and LBW showed all levels of strength, and pre-eclampsia showed only suggestive and weak strength. Regarding the consistency of the significant estimates, only 8.7% were likely to change in the future. The impact of periodontal treatment on APOs was examined in 15 SRs, 11 of which conducted meta-analyses. Forty-one meta-analyses were included and showed that periodontal treatment did not have a strong association with APOs, although PTB revealed all levels of strength and LBW showed only suggestive and weak evidence. Strong and highly suggestive evidence from observational studies supports an association of periodontitis with a higher risk of PTB, LBW, GDM, and pre-eclampsia. The effect of periodontal treatment on the prevention of APOs is still uncertain and requires future studies to draw definitive and robust conclusions.

Effect of Treating Periodontal Disease in Pregnant Women to Reduce the Risk of Preterm Birth and Low Birth Weight: An Umbrella Review

“…In contrast to Machado et al [ 98 ], who analyzed the systematic reviews and only described the main findings on the association between maternal periodontitis and adverse pregnancy outcomes (APOs), this review performed an analysis of the meta-analytic estimates from all systematic reviews with meta-analyses from inception to February 2023. These results allow for the generation of solid scientific evidence maps that will contribute decisively to developing oral and periodontal care strategies for pregnant women, with the primary goal of minimizing pregnancy complications.…”

“…The SRs examined in this study suggest a positive and direct association between the treatment of PD and the reduction in the risk of PB/LBW, supporting previous findings by other authors such as Rangel-Rincón et al [ 96 ] and López et al [ 74 ]. However, researchers such as Machado et al [ 98 ] and Lavigne and Forrest [ 100 ] have raised doubts about this reduction and point to the need for future research to clarify this association.…”

The Impact of Periodontal Disease on Preterm Birth and Preeclampsia

“…The symptoms of preeclampsia, such as arterial hypertension, oxidative stress, and proteinuria, are believed to stem from a generalized dysfunction of the pregnant endothelium. Redman et al proposed that inflammation triggers endothelial dysfunction, but it is unclear whether inflammation is a consequence or a precursor of preeclampsia [25,26]. Preeclampsia has been associated with deficient remodeling of spiral arteries, a process that begins in the first trimester and concludes by 18-20 weeks of gestation [27].…”

“…The potential link between preeclampsia and an unidentified microbial factor, combined with evidence that periodontitis can alter microbiota and heighten risks of cardiovascular disease, atheromatous plaques, and endothelial damage, spurred scientific investigation into a potential correlation between periodontitis and preeclampsia. The literature suggests a clear association between periodontitis and increased preeclampsia risk [25,[30][31][32][33]. Sgolastra et al, in a 2013 meta-analysis, found that periodontal disease elevates preeclampsia risk by 117% (OR 2.17) [31,34].…”

Blood count, endocrine, immunologic, renal, and hepatic markers in a case-control animal study of induced periodontitis in female rodents

“…Deterioration of the periodontium allows invasion of periodontal pathogens through the bloodstream and triggers a systemic inflammatory response that can affect any tissue in the body ( Lang and Bartold, 2018 ). Recently, periodontal disease has been strongly associated with an increased risk of several systemic diseases, including adverse pregnancy outcomes, polycystic ovarian syndrome, and altered levels of mean corpuscular hemoglobin and serum C-reactive protein (CRP) ( Machado et al, 2023 ). Furthermore, periodontal health in women during reproductive years is an important component of health and reduces the risk of conceptions difficulties ( Hart et al, 2012 ; Machado et al, 2020a ; Telatar et al, 2021 ).…”