Periodontal Treatment for Preventing Adverse Pregnancy Outcomes: A Meta- and Trial Sequential Analysis

Abstract

ObjectivesPeriodontal treatment might reduce adverse pregnancy outcomes. The efficacy of periodontal treatment to prevent preterm birth, low birth weight, and perinatal mortality was evaluated using meta-analysis and trial sequential analysis.MethodsAn existing systematic review was updated and meta-analyses performed. Risk of bias, heterogeneity, and publication bias were evaluated, and meta-regression performed. Subgroup analysis was used to compare different studies with low and high risk of bias and different populations, i.e., risk groups. Trial sequential analysis was used to assess risk of random errors.ResultsThirteen randomized clinical trials evaluating 6283 pregnant women were meta-analyzed. Four and nine trials had low and high risk of bias, respectively. Overall, periodontal treatment had no significant effect on preterm birth (odds ratio [95% confidence interval] 0.79 [0.57-1.10]) or low birth weight (0.69 [0.43-1.13]). Trial sequential analysis demonstrated that futility was not reached for any of the outcomes. For populations with moderate occurrence (<20%) of preterm birth or low birth weight, periodontal treatment was not efficacious for any of the outcomes, and trial sequential analyses indicated that further trials might be futile. For populations with high occurrence (≥20%) of preterm birth and low birth weight, periodontal treatment seemed to reduce the risk of preterm birth (0.42 [0.24-0.73]) and low birth weight (0.32 [0.15-0.67]), but trial sequential analyses showed that firm evidence was not reached. Periodontal treatment did not significantly affect perinatal mortality, and firm evidence was not reached. Risk of bias, but not publication bias or patients’ age modified the effect estimates.ConclusionsProviding periodontal treatment to pregnant women could potentially reduce the risks of perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to risks of bias, risks of random errors, and unclear effects of confounding. Further randomized clinical trials are required.

The human gut microbiome in health: establishment and resilience of microbiota over a lifetime

“…Recent studies have demonstrated that placentas from healthy, term pregnancies harbour a low abundance but diverse microbiome most akin to the maternal oral microbiome, suggesting that bacteria translocated from the oral cavity may colonize the placenta and serve as an initial source for fetal exposure (Aagaard et al 2014;Zheng et al, 2015). Oral bacteria may enter the blood stream via minor abrasions in the oral mucosa (Lockhart et al, 2008), and preterm birth is associated with both periodontal disease and intrauterine infection, suggesting hematogenous dissemination of bacteria from the oral cavity may be involved in both physiological and pathological uterine bacterial colonization (Goepfert et al, 2004;Klein and Gibbs, 2005;Schwendicke et al, 2015). However, these routes of colonization remain largely speculative, and further detailed studies are needed to characterize the impact of the prenatal maternal microbiome on offspring colonization.…”

Porphyromonas gingivalis Suppresses Trophoblast Invasion by Soluble Factors

“…Clinically, the efficacy of dental intervention during pregnancy is controversial. Schwendicke et al 49 reported that treatment of periodontal disease during pregnancy did not reduce risk of PTB or LBW based on their systematic review and meta‐analysis. Newnham et al 50 suggested that treatment of periodontal diseases during mid‐pregnancy did not prevent PTB, FGR, or PE in their randomized controlled trial.…”

Periodontal Disease and Pregnancy Outcome. Are we Still in the Same Place?

“…Conclusive evidence could not be reached due to risks of bias, risks of random errors, and unclear effects of confounding. Further randomized clinical trials are required for this author [24]. But for others, some evidence from observational studies suggests that periodontal intervention may reduce adverse pregnancy outcomes [25].…”

“…Schwendicke et al [24] stated that providing periodontal treatment to pregnant women could potentially reduce the risks of perinatal outcomes, especially in mothers with high risks. Conclusive evidence could not be reached due to risks of bias, risks of random errors, and unclear effects of confounding.…”