Abstract
This study was designed to determine whether pregnant women with periodontal disease have an increased risk for preeclampsia. We performed a systematic review and meta-analysis of observational studies (cohort, cross-sectional or case-control) that assessed the epidemiological, clinical, microbiological, or pathological association between maternal periodontal disease and preeclampsia. A comprehensive search was conducted, not only of the bibliographic databases, but also of other possible sources of information. Two authors assessed trials for inclusion and extracted data independently. Data from individual studies were combined to calculate pooled unadjusted and adjusted odds ratios (ORs) with associated 95% confidence interval (CI). Heterogeneity was examined using I2. Twelve studies (9 case-control and 3 cohort; 5, 588 women) were assessed to be of sufficient quality to be included. Nine studies (5, 183 women) provided data for meta-analyses. Eight studies reported that periodontal disease was associated with an increased risk for preeclampsia. Overall, women with periodontal disease during pregnancy had a higher risk of preeclampsia than those without it (unadjusted pooled OR, 1.67 [95% CI, 1.12-2.48]; I2=77% and adjusted pooled OR, 1.41 [95% CI, 1.19-1.68]). Examination of the sources of heterogeneity found that in studies conducted in developing countries, periodontal disease was associated with an increased risk for preeclampsia (pooled OR: 1.85; 95% CI, 1.15-2.97) whereas those conducted in developed countries were not (1.26; 95% CI, 0.58-2.72). Six studies reported a dose-response association in which the severity of periodontal disease was associated with the risk of preeclampsia (pooled unadjusted OR, 1.39 [95% CI, 0.87-2.23] for mild/moderate periodontal disease; and 2.26 [95% CI, 1.19-4.26] for severe periodontal disease). Maternal periodontal disease during pregnancy is associated with an increased risk of preeclampsia.
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