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.
Highlights
Bacterial infection and subsequent immunological reactions are hypothesized to cause adverse pregnancy outcomes like preterm birth, low birth weight, and perinatal mortality [1, 2]
Periodontal treatment had no significant effect on preterm birth or low birth weight (0.69 [0.43-1.13])
Trial sequential analysis demonstrated that futility was not reached for any of the outcomes
Summary
Bacterial infection and subsequent immunological reactions are hypothesized to cause adverse pregnancy outcomes like preterm birth, low birth weight, and perinatal mortality [1, 2]. A recently published systematic review and meta-analysis found significantly reduced risks of preterm birth (odds ratio (OR) [95% confidence interval] 0.66 [0.54–0.80]) and low birth weight (0.48 [0.30–0.78]) in populations with high occurrence of adverse pregnancy outcomes, whilst the estimates for those with moderate occurrence of adverse events and all patients were statistically non-significant [1]. Other reviews confirm the potential of periodontal treatment to reduce adverse pregnancy outcomes, and raise doubts as to the generalizability of these findings and the level of reached evidence [1,2,3,4]
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