Aim: The aim of this systemic review was to evaluate epidemiologic data on the association between maternal periodontal disease and adverse...
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Aim: The aim of this systemic review was to evaluate epidemiologic data on the association between maternal periodontal disease and adverse pregnancy outcomes, namely preterm delivery, low birth weight / small for gestational age, preeclampsia and combinations of preterm and low birth weight.
Methods: MEDLINE, EMBASE and Cochrane Central Registers were searched up to and including May 2012, supplemented by a broad hand search of relevant journals and online early peer-reviewed papers. Papers were grouped based on outcomes of interest, were accepted or rejected for inclusion according to predefined criteria, and were then assessed qualitatively by two examiners. Where possible, meta-analyses were carried out.
Results: The search strategy identified 694 potentially suitable articles. These were screened and assessed for each of the outcomes of interest. There was a high degree of variability in study populations, recruitment and assessment, as well as substantial differences in how disease data were recorded and handled, leading to substantial heterogeneity among the studies included in meta-analyses. Maternal periodontitis is modestly but significantly associated with low birth weight and preterm birth, but the use of a categorical or a continuous exposure definition of periodontitis appears to impact the findings: Thus, whilst significant associations emerge from case-control and cross sectional studies using periodontitis ‘case definitions’, these were substantially attenuated in studies assessing periodontitis as a continuous variable. Data from prospective studies followed a similar pattern, but associations were generally weaker. Maternal periodontitis was significantly associated with pre-eclampsia.
Conclusion: Maternal periodontitis is modestly but independently associated with adverse pregnancy outcomes, but the findings are impacted by periodontitis case definitions. It is suggested that future studies employ both continuous and categorical assessments of periodontal status. Further use of the composite outcome preterm, low birth weight is not encouraged.
