Table 17 Impact of interventions for periodontal disease on stillbirth and perinatal mortality

Xiong et al. 2007 [179]

UK.

Review. 2 cohort studies included.

Assessed the association of periodontal disease with fetal death.

Fetal death (miscarriage or SB): Effect size ranged from 2.54–3.84.

Xiong et al. 2006 [176]

UK.

Review. 1 cohort study included (N = 3738 participants).

Assessed any association between periodontal disease and adverse pregnancy outcome.

Fetal death (Miscarriage+SB): adj OR = 2.54 (95% CI: 1.20–5.39)

Intervention studies

Michalowicz et al. 2006 [184]

USA.

RCT. Women (N = 823 women; N = 413 intervention, N = 410 controls) at 13–17 wks' gestation

Used competing-risks analysis to assess the impact of scaling and root planing before 21 wks' gestation, plus monthly tooth polishing and oral hygiene instruction (intervention) vs. scaling and root planing after delivery (controls).

SBR (20–37 wks):

[3/413 vs. 10/410 in intervention vs. control groups, respectively, P = 0.04 [NS]]

Pre-term: P = 0.51 [NS]

Fetal death (miscarriage+SB):

[5/413 vs. 14/410 in intervention vs. control groups, respectively, P = 0.08].

Macones et al. 2008 [182]

USA.

RCT. Multicentre. Women (N = 757; N = 378 intervention, N = 379 controls) < 20 weeks' gestation with periodontal disease identified through screening.

Assessed the impact of periodontal care (scaling and root planing; intervention) vs. tooth polishing (controls) on pre-term birth and its complications.

Major neonatal morbidity/mortality: RR = 1.30 (95% CI; 0.83–2.03) [NS]

[10.6% vs. 8.2% in intervention vs. control groups, respectively]

Pre-term (< 35 wks): RR = 1.55 (95% CI: 0.90–2.67) [NS]

[8.6% vs. 5.6% in intervention vs. control groups, respectively]

Observational studies

Oittinen et al. 2005 [207]

Finland.

Observational study. Women who became pregnant (N = 130) out of a total cohort of women who had discontinued contraception in order to become pregnant.

Assessed the association between maternal disease status, including periodontal disease and BV, with and adverse pregnancy outcome.

Adverse pregnancy outcome (pre-term birth or fetal death):

OR = 5.5 (95% CI: 1.4–21.2, P = 0.014).

[26/130 (20%) of sample. Univariate analysis also showed significant association of periodontal disease with adverse outcome (P = 0.012)].

Fetal death (miscarriage+SB): 17/130.

Pre-term: N = 9.

Mobeen et al. 2008 [181]

Pakistan. Community setting.

Prospective cohort study. Pregnant women enrolled at 20–26 weeks gestation and given dental exam, then followed until delivery.

Assessed the association between maternal periodontal disease severity with adverse pregnancy outcomes.

SBR:

19/1000 vs. 41/1000 (P = 0.069) between the first and the fourth periodontal quartiles (least severe disease vs. most severe disease).

26/1000 vs. 42/1000 (P = 0.131 [NS]) with increasing severity of the clinical attachment measures.

22/1000 vs. 50/1000 stillbirths (P = .033) with increasing severity of plaque index measures,

24/1000 vs. 51/1000 (P = 0.019) with increasing severity of the gingival index measures.