Periodontal treatment during pregnancy decreases the rate of adverse pregnancy outcome: a controlled clinical trial

Abstract

ObjectivesThe aim of this study was to evaluate the effects of non-surgical treatment of periodontal disease during the second trimester of gestation on adverse pregnancy outcomes.Material and MethodsPregnant patients during the 1st and 2nd trimesters at antenatal care in a Public Health Center were divided into 2 groups: NIG – "no intervention" (n=17) or IG- "intervention" (n=16). IG patients were submitted to a non-surgical periodontal treatment performed by a single periodontist consisting of scaling and root planning (SRP), professional prophylaxis (PROPH) and oral hygiene instruction (OHI). NIG received PROPH and OHI during pregnancy and were referred for treatment after delivery. Periodontal evaluation was performed by a single trained examiner, blinded to periodontal treatment, according to probing depth (PD), clinical attachment level (CAL), plaque index (PI) and sulcular bleeding index (SBI) at baseline and 35 gestational weeks-28 days post-partum. Primary adverse pregnancy outcomes were preterm birth (<37 weeks), low birth weight (<2.5 kg), late abortion (14-24 weeks) or abortion (<14 weeks). The results obtained were statistically evaluated according to OR, unpaired t test and paired t test at 5% significance level.ResultsNo significant differences were observed between groups at baseline examination. Periodontal treatment resulted in stabilization of CAL and PI (p>0.05) at IG and worsening of all periodontal parameters at NIG (p<0.0001), except for PI. Significant differences in periodontal conditions of IG and NIG were observed at 2nd examination (p<0.001). The rate of adverse pregnancy outcomes was 47.05% in NIG and 6.25% in IG. Periodontal treatment during pregnancy was associated to a decreased risk of developing adverse pregnancy outcomes [OR=13.50; CI: 1.47-123.45; p=0.02].ConclusionsPeriodontal treatment during the second trimester of gestation contributes to decrease adverse pregnancy outcomes.

The effects of periodontal treatment on pregnancy outcomes

“…Two of the authors (BSM and VTM) reviewed all titles and abstracts, many of which were duplicated in the first two search engines. Three papers reported clinical trials (Jeffcoat et al 2011a, Sant'Ana et al 2011, Weidlich et al 2012, two of which were excluded (Jeffcoat et al 2011a, Sant'Ana et al 2011) because the intervention was not randomly allocated.…”

Periodontal disease treatment and risk of preterm birth: a systematic review and meta-analysis

“…This meta-analysis showed that periodontal disease treatment during pregnancy does not confer a general protec- tion against preterm birth and low birth weight. Our systematic review identified 13 randomized 3,5,6,7,12,13,14,15,16,17,18,19,20 , relevant studies published between 2002 13 and 2012 20 . These studies provided evidence from 6,988 pregnant women with periodontal disease who experienced a total of 790 preterm births.…”

“…The literature search yielded 62 potentially relevant publications, of which 13 were considered eligible for inclusion in this review ( Figure 1) 3,5,6,7,12,13,14,15,16,17,18,19,20 . Reviews of the reference lists 13 primary studies included in meta-analysis 28 studies excluded 11 reviews 9 news, letters, editorials, replays 4 nonrandomized 4 different outcomes yielded two further citations.…”

“…Although all studies described randomization, nine did not adequately describe the random sequence generation methods 3,5,7,12,15,16,17,18,19,20 and nine did not adequately describe allocation concealment 3,5,7,12,15,16,17,18,19,20 . Twelve studies did not use blinding methods for adjudication outcomes 3,5,6,7,12,13,14,15,16,17,18,19,20 . Four trials described a modified intention-to-treat analysis 3,6,13,15 .…”

“…Preterm births < 37 weeks: a meta-analysis of 13 studies 3,5,6,7,12,13,14,15,16,17,18,19,20 showed that periodontal disease treatment during pregnancy had no significant effect on the overall rate of preterm birth (RR = 0.90, 95%CI: 0.68-1.19; p = 0.45; I 2 : 74%) (Figure 2). Low birth weight < 2,500g: a meta-analysis of nine studies 3,5,6,7,12,14,15,17,20 showed a weak association between periodontal disease treatment during pregnancy and decreases in low birth weight, with no significant effect (RR = 0.92, 95%CI: 0.71-1.20; p = 0.55; I 2 : 56%) (Figure 3).…”