Exploratory Efficacy of Calcium-Vitamin D Milk Fortification and Periodontal Therapy on Maternal Oral Health and Metabolic and Inflammatory Profile

Abstract

In this 2 × 2 factorial, outcome-assessor blinded, feasibility randomised trial we explored the effect of a non-pharmaceutical multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis receiving prenatal care in a Brazilian public health centre. 69 pregnant women (gestational age ≤20 weeks, T0) were randomly allocated into four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT) (n = 17); (2) placebo sachet and powdered milk plus early PT (n = 15); (3) fortified sachet and powdered milk plus late PT (after delivery) (n = 19); (4) placebo sachet and powdered milk plus late PT (n = 18). Third trimester (T1) and 6–8 weeks postpartum (T2) exploratory outcomes included periodontal health (% sites with bleeding on probing (BOP)), glucose, insulin, C-Reactive Protein, serum calcium and vitamin D. The mean BOP was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed. Changes in glucose levels and variation on birthweight did not differ among groups This feasibility trial provides preliminary evidence for estimating the minimum clinically important differences for selected maternal outcomes. A large-scale trial to evaluate the interventions’ clinical benefits and cost-effectiveness is warranted.

Calcium and Vitamin D Supplementation as Non-Surgical Treatment for Periodontal Disease with a Focus on Female Patients: Literature Review

“…The authors reported no adverse effects; the intervention was acceptable, well tolerated, and feasible in the study population of low-risk pregnant women. The second study was a related trial that evaluated several combinations of calcium and vitamin D supplementation in milk, in addition to early (during pregnancy) vs late (after delivery) periodontal therapy [ 64 ]. The authors found no differences among groups regarding fortification; however, early periodontal therapy was associated with significantly less bleeding on probing.…”

Recent Advances in Nutrition and Diabetes

“…There is evidence that the inflammation due to gingivitis and/or periodontitis tends to worsen during pregnancy due to hormonal changes, and these have implications for maternal health beyond the oral cavity [ 5 ]. For example, this inflammation could lead to a low-grade systemic inflammatory and metabolic disturbances which can have an impact on pregnancy outcomes [ 5 ]. Therefore, there appears to be a relationship between periodontal inflammation and diabetes, and thus managing inflammatory periodontal diseases may improve glycaemic control and associated diabetic complications.…”

“…Therefore, there appears to be a relationship between periodontal inflammation and diabetes, and thus managing inflammatory periodontal diseases may improve glycaemic control and associated diabetic complications. In recognition of this, Rodrigues Amorim Adegboye et al [ 5 ] conducted a randomised controlled trial to explore the effect of a non-pharmacological multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis. The study involved 69 pregnant women receiving prenatal care in a Brazilian public health centre who were randomly allocated to four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT), (2) placebo sachet and powdered milk plus early PT, (3) fortified sachet and powdered milk plus late PT (after delivery), and (4) placebo sachet and powdered milk plus late PT [ 5 ].…”

“…The mean bleeding on probing (BOP) was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed, and there were also no significant differences in the glucose levels and birthweight among the groups [ 5 ].…”

“…There is evidence that the inflammation due to gingivitis and/or periodontitis tends to worsen during pregnancy due to hormonal changes, and these have implications for maternal health beyond the oral cavity [5]. For example, this inflammation could lead to a low-grade systemic inflammatory and metabolic disturbances which can have an impact on pregnancy outcomes [5].…”