Periodontal disease as a risk factor for adverse pregnancy outcomes: A systematic review and meta-analysis of case-control studies

Department of Health Technologies, IRCCS Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy.
Odontology (Impact Factor: 1.52). 07/2011; 100(2):232-40. DOI: 10.1007/s10266-011-0036-z
Source: PubMed


Periodontal disease is a highly prevalent group of illnesses of microbial etiology, whose consequence is a severe breakdown of tooth-supporting structures. A link between periodontal infection and several systemic conditions, among which adverse pregnancy outcomes, has been suggested in the recent years. The aim of this review based on case-control studies was to evaluate if periodontal disease could be considered as a risk factor for preterm birth, low birth-weight and preterm low birth-weight. An electronic search (via Pubmed) was performed for case-control studies investigating the relationship between periodontal disease and adverse pregnancy outcomes. From the initially retrieved 417 articles, 17 case-control studies, accounting for a total of 10,148 patients, were included in the review and in the meta-analysis. The estimated odds ratio was 1.78 (CI 95%: 1.58, 2.01) for preterm birth, 1.82 (CI 95%: 1.51, 1.20) for low birth-weight and 3.00 (CI 95%: 1.93, 4.68) for preterm low birth-weight. Despite the results of the analysis of pooled data suggested a link between periodontal diseases and adverse pregnancy outcomes, the presence of important confounders, whose effect could not be addressed, prevents a validation of the meta-analysis outcomes. Further more accurate investigations based on individual data analysis could give a better insight into the topic of the present review.

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    • "A recent systematic review reported a consistent association between periodontitis and PB and/or LBW, but data must be taken with reservation (Chambrone et al., 2011). However, contradictory results were reported by six meta-analyses on the association between maternal periodontal disease and the risk of PB and/or LBW (Khader and Ta'ani, 2005; Vergnes and Sixou, 2007; Polyzos et al., 2009; Polyzos et al., 2010; Fogacci et al., 2001; Corbella et al., 2012). Some authors proposed that periodontitis may not be causally related to negative pregnancy outcomes and that both may result from the same hyperinflammatory and/or environmental influences on the mothers (Ferguson et al., 2007) (Klebanoff and Searle, 2006). "
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    ABSTRACT: Material and methods: An observational case-control study was performed in 130 puerperal women: mothers of PB/LBW neonates (cases, n=65) and mothers of full-term normal-weight neonates (controls, n=65). Data were gathered from all participants on socio-demographic, gynecological, and periodontal variables and on placental immunohistochemical COX-2, IL-1β, VEGFR1, podoplanin, and HSP70 expression. Results: Among the 42 women with mild/moderate periodontitis or gingivitis, the studied periodontal variables were significantly worse and the placental COX-2 (p=0.043), HSP70 (p=0.001), IL-1β (p=0.001), VEGFR1 (p=0.032), and podoplanin (p=0.058) expressions were significantly higher in the cases than in the controls. In comparison to the mothers without periodontitis, only COX-2 (p=0.026) and VEGFR1 (p=0.005) expressions were significantly increased in those with the disease. Increased COX-2 values were detected in the women with a history of genitourinary infection (p=0.036), premature rupture of membrane (p=0.012), or drug treatment (p=0.050). Conclusions: The etiology of preterm birth and/or low birth weight is multifactorial and involves consumption habits, social-health factors, and infectious episodes. These adverse pregnancy outcomes were associated with periodontitis and the increased placental expression of IL-1β, COX-2, VEGFR1, and HSP70.
    Histology and histopathology 10/2015; DOI:10.14670/HH-11-671 · 2.10 Impact Factor
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    • "This hypothesis is consistent with other medical literature suggesting that the inflammatory process in the fetal/placental unit and/or an elevated systemic inflammation may impact pregnancy outcomes [9]. A meta-analysis of case control studies showed a significant association between LBW and periodontal disease having an OR of 1.82 [10]. Recently, a case control study among the Iranian population found periodontal disease to be a risk factor for LBW [11]. "
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    ABSTRACT: Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing <2,500 g, while the control group consisted of 170 women who had given birth to babies weighing ≥2,500 g. Details of the mothers were taken from the hospital records and through a personal interview, and a full-mouth periodontal examination was performed postpartum, which included probing depth, clinical attachment level, and bleeding on probing on six sites per tooth. LBW cases had a significantly worse periodontal status than the controls, having an odds ratio (OR) of 2.94 (P=0.01). The multivariate logistic regression model demonstrated that periodontal disease is a significant independent risk factor with an adjusted odds ratio (aOR) of 2.85 for the LBW group (95% confidence interval [CI], 1.62-5.5). Other factors showing significant associations with LBW were pre-eclampsia (aOR, 4.49; 95% CI, 1.4-14.7), preterm labor (aOR, 5.5; 95% CI, 3.2-9.9), and vaginal type of delivery (aOR, 2.74; 95% CI, 1.4-5.2). Periodontitis represents a strong, independent, and clinically significant risk factor for LBW. Periodontal therapy should form a part of the antenatal preventive care among rural women in India.
    Journal of periodontal & implant science 04/2014; 44(2):85-93. DOI:10.5051/jpis.2014.44.2.85 · 1.15 Impact Factor
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    • "PD affects at least 35% dentate adults aged 30 to 90 years in the USA [4], and up to 90% of the worldwide population [5]. Based on the “focal infection” theory that emerged at the beginning of the 20th century, many studies over the past two decades have investigated the possibility of PD being a risk factor of systemic conditions [6], such cardiovascular diseases [7], diabetes [8], chronic obstructive pulmonary diseases [9], adverse pregnancy outcomes [10], etc. "
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    ABSTRACT: Many epidemiological studies have found a positive association of periodontal disease (PD) with risk of head and neck cancer (HNC), but the findings are varied or even contradictory. In this work, we performed a meta-analysis to ascertain the relationship between PD and HNC risk. We searched the PubMed, Embase, and Cochrane Library databases for relevant observational studies on the association between PD and HNC risk published up to March 23, 2013. Data from the included studies were extracted and analyzed independently by two authors. Meta-analysis was performed using RevMan 5.2 software. We obtained seven observational studies involving two cohort and six case-control studies. Random-effects meta-analysis indicated a significant association between PD and HNC risk (odds ratio = 2.63, 95% confidence interval = 1.1.68 - 4.14; p < 0.001), with sensitivity analysis showing that the result was robust. Subgroup analyses based on adjustment for covariates, study design, PD assessment, tumor site, and ethnicity also revealed a significant association. Based on currently evidence, PD is probably a significant and independent risk factor of HNC.
    PLoS ONE 10/2013; 8(10):e79017. DOI:10.1371/journal.pone.0079017 · 3.23 Impact Factor
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