Cochrane · intervention · CD005297
Treating periodontal disease for preventing adverse birth outcomes in pregnant women
Iheozor‐Ejiofor, Z, Middleton, P, Esposito, M, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
33
current version
GRADE rated
16
No studies
4
Included studies
15
as reported
No studies 4 · 12.1%Ungraded 13 · 39.4%Very low 13 · 39.4%Low 3 · 9.1%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Pregnant women considered to have periodontal disease (gingivitis or periodontitis) after dental examination | Pregnant women with periodontitis (n=14 studies) or gingivitis (n=1 study) recruited from prenatal care facilities (n=15 studies; 7161 participants) |
| Intervention | Periodontal treatment during pregnancy: mechanical debridement (scaling and root planing), polishing, or surgery; Oral hygiene counselling; Antiseptic oral agents; Topical or systemic antimicrobial therapy (singly or in combination) | Scaling and root planing (n=15 studies); Scale and polish; Scaling and root planing + antimicrobial |
| Comparison | Placebo (for adjunctive treatment); No treatment; Alternative treatment | No treatment (n=11 studies); Alternative/less intensive mechanical periodontal treatment (n=4 studies); SRP + placebo; Alternative mechanical treatment + placebo |
| Outcomes | Primary: Gestational age at birth (preterm birth < 37 weeks, very preterm birth < 34 weeks, extremely preterm birth < 28 weeks); Birth weight; Small for gestational age; Perinatal mortality; Maternal mortality; Pre-eclampsia; Adverse effects of therapy; Secondary: Plaque levels; Gingival health; Changes in probing depth; Changes in clinical attachment levels | Preterm birth < 37 weeks (n=15 studies); Preterm birth < 35 weeks (n=6 studies); Preterm birth < 32 weeks (n=3 studies); Mean gestational age (n=8 studies); Low birth weight < 2500 g (n=8 studies); Low birth weight < 1500 g (n=3 studies); Mean birth weight (n=10 studies); Small for gestational age (n=3 studies); Perinatal mortality (n=9 studies); Maternal mortality (n=4 studies); Pre-eclampsia (n=3 studies); Severe pre-eclampsia (n=1 study); Adverse effects of therapy (n=4 studies); Probing depth; Clinical attachment level; Bleeding on probing; Plaque index; Gingival index |
| Study designs | Randomised controlled trials | Randomised controlled trials (n=15) |
| Timing | Treatment during pregnancy; perinatal and maternal outcomes at/around birth | Outcomes at birth; perinatal mortality to first 28 days after birth |
Search date: 2016-10. Databases: Cochrane Oral Health's Trials Register; Cochrane Pregnancy and Childbirth's Trials Register; CENTRAL; MEDLINE Ovid; Embase Ovid; LILACS BIREME; ClinicalTrials.gov; WHO ICTRP
Questions and results
Periodontal treatment (scaling and root planing, polishing, or surgery), alone or with oral hygiene counselling, antiseptics, or antimicrobials vs No treatment
Population: Pregnant women considered to have periodontal disease (gingivitis or periodontitis) after dental examination
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Preterm birth < 35 weeks | RR 1.19 [0.81, 1.76] | 2 studies · 2557 participants | Very low Downgraded: risk of bias, imprecision |
Low birth weight < 1500 g | RR 0.80 [0.38, 1.70] | 2 studies · 2550 participants | Very low Downgraded: risk of bias, imprecision |
Gestational age (preterm birth < 37 weeks) | RR 0.87 [0.70, 1.10] -17 [-39, 12] per 1000 | 11 studies · 5671 participants | Low Downgraded: risk of bias, inconsistency |
Mean gestational age (weeks) | Six studies (2573 participants) reported mean gestational age in weeks; data not pooled due to skewness; mean difference ranged between -0.1 and 1.4 weeks. Two studies reported gestational age as time-to-event data… | 6 studies · 2573 participants | Ungraded |
Preterm birth < 32 weeks | RR 1.35 [0.78, 2.32] | 3 studies · 2755 participants | Very low Downgraded: risk of bias, imprecision |
Mean birth weight (grams) | Eight studies (5120 participants) reported birth weight in grams; data not pooled due to skewness; mean difference ranged between -52.8 and 476.6 grams. | 8 studies · 5120 participants | Ungraded |
Bleeding on probing | Reported as a secondary periodontal outcome (Analysis 1.9); results not meta-analysed due to considerable heterogeneity (I2 91% to 100%); reduction in favour of periodontal treatment. | 6 studies | Ungraded |
Severe pre-eclampsia (progression from mild pre-eclampsia) | RR 1.21 [0.77, 1.92] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects of therapy | 0% in both groups; Not estimated; 2389 participants (4 RCTs) | 4 studies · 2389 participants | Ungraded |
Perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth) | RR 0.85 [0.51, 1.43] -2 [-9, 8] per 1000 | 7 studies · 5320 participants | Very low Downgraded: risk of bias, imprecision |
Clinical attachment level (change) | Reported as a secondary periodontal outcome (Analysis 1.7); results not meta-analysed due to considerable heterogeneity (I2 91% to 100%); reduction in favour of periodontal treatment. | 4 studies | Ungraded |
Probing depth (change) | Reported as a secondary periodontal outcome (Analysis 1.6); results not meta-analysed due to considerable heterogeneity (I2 91% to 100%); reduction in favour of periodontal treatment. | 4 studies | Ungraded |
Small for gestational age | RR 0.97 [0.81, 1.16] -4 [-22, 18] per 1000 | 3 studies · 3610 participants | Low Downgraded: risk of bias, inconsistency |
Birth weight (low birth weight < 2500 g) | RR 0.67 [0.48, 0.95] -42 [-66, -6] per 1000 | 7 studies · 3470 participants | Low Downgraded: risk of bias, inconsistency |
Maternal mortality | 0% in both groups; Not estimated; 2134 participants (4 RCTs) | 4 studies · 2134 participants | Ungraded |
Pre-eclampsia | RR 1.10 [0.74, 1.62] 6 [-17, 40] per 1000 | 3 studies · 2946 participants | Very low Downgraded: risk of bias, imprecision |
Plaque index | Reported as a secondary periodontal outcome (Analysis 1.8); results not meta-analysed due to considerable heterogeneity (I2 91% to 100%); reduction in favour of periodontal treatment. | 2 studies | Ungraded |
Periodontal treatment (scaling and root planing, alone or with antimicrobials) vs Alternative (less intensive) periodontal treatment, alone or with placebo
Population: Pregnant women considered to have periodontal disease (gingivitis or periodontitis) after dental examination
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinical attachment level | MD -0.13 [-0.23, -0.03] | 1 study · 53 participants | Ungraded |
Perinatal mortality (including fetal and neonatal deaths up to the first 28 days after birth) | RR 1.06 [0.60, 1.85] | 2 studies · 855 participants | Very low Downgraded: risk of bias, imprecision |
Low birth weight < 1500 g | RR 1.85 [0.69, 4.96] | 1 study · 756 participants | Very low Downgraded: risk of bias, imprecision |
Bleeding on probing | MD -28.00 [-38.54, -17.46] | 1 study · 53 participants | Ungraded |
Gingival index | MD -28.00 [-144.13, 88.13] | 1 study · 53 participants | Ungraded |
Adverse effects of therapy | Adverse effects of therapy: Not reported for this comparison. | 0 studies | No studies |
Gestational age (preterm birth < 37 weeks) SRP + antimicrobial vs alternative mechanical treatment + placebo | RR 1.40 [0.67, 2.92] | 1 study · 243 participants | Very low Downgraded: risk of bias, imprecision |
Mean birth weight | Not pooled. Pirie 2013 (99 participants): mean difference in birth weight -0.07 kilograms. Macones 2010 (756 participants): difference in mean birth weight -67.7 grams. | 2 studies | Ungraded |
Gestational age (preterm birth < 37 weeks) SRP vs alternative mechanical treatment | RR 0.87 [0.46, 1.67] | 4 studies · 1168 participants | Very low Downgraded: risk of bias, imprecision |
Maternal mortality | Maternal mortality: Not reported for this comparison. | 0 studies | No studies |
Pre-eclampsia | Pre-eclampsia: Not reported for this comparison. | 0 studies | No studies |
Low birth weight < 2500 g | RR 1.39 [0.92, 2.09] | 1 study · 756 participants | Very low Downgraded: risk of bias, imprecision |
Preterm birth < 35 weeks | Preterm births < 35 weeks reported in four studies across three subcomparisons; none of the subcomparisons showed a difference; SRP versus alternative mechanical treatment not pooled due to considerable heterogeneity;… | 4 studies | Very low Downgraded: risk of bias, imprecision |
Probing depth | MD -0.93 [-1.12, -0.74] | 1 study · 53 participants | Ungraded |
Small for gestational age | Small for gestational age: Not reported for this comparison. | 0 studies | No studies |
Gestational age (preterm birth < 37 weeks) SRP + antimicrobial vs SRP + placebo | RR 3.08 [1.15, 8.20] | 1 study · 243 participants | Very low Downgraded: risk of bias, imprecision |