Maternal periodontal disease and risk of preeclampsia: A meta-analysis

Abstract

Research on the association between maternal periodontal disease and the risk of preeclampsia has generated inconsistent results. This meta-analysis was conducted to evaluate the association between maternal periodontal disease and the risk of preeclampsia. A literature search of PubMed and Embase was performed to identify relevant papers published before March 2013. Only observational studies that assessed maternal periodontal disease and the risk of preeclampsia were selected. Patients’ periodontal status was examined at different time points during pregnancy or after delivery (at 14–32 weeks of gestation, within 48 h prior to or within 5 days after delivery). Pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated for cases and controls. Cases were defined as women with concurrent hypertension and proteinuria after 20 weeks of gestation. Eleven studies involving 1118 women with preeclampsia and 2798 women without preeclampsia were identified and analyzed. Women with periodontal disease before 32 weeks of gestation had a 3.69-fold higher risk of developing preeclampsia than their counterparts without periodontal disease (OR=3.69; 95% CI=2.58–5.27). Periodontal disease within 48 h prior to delivery was associated with a 2.68-fold higher risk of preeclampsia (OR=2.68; 95% CI=1.39–5.18). Pregnant women with periodontal disease within 5 days after delivery had a 2.22-fold higher risk of preeclampsia than women without periodontal disease (OR=2.22; 95% CI=1.16–4.27). In conclusion, this meta-analysis suggests that maternal periodontal disease is an independent predictor of preeclampsia.

Keywords

periodontal disease / preeclampsia / risk factor / pregnancy / meta-analysis

References

[1] SteegersEA, von DadelszenP, DuvekotJJ, et al. . Pre-eclampsia. Lancet, 2010, 376(9741): 631-644 PMID: 20598363

[2] KhanKS, WojdylaD, SayL, et al. . WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367(9516): 1066-1074 PMID: 16581405

[3] Conde-AgudeloA, VillarJ, LindheimerM. Maternal infection and risk of preeclampsia: systematic review and meta analysis. Am J Obstet Gynecol, 2008, 198(1): 7-22 PMID: 18166297

[4] BoggessKA, LieffS, MurthaAP, et al. . Maternal periodontal disease is associated with an increased risk for preeclampsia. Obstet Gynecol, 2003, 101(2): 227-231 PMID: 12576243

[5] CanakciV, CanakciCF, CanakciH, et al. . Periodontal disease as a risk factor for pre-eclampsia: a case control study. Aust N Z J Obstet Gynaecol, 2004, 44(6): 568-573 PMID: 15598299

[6] ContrerasA, HerreraJA, SotoJE, et al. . Periodontitis is associated with preeclampsia in pregnant women. J Periodontol, 2006, 77(2): 182-188 PMID: 16460242

[7] CanakciV, CanakciCF, YildirimA, et al. . Periodontal disease increases the risk of severe pre-eclampsia among pregnant women. J Clin Periodontol, 2007, 34(8): 639-645 PMID: 17590155

[8] SiqueiraFM, CotaLO, CostaJE, et al. . Maternal periodontitis as a potential risk variable for preeclampsia: a case-control study. J Periodontol, 2008, 79(2): 207-215 PMID: 18251635

[9] ShettyM, ShettyPK, RameshA, et al. . Periodontal disease in pregnancy is a risk factor for preeclampsia. Acta Obstet Gynecol Scand, 2010, 89(5): 718-721 PMID: 20196677

[10] CotaLO, GuimaraesAN, CostaJE, et al. . Association between maternal periodontitis and an increased risk of preeclampsia. J Periodontol, 2006, 77(12): 2063-2069 PMID: 17209792

[11] Lohsoon-thornV, KungsadalpipobK, ChanchareonsookP, et al. . Maternal periodontal disease and risk of preeclampsia: a case-control study. Am J Hypertens, 2009, 22(4): 457-463

[12] CastaldiJL, BertinMS, GimenezF, et al. . Periodontal disease: Is it a risk factor for premature labor, low birth weight or preeclampsia?. Rev Panam Salud Publica, 2006, 19(4): 253-258 PMID: 16723066

[13] SrinivasSK, SammelMD, StamilioDM, et al. . Periodontal disease and adverse pregnancy outcomes: is there an association?. Am J Obstet Gynecol, 2009, 200(5): 497 e1-8

[14] MatevosyanNR. Periodontal disease and perinatal outcomes. Arch Gynecol Obstet, 2011, 283(4): 675-686 PMID: 21120511

[15] IdeM, PapapanouPN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes - systematic review. J Clin Periodontol, 2013, 40(Suppl14): S181-S194 PMID: 23627328

[16] PolitanoGT, PassiniR, NomuraML, et al. . Correlation between periodontal disease, inflammatory alterations and pre-eclampsia. J Periodontal Res, 2011, 46(4): 505-511 PMID: 21501170

[17] HaJE, OhKJ, YangHJ, et al. . Oral health behaviors, periodontal disease, and pathogens in preeclampsia: a case-control study in Korea. J Periodontol, 2011, 82(12): 1685-1692 PMID: 21486182

[18] Moura da SilvaG, CoutinhoSB, et al. . Periodontitis as a risk factor for preeclampsia. J Periodontol, 2012, 83(11): 1388-1396 PMID: 22309175

[19] KumarA, BasraM, BegumN, et al. . Association of maternal periodontal health with adverse pregnancy outcome. J Obstet Gynaecol Res, 2013, 39(1): 40-45 PMID: 22845916

[20] TaghzoutiN, XiongX, GornitskyM, et al. . Periodontal disease is not associated with preeclampsia in Canadian pregnant women. J Periodontol, 2012, 83(7): 871-877 PMID: 22191787

[21] StroupDF, BerlinJA, MortonSC, et al. . Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012 PMID: 10789670

[22] BeggCB, MazumdarM. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994, 50(4): 1088-1101 PMID: 7786990

[23] EggerM, Davey SmithG, SchneiderM, et al. . Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634 PMID: 9310563 PMCID: 2127453

[24] MichalowiczBS, HodgesJS, DiAngelisAJ, et al. . Treatment of periodontal disease and the risk of preterm birth. N Engl J Med, 2006, 355(18): 1885-1894 PMID: 17079762

[25] OffenbacherS, BeckJD, JaredHL, et al. . Effects of periodontal therapy on rate of preterm delivery: a randomized controlled trial. Obstet Gynecol, 2009, 114(3): 551-559 PMID: 19701034 PMCID: 2917914

[26] NewnhamJP, NewnhamIA, BallCM, et al. . Treatment of periodontal disease during pregnancy: a randomized controlled trial. Obstet Gynecol, 2009, 114(6): 1239-1248 PMID: 19935025

[27] ChavarriaME, Lara-GonzalezL, Garcia-PaletaY, et al. . Adhesion molecules changes at 20 gestation weeks in pregnancies complicated by preeclampsia. Eur J Obstet Gynecol Reprod Biol, 2008, 137(2): 157-164 PMID: 17706337

[28] SargentIL, BorzychowskiAM, RedmanCW. Immunoregulation in normal pregnancy and pre-eclampsia: an overview. Reprod Biomed Online, 2006, 13(5): 680-686 PMID: 17169180

[29] BoggessKA. Maternal oral health in pregnancy. Obstet Gynecol, 2008, 111(4): 976-986 PMID: 18378759

[30] NesseW, AbbasF, van der PloegI, et al. . Periodontal inflamed surface area: quantifying inflammatory burden. J Clin Periodontol, 2008, 35(8): 668-673 PMID: 18564145

[31] LachatMF, SolnikAL, NanaAD, et al. . Periodontal disease in pregnancy: review of the evidence and prevention strategies. J Perinat Neonatal Nurs, 2011, 25(4): 312-319 PMID: 22071614

[32] XiongX, BuekensP, GoldenbergRL, et al. . Optimal timing of periodontal disease treatment for prevention of adverse pregnancy outcomes: before or during pregnancy?. Am J Obstet Gynecol, 2011, 205(2): 111 e1-e6